| OPHTHALMOLOGY | ARTICLE
OF THE EYES: COMBINED TECHNIQUES
REJUVENATION
To successfully achieve the rejuvenation of the eye, it is sometimes necessary to combine a number of techniques. Sylvie Poignonec presents a study examining the treatment of this aspect of the ageing face.
ABSTRACT This article discusses the adjuvant techniques available as an alternative to traditional blepharoplasty. Fat grafting and radiofrequency should be proposed for the rejuvenation and beautification of the orbital and periorbital regions.
T
he definition of a youthful look centres on the eyelid and orbitopalpebral area. Looking young is a full and open look: there is little or no excess skin, the brow is slightly convex, and the upper eyelid fold is located approximately 8 mm from
the edge of the eyelid cilia, except in Asian populations where the absence of an upper eyelid crease is the result of an absence of the cutaneous insertion of the levator. The position of the canthus is horizontal or high (except in deformity), and the lower eyelid is toned with a good exposure to the ciliary margin and conjunctiva. However, beauty and youth are generally measured by the appearance of the periorbital region. Periorbital ageing is multifaceted, depending on the
anatomical element concerned. Excess skin, for example, can be a cap that can sometimes interfere with vision; it can be wrinkled, faded, and stained. The eye is protected by an oily layer of fat, but over time this fat can atrophy, hernia or otherwise create the appearance of hollow eyes, which is very unsightly. Dermatochalasis typically comprises an excess in cutaneous skin and fat pads. Fat
hernias owing to laxity of the septum are sometimes associated with outer canthal discharge and a scleral look. What is striking when comparing a young eye to an older eye, is the area of the slit eyelid causing a narrowing of the transverse eyelid. The orbicularis muscle closes the eyelids and has many fibres of different embryological/undeveloped origin. It can be enlarged ® especially in myopic hyperlaxity ® or form festoons. It is important to note that a preoperative ptosis may be owing to a disinsertion of the levator aponeurosis. It is also necessary to test the laxity of the lower eyelid using the snap-back test to assess any movement associated with tension or canthopexy. The position of the eyebrow is often stable with age,
but in some cases ptosis may be evident. The cheek may also flatten with age, creating a sad look. All these elements are taken into account when undertaking facial rejuvenation and beautification of the eyes.
Materials and methods This retrospective study included 45 patients, 43 of whom were women and two of whom were men, between the ages of 38 and 72 years, seeking a rejuvenation of the eye. The patients received between two and four sessions of periorbital radiofrequency and/ or phototherapy, and four patients received a preoperative fat-grafting blepharoplasty of the eyelid using the Coleman technique. If hyperlaxity of the lid
SYLVIE POIGNONEC, MD is Plastic Surgeon, Pitié-Salpêtrière Hospital, Paris, France
email:
sylvie@poignonec.com
KEYWORDS blepharoplasty, fat grafting, radiofrequency, orbital, periorbital, rejuventation
prime-journal.com | March 2012
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