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Periorbital and midfacial filling with cosmetic injectables has become ubiquitous, with the primary targets being the central, anterior cheek and the medial tear trough. However, these may not be the most important areas to fill, and to achieve an excellent result requires a balanced strategy of injecting multiple areas rather than only 1 or 2 areas. I find it better to partially correct multiple shadow points on the face that impart aging rather than to try to ameliorate only 1 or 2 principal shadows perfectly. I liken it to remodeling a house: If the bathroom is fixed up nicely, the kitchen now looks old. I notice the same thing in the face: If I fix the tear trough well but not other surrounding shadows, I find that the result looks unbalanced or the individual simply does not look better. What I mean by better is the conclusion drawn by my synthetic right brain that reads whether someone looks more attractive rather that of my left brain, which tells me whether a line or hole is properly filled (Figure 1). It is critical to engage both sides of the brain when designing the face, as illustrated in the Video.
Lam SM. Periorbital and Midfacial Volume Enhancement With Cannula. JAMA Facial Plast Surg. 2016;18(1):71-72. doi:10.1001/jamafacial.2015.1192