Figure 2. A 27G cannula.

 

Figure 3. A 30G cannula.

 

It helps to have the patient sitting upright during the procedure. This allows visualizing the degree of protrusion of the eyeball and avoid over-correction. Ideally, the eye should remain open during the procedure but this could be difficult with the insertion of the cannula. It is important to have the patient in a relaxed state and proceed accordingly.

 

I measure the length of the cannula to set the entry point. But in general, the ideal entry point is the intersection between a line perpendicular to the lateral canthus and the orbital rim. Inserting the cannula into the orbicularis oculi muscle has a high risk of bleeding. Injecting directly into the intraorbital fat in the orbital septum has a high risk of bleeding and difficult hemostasis.

 

Moreover, if the septum is damaged, it causes discomfort during opening and closing of the eye. Therefore, I advise injecting under the orbital roof along the orbital rim margin.

 

HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)

 

To avoid intra-arterial injection, push the cannula until it gently touches the orbital rim bone to withdraw slightly and inject the filler close to the surface of the orbital septum. Use the retrograde linear threading injection and inject very small amounts slowly. Use a soft filler.

 

Have the patient close and open their eyes to check natural mobility and any lumps on the eyelid. Swelling can cause over-correction and the injected filler can drift downward due to the muscle movement. Inject small amounts and make 2-3 retouches afterwards if further correction is needed.

 

-To be continued