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Case Reports
, 3 (12), e592

"Walk the Rim, Feel the Bone" Technique in Superior Sulcus Filling

Case Reports

"Walk the Rim, Feel the Bone" Technique in Superior Sulcus Filling

Audrey L G Looi et al. Plast Reconstr Surg Glob Open.


Superior sulcus filler injection is a nonsurgical method to rejuvenate the upper face. Blindness and stroke are devastating complications of facial filler injection. This study describes an injection technique that minimizes the risk of blindness and includes a case study demonstrating the cosmetic benefits of this procedure. To avoid retrograde injection of filler embolus into the ophthalmic artery, we advocate a "'walk the rim, feel the bone" approach. Small boluses of hyaluronic acid filler are given in preperiosteal plane, avoiding the superior orbital foramen.

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the Oculoplastic Department, Singapore National Eye Centre.


Fig. 1.
Fig. 1.
Small amount of filler should be deposited in the preperiosteal space just superficial to bone.
Fig. 2.
Fig. 2.
Multiple small volume filler injection at superior orbital rim, avoiding the supraorbital foramen transmitting supraorbital artery (SO), which lies at medial one-third of the rim, and the supratrochlear artery (ST), which is medial to it. Filler should be injected medially first (green dots) and depending on the sulcus deformity, additional filler may be injected laterally (blue dots).
Fig. 3.
Fig. 3.
A, Before treatment, patient had hollowing of left upper sulcus and higher left upper lid crease. B, Filler treatment to both upper sulci shows improved symmetry and reduction of upper sulcus deformity.

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