Periorbital Rejuvenation Techniques

Periorbital Rejuvenation Techniques

• Fractional laser resurfacing improves malar bags and eyelid skin, but doesn't reposition structures. May stimulate collagen, tighten tissue, or correct skin folds. Potential risks include scarring, ectropion, and hyperpigmentation.

Palpebral Bags

• Develop at any age, caused by infra-orbital fat bulging against a weakened orbital septum and oculi muscle.
• Reinforcement of these structures is crucial for correction.
• Lid vector (relationship between cornea and lower lid/cheek) should be considered.
  • "Negative vector" occurs when the cornea is more anterior than the lower lid, requiring extra care to avoid lid over-tightening or skin excision issues.
• Tear trough deformity often relates to maxillary hypoplasia and loss of subcutaneous fat.
  • Debate over whether tear trough deformities should be considered during palpebral bag treatment.
• Infra-orbital fat volume deficit and available native fat should balance during treatment.
  • Fat may be excised, repositioned, or a combination.
• Procedures like "intra-SOOF" secure fat pads.
  • Some centers prefer fat repositioning alone, others add lower eyelid tightening or implants.
  • Postoperative edema and recurrence are possible.

Non-Invasive Treatments

• Laser resurfacing and Ultherapy can be adjunctive in selected cases.
• Future advancements like non-invasive polymer emulsion may be useful.

Treatment Approach

• Awareness of festoons, malar mounds, and palpebral bags is essential.
• Preoperative assessment and patient discussion are vital.
• Patient perceptions and expectations are crucial for acceptable results.
• Combining malar septum repositioning, midface lifting, and liposculpting targets individual abnormalities and restores the "troublesome triad".
• Ongoing advancements expand rejuvenation options.