Treating the SOOF - Midface Rejuvenation Techniques

Treating the SOOF with filler is a great way to rejuvenate the midface. But what is the SOOF and how do you treat it? We turned to our experienced faculty to find out!

Dr Karla Orsine Murta Dias is a Clinical Trainer at Harley Academy and an aesthetics specialist. Having successfully completed her Level 7 Diploma in injectables with us, she now helps us to train the next cohort of injectors. 

Read on for her insights…

What is the SOOF?

“‘SOOF’ is an acronym and it refers to the sub-orbicularis oculi fat. This is a fat pad located in the midface,” Dr Karla explains.  

Where is it located?

Dr Karla describes, “The SOOF is situated within the midface region, specifically between the lower eyelid and cheek area,” Dr Karla describes. 

“It lies supraperiosteally beneath the orbicularis oculi muscle, below the lateral half of the infraorbital rim above the zygoma.”

What does the sub-orbicularis oculi do?

“The SOOF serves as a supportive structure for the lower eyelid, contributing to the overall contour and volume of the midface,” Dr Karla highlights. 

One of the first signs of ageing is volume loss in the midface and periorbital area. Therefore, injecting the SOOF is a good option for patients looking to address ageing or a flatter midface. 

This treatment isn’t just reserved for older patients, you may also have younger patients looking to add more definition to the area. 

SOOF treatment presentations in patients

As an aesthetic practitioner, you should understand the ageing process and how it affects each layer of the skin. Signs of ageing can present in several ways. 

When you have this in-depth knowledge of how it impacts each muscle and layer, you can treat concerns more effectively. Furthermore, this allows you to create a tailored treatment plan for your patient and subtly restore volume loss accordingly.

“Patients suited for SOOF rejuvenation may present with signs of midface volume loss, under-eye hollowing, or tear trough deformities,” Dr Karla notes. They may also express concerns about “looking tired.”

Complementary midface treatments 

First of all, it’s important to appreciate the context. If the aesthetic aim is replacing lost volume due to ageing, there may be other areas in the midface that might need addressing. These regions include the:

• Deep medial cheek
• Preauricular
• Zygoma
• Apex.

This is something to be aware of when assessing your patient and devising their treatment plan. Now let’s get specific about the SOOF.

How to treat the SOOF 

When treating the SOOF – as with any aesthetics treatment – it’s vital to choose the correct filler product and tool. Some questions to ask yourself include:

• What aesthetic results am I trying to achieve?
• Is the area sensitive to bruising and complications?
• Which technique do I want to apply?
• Which filler product will sit best in that area?
• What other areas do I need to treat?

Filler product selection

When selecting a product to inject, remember that a high G prime filler in this region can interfere with lymphatic draining. In some rare cases, this can cause malar oedema. 

Dr Karla says that to “treat the SOOF area effectively, you can use a cannula or a needle, based on your skill level and the result you’re after.” 

Cannulas

She advises, “Blunt-tipped cannulas are often preferred for injecting filler in delicate areas to minimise trauma and reduce the risk of vascular events.” This is especially true for regions with complex facial anatomy such as the SOOF.

Most aesthetic practitioners use a cannula introducer needle. You can, however, also use a cannula introducer guide, if you prefer. These create an entry port for your cannula and can provide precision with improved control when injecting.

Needles 

“Needles can be used for more precise injections,” Dr Karla counsels. When using a needle, ensure you withdraw slowly after each bolus. This can help to reduce bleeding and bruising in the area.

At Harley Academy we use TSK needles, cannulas and cannula introducers during our aesthetics training courses. As a trusted partner, we have special offers on these products available to our trainees, which you'll learn about after enrolling.

Injection techniques to treat the SOOF 

Dr Karla outlines two techniques to effectively restore volume in the SOOF. 

She notes, “One injection technique to address SOOF volume loss involves precise filler placement to restore volume and contour to the midface.  

“The following techniques aim to target the region while reducing the risk of complications.” 

Supra-periosteal bolus injections

Dr Karla explains, “Supra-periosteal bolus injections involve injecting filler with a needle directly over the periosteum. This provides structural support to the midface. 

“Placing filler in this deep plane helps restore volume and rejuvenate the under-eye area.”

Deep plane cannula technique

“Using a blunt-tipped cannula for filler injections in the SOOF region can minimise trauma and reduce complications,” Dr Karla shares.

She continues, “The cannula is inserted through a single entry point and manoeuvred to distribute filler evenly along the desired treatment area. This ensures natural-looking results with minor discomfort and downtime while minimising the risk of adverse vascular events.”

Ensuring your filler injection techniques are up-to-date

Aesthetic medicine moves fast with techniques evolving rapidly as new evidence becomes available. For the most up-to-date, evidence-based filler injection techniques for treating the SOOF - and every other area of the face - check out our innovative Global Evidence Matrix framework.

Also known as GEM©, this is the "periodic table of cosmetic injectables" and outlines every step of each facial filler treatment, based on the latest research and your level of expertise. From needle or cannula size, to product choice, patient selection, risks, injection depths, anatomical targets, techniques and more, you'll find all the information you need is just a couple of screen taps away.

GEM© and HarleyAcademy.ai

All Harley Academy medical aesthetics courses are taught using GEM© principles, and the framework can be accessed as part of the Harley Pro subscription to HarleyAcademy.ai.

This is available to all healthcare professionals, not just Harley Academy alumni or current trainees. You can also explore the latest research and try free aesthetic education modules in filler mastery and more, just by creating a free account!

Develop your cannula techniques

A cannula is a great way to avoid some common mistakes in SOOF treatments by new injectors. They also help to reduce side effects like bruising as the midface is a sensitive area to inject. 

You can learn all about administering filler treatments with a needle and cannula on our Level 7 Diploma in Botox & Dermal Fillers course. This JCCP-approved postgraduate aesthetics course for medics was created by our CEO & Founder, Dr Tristan Mehta. It teaches you how to inject safely, as part of a detailed education on facial anatomy, injecting techniques, patient care, ethics and more. 

Throughout the course, you’ll develop a broad range of proficiency and skills and witness live injecting demonstrations. Following this, you’ll treat your own patients - provided by us - and get to practise your practical injecting approaches. 

Our Level 7 Diploma is designed to make you a safe, effective and ethical injector. It’s the perfect start or continuation of your aesthetics career and will help you build a portfolio of successful cases.

Don’t just take our word for it! We have a whole host of graduates who have gone on to have successful aesthetic careers. Whether they’ve started their clinic or work for one, they regularly keep up with us to let us know how they’re doing.

How long does SOOF filler treatment last?

“SOOF filler treatment results can vary depending on factors such as the type of filler used, the patient's metabolism, and individual response to treatment. 

“Generally, hyaluronic acid fillers last approximately 6 to 18 months in this area, with results gradually fading over time. For some patients, regular maintenance treatments for the SOOF may be needed to sustain optimal results,” Dr Karla advises.

If you’re already a practising injector and are looking specifically to improve your midface rejuvenation injecting skills, our Facial Contouring Masterclass is for you. You’ll learn to treat the SOOF and inject midface filler treatments while maintaining natural results that subtly enhance the patient’s anatomy. 

Creating an immersive learning environment is important to us, which is why every Injectables Masterclass is capped to ensure a small peer group. What’s more, each one is led by one of our experienced Clinical Trainers, so you’re getting the best aesthetic education possible. 

As your injecting confidence grows, so will your treatment menu and patient list! 

Want to hear more about how our award-winning aesthetics training courses can enhance your career? Book a call with us. One of our helpful Course Advisors is on hand to answer your questions and offer the guidance you need to help you achieve your goals. 

All information correct at the time of publication