Minimal Invasive Techniques For Periorbital Rejuvenation

Background:The lower eyelid anatomy is very complex and variable. Many interventions have been described to improve the aesthetic properties of the lower eyelid and cheek region. In general, the more invasive the procedure, the higher the risks and complications. As our knowledge of orbital soft tissue and bony aging deepens, our focus in minimizing invasive surgical interventions has accelerated. Herein, we describe a series of new minimally invasive techniques that can be customized to enhance outcomes of lower eyelid and cheek rejuvenation.

Methods:  The lower eyelid is evaluated for canthal position, degree of scleral show, globe protrusion, inferior, lateral and superior orbital rim position relative to the anterior cornea and dorsal nasal height. The regional anatomy of the orbit is analyzed in the context of eyebrow position and shape, the inclination of the forehead and the relative prominence of the zygomatic-orbital and maxillary bones. The deep and superficial fat compartments of the orbital region and lower eyelid are assessed. The degree and extent of tear trough deformity is noted. The degree of excess skin and the extent of textural and pigmentary charges of the skin surface are noted along with the tone of the lower eyelid.

Results: Diagnosis of the presenting deformities associated with periorbital and eyelid aging led us to formulate 4 minimally invasive procedures that can be used alone or in combination:

 

1. Superficial Cell Grafting and Deep Compartment Fat Injection. A specially designed, disposable, off the shelf fat drawing and cell grafting kit is used. Fat is injected through 18 gauge needle incisions with a variety of cannulae.
2. Minimally invasive release and suspension of the orbitomalar ligament, arcuate line and lateral canthus is carried out through 3 mm incisions after volume restoration if needed.
3. Pinch blepharoplasty and chemical peel or laser resurfacing is then performed if indicated for skin laxity and/or photodamage.
4. Marionette browlift with shuttle needles

Over a 6 year period, these procedures have been carried out in more than 60 patients either alone or in combination with other procedures. Case examples will be presented for each of the 4 techniques and their limitations will be discussed.

Conclusions: Using a precise diagnostic workup, complex orbital and eyelid aging can be addressed using a simplified treatment algorithm without compromising outstanding surgical outcomes.