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It is often said that the eyes are the windows to the soul. What would an aged periorbital appearance imply? It is no wonder that rejuvenation of the periorbital region is one of the commonest aesthetic requests. A youthful and aesthetically pleasing lower eyelid region consists of smooth and crisp lower eyelid skin without wrinkles or pigmentary blemishes, well-positioned lower eyelids, and blends smoothly into the cheek.
When viewed from the side, the eyelid and cheek should form a gentle convexity. A youthful lower eyelid and cheek region imparts the image of an individual who is attentive, energetic, and confident.
Lower eyelid wrinkles may be dynamic (intermittent) or static (permanent). They are most prominently displayed when an individual smiles or forcefully closes the eyes. These wrinkles may start to manifest in the late thirties and may occur together with crow’s feet and add to one’s perceived age.
Lower eyelid wrinkles arise from two processes occurring simultaneously: laxity of the lower eyelid skin and gradual thinning of the subcutaneous fat. With advancing age, the skin becomes thin, loses elastin and collagen fibers and becomes lax. The underlying subcutaneous fat also loses volume and thickness due to changes in the metabolism of adipocytes (fat storage cells). The result is increasing prominence of the skin wrinkles with age when the underlying orbicularis muscle contracts.
Lower eyelid wrinkles arise from two processes occurring simultaneously: laxity of the lower eyelid skin and gradual thinning of the subcutaneous fat. With advancing age, the skin becomes thin, loses elastin and collagen fibers and becomes lax. The underlying subcutaneous fat also loses volume and thickness due to changes in the metabolism of adipocytes (fat storage cells). The result is increasing prominence of the skin wrinkles with age when the underlying orbicularis muscle contracts.
Lower eyelid wrinkles are reliably treated with botulinum toxin injection treatments and attain a high degree of satisfaction in most cases. The popularity of botulinum toxin injection has grown rapidly since the 1990s, and it is now one of the most commonly administered procedures in the world. Botulinum toxin reduces signs of ageing by the partial weakening of the orbicularis oculi muscles that cause the formation of wrinkles.
Individuals with shallow, dynamic wrinkles with minimal skin laxity, and are willing to have repeat treatments are ideal candidates for botulinum toxin injection.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using botulinum toxin alone, resulting in stiff and unnatural results.
Botulinum toxin effaces wrinkles by the partial weakening of the orbicularis oculi muscle but does not reverse skin and muscle laxity or fat atrophy. Attaining bespoke and attractive results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate product choice, precise administration by an experienced practitioner.
Botulinum toxin causes partial weakening of the orbicularis muscle that is involved in the formation of lower eyelid wrinkles. The number of injections and the dose is determined by individual anatomy and gender.
Males generally require higher doses of botulinum toxin for optimal results (Brotox). Injection of the lower eyelid region is a delicate art balancing the desire to remove the wrinkles and preservation of appropriate amount of muscle function to allow blinking and normal facial expressions.
The effects of botulinum toxin take 1 to 3 days to be observed, and will last for 4 to 6 months. Repeat treatments are necessary for maintenance of the result.
Individuals are advised to avoid vigorous massage to the treatment area for 2 hours following the injection. This is to prevent spread of the botulinum toxin, which may result in potential unintended adjacent muscle paralysis. Individuals may resume their usual activities immediately following the procedure.
Nanofat injection involves harvesting fat graft from areas of excess. This fat is purified and emulsified using proprietary techniques, then injecting this fine mixture containing adipose-derived stem cells (ADSCs) into the crow’s feet. Nanofat injection provides natural-looking results and long-term improvement as compared with botulinum toxin injection.
Nanofat injection is a minimally-invasive ambulatory surgical procedure performed under local anaesthesia, with optional intravenous sedation if requested.
Individuals with any degree of lower eyelid wrinkles and seeking long-term improvement are good candidates. Structural fat grafting may be simultaneously performed in other areas of hollowing and volume loss such as the face, neck and hands, and deliver benefit in multiple sites in one single procedure. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified and emulsified using proprietary techniques. The fat particles are gradually reduced in size until the final mixture is almost liquid-like and behaves like a natural, biological filler. During the emulsification process, the larger adipocytes (fat storage cells) are destroyed, leaving the smaller adipose-derived stem cells (ADSCs) within the mixture. These are injected into the lower eyelid wrinkles, and it is thought that the ADSCs exert regenerative effect on the skin in addition to filling the deficient volume. Nanofat injection improves the quality and pigmentation of the overlying skin and is its unique advantage over synthetic fillers.
Many individuals are able to return to work on the day after the surgery. Depending on the extent of fat harvesting performed, most of the swelling and bruising will resolve by the 7th postoperative day. Stitch removal is usually performed on the 5th postoperative day.
Individuals are advised to avoid pressure on the grafted areas to optimize graft survival. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Individuals may return to their original exercise and gym routines after 2 weeks.