Belotero - HELP! - Superficial or on the bone?

Injecting soft fillers like Belotero in this area can reduce lines, wrinkles and folds as well as improve skin texture with long-term collagen production. Fillers are being used more frequently to contour and lift rather than solely line fill. Of course, fillers are best used in combination with lasers and microneedling​ with PRP to get the optimal outcome. Typically, the best outcome for HA fillers in the tear trough is for it to be injected deep and on the bone.

Belotero is injected supraperiosteal, over the bone, in the area of the tear trough.  Injection more superficial in that area can sometimes lead to long term swelling.

I typically inject a small amount superficial to the periosteum, then another amount a bit more superficial to the initial injection. I do not think this is a waste of product. Patients often require more than one syringe to see dramatic results. It all depends on your anatomy. 
Often times the deeper injections can end up with the most natural results as it lifts the tissues instead of only filling the defects. 
Hope this helps. 
Best of luck, 
DrC

Belotero is injected above the bone to reduce potential for undue or excessive swelling.Belotero is a hydrophilic agent, retaining water molecules in the area where it is injected. 
Citrus bioflavonoids may help with localized inflammation and water retention.
Try swell-x pt from VenaSmart. It contains citrus bioflavonods and Diosmin.
H Karamanoukian MD FACS

Thank you for your question. To prevent swelling and lumpiness most injectors will place Belotero over the bone of the orbital rim. You get a more natural look this way. 

It sounds like your injector used the proper technique. It may be an issue of needing more belotero for the effect you are looking for.

Boletero injected deep along the orbital rim for tear trough enhancement is the way to go. You are not wasting product with this technique. You do to want dramatic results in this area. You want a soft fill to make you look less tired. Overfilling this area is a mistake and oftentimes can make you look like you have bags. It is always best to under fill this area. You can always go back and add another half a syringe if you feel you need more.

Thank you so much for your question.  Belotero placed deep onto the bone is the best why to inject this filler.  Belotero does tend to attract some water to the area where it was placed, so, by layering the filler on the bone, the physician is able to minimize swelling and, often, bruising. If the Belotero was injected more superficially, lumpiness and unevenness would most likely occur.  With tear troughs, it usually doesn't take too much of the product to get amazing results.  But waiting a couple of weeks post-injection gives the filler a chance to integrate with your own body and look smooth and even.  Wishing you so much bliss on your journey!

Dear JameKnox:   Mist expert injectors will place Belotero just over the bone of the orbital rim to prevent swelling and lumpiness. The effect is much more natural in this location.   All the best,   Dr. Clark

The depth of plane for injection of Belotero can be deep and/or superficial in the lower eyelids.  Some of this depends upon the skin thickness of your eyelids and the improvement desired.  Belotero can be injected very superficially, but it can show some contour irregularities that can show through the skin.  Fortunately it usually doesn't cause a tyndall (blue-effect):  think how your blood vessels look blue through the skin.  Belotero and Restylane are my preferred lower eyelid fillers.  They last a long time, and don't absorb significant amounts of fluid that can cause the eyelids to appear puffy or swollen, which I have seen with Juvederm.  Rarely, any of the "sugar" fillers (hyaluronic acids) can cause prolonged swelling around the lower eyelids, and need to be treated with an injected enzyme (hyaluronidase) to absorb the filler, so the lower eyelids look smooth and not swollen or puffy.  For their thin-skinned patients, injection right on the bone is the preferred technique to avoid getting contour irregularities.  Some patients only get a moderate response if the deeper attachments of their eyelid tissues are very tight to the underlying bone, which makes it hard to fill in the hollows as the tissues don't easily fill and smooth out.  This is not a technique issue as much as an anatomic difficulty to improve.  It is possible that more Belotero can be placed to help further fill in the hollows.  In my practice, most patients only need 1 syringe, but occasionally more.  I find Restylane to be superior as it is "thicker" and can push up the hollows better in some patients, but it carries more risk of appearing blue if placed too superficially.  Best regards.