ABSTRACT
The periocular region is the first to show signs of facial aging. The eyelid skin is the thinnest in the body, and shows wide variation in pigmention, skin texture, and periorbital soft anatomy. Multiple specialists, including dermatologists, ophthalmologists and oculoplastic surgeons address periocular aesthetic concerns with several non-surgical as well as surgical treatment options. In the periorbital region, the margin for error is narrow, and stakes are high.
The relevant functional periorbital anatomy with focus on ethnic variations is described. botulinum toxin injection for periocular rhytids, namely glabellar lines, crow’s feet and forehead lines is covered next. The soft tissue changes in the periocular region are simplified into hills and valleys for easy understanding. Their anatomic basis, and treatment implications are discussed. The most common valley or hollow is the orbital rim hollow, also called the tear trough. The three most commonly seen elevations or hills are prominent orbicularis roll, fat bags, and fluid festoons. An oculoplastic surgeon’s perspective on periocular pigmentation is briefed, with a final focus on upper and lower eyelid blepharoplasty. Upper eyelid blepharoplasty is primarily skin excision, along with medial fat debulking, whereas lower eyelid blepharoplasty predominantly targets the far bags, most popularly through a trans-conjunctival incision.
