BB8 Technique: An Innovative Approach for Delivering Diluted Belotero® Balance to Treat Infraorbital Hollows

The infraorbital hollow (IOH) and periorbital skin are among the first areas to show signs of facial aging, but are challenging to treat with hyaluronic acid (HA) fillers because of the thin dermis and scant subcutaneous fat. Cohesive polydensified matrix hyaluronic acid (CPM HA, 22.5 mg/mL HA) Belotero Balance gel (CPM-B) is one of the preferred fillers in this region due to its cohesivity and long-held safety reputation. It is typically injected deep into the orbicularis oculi muscle, but adverse events (AEs), including swelling and the Tyndall effect, can still occur. This retrospective, observational three-patient case series describes and evaluates the efficacy and safety of CPM-B delivered superficially (via the novel BB8 technique) in improving the appearance of IOH. Per the BB8 technique, 1 mL of CPM-B was diluted with 0.8 mL of normal saline to achieve an effective HA concentration of 12.5 mg/mL (dilution ratio 1:0.8) and injected superficially to the subdermal plane of the infraorbital region via a cannula. Patients were photographed before and after treatment and followed up regularly for six to nine months post-treatment. IOH severity was graded using the Merz Aesthetic Scale (MAS), while perceived aesthetic improvements by physicians and patients were assessed using five‑point physician (physician global aesthetic improvement scale (PGAIS)) and subject (subject global aesthetic improvement scale (SGAIS)) global aesthetic improvement ratings (1 = very much improved to 5 = worse). The BB8 technique demonstrated efficacy in improving the appearance of IOH. MAS for IOH improved by one to two grades, with effects lasting for six to nine months, while perceived aesthetic improvement ratings were at least "much improved" at all follow-up visits. No persistent or serious AEs were reported. The BB8 technique is a safe and straightforward method for IOH rejuvenation, allowing injectors to effectively address this delicate and challenging area.