| FACIAL AESTHETICS | PEER-REVIEW REJUVENATING THE
PERIORBITAL AREA: LOWER EYELID,
TEAR TROUGH AND MID-FACE
Riekie Smit explains how to develop an effective treatment plan and how a good anatomical and artistic analysis can play a role in rejuvenating the periorbital area
ABSTRACT
The periorbital area is a vital facial feature with psychological, functional and aesthetic significance. This area has always been a focus for rejuvenation by physicians and surgeons involved in practising plastic
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surgery, dermatology and aesthetic medicine. A number of important aspects have to be taken into consideration to ensure successful rejuvenation of this area. The timeworn rationale of merely treating wrinkles or filling folds will
HE PERIORBITAL AREA IS A CORE feature on the human face, an area by which people are recognised, emotion portrayed, and character displayed and predicted by others. Changing or enhancing this area can further
complement the person, or it could be unfavourable to their appearance and character. Therefore, when considering a treatment plan to successfully enhance the periorbital area, there are a number of vital facets that the aesthetic practitioner should take into consideration. It is imperative to understand and respect true natural
beauty that is also age-appropriate. Secondly, a full understanding of the anatomy of the periorbital area, eyelid and the mid-face is essential, as well as a strong grasp of the pathology involved in the ageing of the periorbital area. Finally, and perhaps most importantly, the aesthetic practitioner must understand his/her patients, their needs, and their preferences.
Anatomy and ageing pathology of the periorbital and mid-facial areas The anatomical and pathological qualities of the periorbital area clearly define the treatment protocols needed to enhance this region. The delicate and unique
certainly not complement a naturally and aesthetically pleasing result. An artistic, anatomically expert, and functionally considerate approach will be more ideal to ensure maximum patient and physician satisfaction.
anatomy should be perfectly understood in order to comprehend the pathology of ageing. The mid-face should also be considered when evaluating the periorbital area, as it will contribute to the ageing pathology and undesirable appearance of the periorbital region. The important structures to understand in this region
include the skin, subcutaneous structures, fat pads, muscles, the venolymphatic and nervous structures, and the skeletal aspects. The skin around the eyes is delicate and thin;
therefore, it is inclined to ageing. The ageing changes evident in this region include loose skin, fine wrinkles, loss of elasticity and hyperpigmentation. These changes cause an unattractive appearance in the upper and/or lower eyelid regions. Loose skin on the upper eyelid results in either a
hooding or crepe paper (i.e. fragile, wrinkled) appearance of this orbital region. The lower eyelid region is more prone to hyperpigmentation, but also suffers from loose skin, fine wrinkles and thinning of subcutaneous fat, and the dermis reveals the dark hue of the muscular and vascular aspects beneath. Just below the skin and just above the orbicularis
oculi muscle, lies the superficial subcutaneous fat pad. This thin layer of fat disguises the dark vascular appearance of muscle; therefore, atrophy of this fat
KEYWORDS periorbital, tear trough, mid-face, dermal fillers
prime-journal.com | March 2013 ❚ 61
DR RIEKIE SMIT, MBCHB (UOFS), MSC SPORTS MED (PRET), is Aesthetic and Sports Physician, Pretoria, South Africa; and President of the Aesthetic and Anti-aging Medicine Society of South Africa
email:
drsmit@ackmain.com
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