ABSTRACT
INTRODUCTION The peri-orbital area is an important esthetic unit because it is highly visible. During face-to-face conversation, the eyes are the part of the face most viewed by an interlocutor. Aging changes in the eyelids, temples, glabella, and forehead frequently prompt patients to seek cosmetic improvement. As is true for the face in general, aging of the peri-orbit and upper face occurs by three primary mechanisms: photo-aging (affecting the skin), gravitational aging (causing ptosis of all soft tissue), and volumetric aging (atrophy of soft tissues and, with advanced age, of bone). All three aging mechanisms synergize with overuse of facial muscles of expression to produce characteristic wrinkles such as frown lines in the glabella, horizontal forehead wrinkles and, ‘‘crow’s feet’’ wrinkles.
