Belotero - HELP! - Superficial or on the bone?

I recently got half syringe of Belotero injected into each tear trough with a cannula. No bruising, No pain, and I did notice slight improvement. My doctor injected right on the bone and I am curious if this is why I didn't see more dramatic results? I know that Belotero can be injected superficially so I wonder if injecting deep on the bone is a waste of the product. I imagine it takes more product to fill a hollow if product is placed deeper under the skin as opposed to right under the skin.

Doctor Answers 9

Where should Belotero be injected in the under eye?

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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

Belotero for Tear troughs

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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.

Jennifer Parker Porter, MD, FACS
Bethesda Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews


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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. 

Hardik Soni, MD (not currently practicing)
Summit Emergency Medicine Physician

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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.


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I typically inject a small alloquot superficial to the periosteum and then another bit more superficial to that. 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 


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews


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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.

Cynthia Stolovitz, MD
Montreal Physician

Belotero Injected Deep

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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!

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

#Belotero for #TearTroughs

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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

Sheryl D. Clark, MD
New York Dermatologist
4.7 out of 5 stars 10 reviews

Belotero Filler Injections for Lower Eyelid Improvement.

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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. 

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.