Periorbital facial rejuvenation; applied anatomy and pre-operative assessment

Abstract

PurposeSince different subspecialties are currently performing a variety of upper facial rejuvenation procedures, and the level of knowledge on the ocular and periocular anatomy and physiology is different, this review aims to highlight the most important preoperative examinations and tests with special attention to the eye and periocular adnexal structures for general ophthalmologist and specialties other than oculo-facial surgeons in order to inform them about the fine and important points that should be considered before surgery to have both cosmetic and functional improvement.MethodsEnglish literature review was performed using PubMed with the different keywords of “periorbital rejuvenation”, “blepharoptosis”, “eyebrow ptosis”, “blepharoplasty”, “eyelid examination”, “facial assessment”, and “lifting”. Initial screening was performed by the senior author to include the most pertinent articles. The full text of the selected articles was reviewed, and some articles were added based upon the references of the initial articles. Included articles were then reviewed with special attention to the preoperative assessment of the periorbital facial rejuvenation procedures.ResultsThere were 254 articles in the initial screening from which 84 articles were found to be mostly related to the topic of this review. The number finally increased to 112 articles after adding the pertinent references of the initial articles.ConclusionStatic and dynamic aging changes of the periorbital area should be assessed as an eyelid-eyebrow unit paying more attention to the anthropometric landmarks. Assessing the facial asymmetry, performing comprehensive and detailed ocular examination, and asking about patients' expectation are three key elements in this regard. Furthermore, taking standard facial pictures, obtaining special consent form, and finally getting feedback are also indispensable tools toward a better outcome.

Periocular rejuvenation using hyaluronic acid fillers

“…In periorbital aging, the preseptal and the ROOF fat descends and may lose volume, facilitating gravitational descent of the unsupported lateral brow, which causes brow ptosis and produces the appearance of a heavy lid with or without dermatochalasis. This is also attributable to the weakening of the orbital septum and subsequent pseudoherniation of the fat pads [13,14] . This will result in the deflation of the upper eyelid as well as hollowing and increased visibility of the supraorbital rim prominence.…”

“…The dynamic component is related to muscular activities and changes in resting muscle tone. The static component is defined as the changes related to volume loss as well as bony and fat pad changes [14] . Fillers are ideal to address the static component such as deep furrows and lines as well as age-related volume loss and skeletonization.…”

Endoscopy in the field of oculo-facial plastic surgery

“…The eyebrows are an essential part of any upper face rejuvenation procedure. 20 , 21 , 22 Currently, one of the most popular endoscopic cosmetic procedure is endoscopic upper face and eyebrow lift. 23 It significantly decreases the complications of conventional transcoronal lift, even though under-correction of the lift was one of its drawbacks in the beginning.…”

Endoscopic Brow Lift Without Muscle Resection: Objective and Subjective Changes in Intereyebrow Width

“…With advancing age, bone and fat support for the eyebrow is lost, resulting in volume loss and ptosis of the eyebrow and eyelid complex. 1 Forehead and glabellar rhytids will form in areas of strong muscle activity due to chronic use of muscles of facial expression. Additional factors such as chronic sun damage, forces from gravity, and smoking can accelerate these changes.…”