BSAPS Journal

ISSN (e): 2958-6208; ISSN (p): 2958-6194

Volume 3; Issue 2 (July-December 2022) jbsaps.com

Periorbital Rejuvenation Procedures in Facial Plastic Surgery

1*
Professor Sayeed Ahmed Siddiky FCPS, FRCS, FACS, 1Dr. Chowdhury Rashedul Mughni FCPS, MRCS
1Bangladesh Specialized Hospital Ltd & Cosmetic Surgery Centre Ltd.
Review Article Abstract: DOI:
Rejuvenation of the face is an important component of aesthetic plastic
Correspondence to: surgery practice. Periorbital aging contributes significantly to the overall
Professor Sayeed Ahmed Siddiky facial aging. Therefore, periorbital rejuvenation is a big concern for
Bangladesh Specialized Hospital Ltd &
Cosmetic Surgery Centre Ltd.
aesthetic plastic surgeons. Various surgical and nonsurgical treatment
procedures are available for correction of these signs of aging. The study
[email protected]; +8801911352546
was conducted in Cosmetic Surgery Centre and Bangladesh Specialized
Hospital Ltd. The period of study was from December 2017 to December
2020. A total of 495 procedures were carried out in 121 patients who had
signs of periorbital aging. 92 were females and 29 were males. Both
This open-access article is distributed under the
terms of the Creative Commons Attribution 4.0 surgical and nonsurgical procedures were done. Each of the procedure was
International License (CC BY 4.0), which permits evaluated in terms of their effectiveness and probability of complications.
unrestricted use, distribution, and reproduction in any The overall results are very nice and pleasing. Complications were
medium, provided the original author and source are
minimal. Well-chosen procedures, especially when done in combination,
properly credited.
can provide gratifying results in patients undergoing periorbital
rejuvenation.
Keywords: Plastic Surgery, aesthetic, Periorbital Rejuvenation Procedures.

Scan the QR code for the Journal Homepage

|| BSAPS Journal || Publication History - Received: 08.07.2022 || Revised: 11.09.2022 || Accepted: 15.10.2022 || Published: 25.12.2022 ||

INTRODUCTION:
Facial rejuvenation is an important component of aesthetic plastic surgery practice. Appearance of wrinkles along with
sagging and volume loss are the major changes that occurs with facial aging. 1 These changes typically involves the
periorbital areas, in addition to the cheeks, jowls and neck. With advancing age periorbital changes often become the
main cause behind a person looking old and “tired”. But sometimes these aging factors, like wrinkles, sagging and
volume depletion can start to appear prematurely. Periorbital aging is therefore a big concern for the aesthetic plastic
surgeons.

A wide variety of surgical and nonsurgical procedures are available for correction of these signs of aging process. But it
is vitally important for the surgeon to assess correctly and choose the right procedure or combination of procedures for
that particular patient - in order to provide gratifying results.2

MATERIALS AND METHODS:

The study was conducted in Cosmetic Surgery Centre and Bangladesh Specialized Hospital Ltd.
The period of study was from December 2017 to December 2020. Total of 495 procedures were carried out in 121
patients who had signs of periorbital aging. 92 were females and 29 were males.

Table-1:
No. of Patients Female Male
121 92 29

The procedures included upper and lower Blepharoplasty, Lipoinjection, Eyebrow lift, Eyebrow transplant, Fractional
CO2 Laser, Microneedling, Filler and Botox. Preoperative assessment and adequate counseling was done in all the
patients. Majority of the patients were done under Local anesthesia (or none at all, eg in botox and fillers). But lower
eyelid blepharoplasty and lipoinjections, specially when done in combination required general anesthesia.

Copyright © 2022: Bangladesh Society of Aesthetic Plastic Surgeons 51

www.jbsaps.com Sayeed A. S. & Chowdhury R. M., BSAPS Journal, Jul-Dec, 2022; 3(2): 51-53
Table-2: Number of Procedures among the 121 patients
Procedure Name Numbers (n=495)
Lower Blepharoplasty 24
Upper Blepharoplasty 19
Lipoinjection 28
Eyebrow Hairtransplant 10
Eyebrow Lift 18
Microneedling 139
Botox 172
Filler 60
Laser (CO2 Fractional) 25

Procedures -
Lower Eyelid Blepharoplasty: Is done for reshaping the lower eyelids. Here a transverse elliptical area of skin is
removed and suborbicular fat compartments are opened. 3 Careful trimming of this excess fat is then done with the use of
diathermy. Closure is attained with 6/0 vicryl.

Upper Eyelid Blepharoplasty: This is done mainly to remove the excess skin fold from the upper eyelids. But
sometimes suborbicular fat trimming is also required.

Lipoinjection: Fat is harvested from the patient’s abdomen, waist or medial thighs, using low suction pressure. 4And after
decantation of oil from the top and removal of RBC from below, lipoinjection is done to fill up the depressions.

Microneedling: It is a procedure where the skin is treated with multiple micro punctures done with a device containing
fine needles. Dermaroller and Dermapen are both used commonly for microneedling.

Platelet Rich Plasma (PRP): this is injected into the periorbital skin for achieving rejuvenation, either singularly or in
combination with lipoinjection.5 PRP can also be used on the skin surface while doing microneedling.

Botox: This isone of the commonest procedures used for facial rejuvenation. Skin wrinkles and fine lines can easily be
smoothened out by inject this neurotoxin. 6 The result starts to becomes evident after 5 to 7 days after the injection. And
it’s effect lasts for around six months. This treatment therefore needs to be repeated every six months or so.

RESULTS:
Each of the procedure was evaluated in terms of their effectiveness and probability of complications. The overall results
are very nice and pleasing. Complications were minimal.

DISCUSSION:
Since periorbital aging is the result of a combination of skin wrinkling, gravity induced sagging and volume depletion, it
is vitally important to assess the tissue changes accurately. It is only then that the surgeon can decide which combination
of procedure will be best for the patient. Surgical procedures like blepharoplasty are often combined with nonsurgical
procedures like Botox or lasers.7

Transcutaneous blepharoplasty utilizing external incisions for removal of excess skin from lower eyelid generally heals
well, and the scar is hardly visible.8 Recently we have started doing blepharoplasty through transcutaneous route. This
obviates the need for an external incision, and there is no worry of any visible scar.

Volume loss in the Periorbital area can make a person look tired and aged. And this is addressed by injecting HA filler or
autologous fat harvested from the patients abdomen, waist or thighs. HA filler is safe; but reabsorbs completely within 6
months.9,10Whereas fat injection can give permanent result, if done properly. Improving the harvesting technique, along
with careful processing and injection often give better graft survival. Another distinct advantage of fat grafting over HA
filler, is that the skin quality improves over time due to its rejuvenating potential. 4This is because of presence of ADRC
(adipose derived regenerative cells) in the harvested fat.

Complications like bruising, excessive swelling, infection or ptosis can be treated accordingly, with a good outcome. But
preoperative counseling along with reassurance is vitally important. Dreadful complications like blindness can very
rarely happen when filler or fat is inadvertently injected intravascularly. 11Blockage of Supra Orbital, Dorsal Nasal or
Superior Labial arteries can ultimately occlude the Central Artery of Retina and cause intraoperative blindness. It is
therefore important to adhere to the guidelines – such as avoiding sharp cannulas, injecting only while withdrawing the
cannula, and never injecting more than 0.1 ml at any one given point. Of course, the surgeon must remember thedetailed
Copyright © 2022: Bangladesh Society of Aesthetic Plastic Surgeons 52
www.jbsaps.com Sayeed A. S. & Chowdhury R. M., BSAPS Journal, Jul-Dec, 2022; 3(2): 51-53
vascular anatomy of the face while injecting fat or filler in the face. Immediate recognition and injection of hyaluronidase
can reverse the situation, in case of blindness after injection of HA (hyaluronic acid) filler. Dermal threads are also be
known to be used in some patients for periorbital rejuvenation. 12

In our experience, Periorbital rejuvenation is a complex area of treatment for aesthetic plastic surgeons. The results can
be unrewarding if proper assessment and counseling is not done before the beginning of treatment.

CONCLUSION:
Well chosen procedures especially when done in combination, can provide gratifying results in patients undergoing
periorbital rejuvenation.

REFERENCES:
1. Hall MB, Roy S, Buckingham ED. Novel use of a volumizing hyaluronic acid filler for treatment of infraorbital
hollows. JAMA Facial Plastic Surgery. 2018 Sep 1;20(5):367-72.
2. Glaser DA, Lambros V, Kolodziejczyk J, Magyar A, Dorries K, Gallagher CJ. Relationship between midface
volume deficits and the appearance of tear troughs and nasolabial folds. Dermatologic Surgery. 2018 Dec
1;44(12):1547-54.
3. Lambros V. Observations on periorbital and midface aging. Plastic and reconstructive surgery. 2007 Oct
1;120(5):1367-76.
4. Atiyeh BS, Chahine F. Outcome measurement of beauty and attractiveness of facial aesthetic rejuvenation surgery.
Journal of Craniofacial Surgery. 2021 Sep 1;32(6):2091-6.
5. Jacono AA. Transcutaneous Blepharoplasty with Volume Preservation: Indications, Advantages, Technique,
Contraindications, and Alternatives. Facial Plastic Surgery Clinics of North America. 2021 Apr 24;29(2):209-28.
6. Yang F, Ji Z, Peng L, Fu T, Liu K, Dou W, Li J, Li Y, Long Y, Zhang W. Efficacy, safety and complications of
autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis. PloS one. 2021
Apr 1;16(4):e0248505.
7. Yuksel EP, Sahin G, Aydin F, Senturk N, Turanli AY. Evaluation of effects of platelet-rich plasma on human facial
skin. Journal of Cosmetic and Laser Therapy. 2014 Oct 1;16(5):206-8.
8. Kapoor KM, Chatrath V, Anand C, Shetty R, Chhabra C, Singh K, Vedamurthy M, Pai J, Sthalekar B, Sheth R.
Consensus recommendations for treatment strategies in Indians using botulinum toxin and hyaluronic acid fillers.
Plastic and Reconstructive Surgery–Global Open. 2017 Dec 1;5(12):e1574.
9. Cohn JE, Greco TM. Advanced techniques for the use of neurotoxins in non-surgical facial rejuvenation. Aesthetic
plastic surgery. 2020 Oct;44:1788-99.
10. Branham GH. Lower eyelid blepharoplasty. Facial Plast Surg Clin North Am. 2016 May 1;24(2):129-38.
11. Cui Y, Wang F, Voorhees JJ, Fisher GJ. Rejuvenation of aged human skin by injection of cross-linked hyaluronic
acid. Plastic and reconstructive surgery. 2021 Jan 1;147(1S-2):43S-9S.
12. Chang JW, Koo WY, Kim EK, Lee SW, Lee JH. Facial rejuvenation using a mixture of calcium hydroxylapatite
filler and hyaluronic acid filler. Journal of Craniofacial Surgery. 2020 Jan 1;31(1):e18-21.

Copyright © 2022: Bangladesh Society of Aesthetic Plastic Surgeons 53