The periorbital region is one of the areas most susceptible to early aging. It is in this zone that the first wrinkles, dark circles under the eyes, zygomatic bags appear, excess skin of the upper eyelid occurs, loss of skin elasticity and ptosis of the outer canthus. Periorbital contouring is becoming more and more popular. However, it is a very complex anatomical area. Therefore, in order to fill the nasolacrimal sulcus , it is important to understand the anatomy of the zone, use refined technique and the right product – this will minimize the risk of complications.
Read more about the anatomical features of correction of dark circles under the eyes on estet-portal.com in this article.
- Anatomical subtleties of dark circles under the eyes correction
- Vascular anatomy of the periorbital zone
- Recommendations for correction of nasolacrimal trough
Anatomical subtleties of dark circles under the eyes correction
The muscle Orbicularis oculi acts as a sphincter and is responsible for closing the eyelids. Under its influence, wrinkles of periocular expression appear, which are best corrected by botulinum toxin.
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The inframedial edge of the Orbicularis oculi anatomically coincides with the lacrimal trough. The nasolacrimal groove in some patients also anatomically coincides with the lower edge of the orbicular muscle of the eye.
Deep infraorbital fat compartments:
- Intraorbital fat: The lower eyelid contains three fat sacs: inner, medial and outer. As we age, the orbital septum containing these sacs weakens, causing them to protrude. This leads to the formation of hernias of the lower eyelid. These hernias can be removed surgically or masked by inserting a filler into the nasolacrimal trough.
- Suborbicularis oculi fat (SOOF): is behind the orbicularis muscle eyes and is divided into medial and lateral parts. Lower bound SOOF – nasolacrimal sulcus.
- Deep medial cheek fat pad (DMC): corresponds to the medial margin of SOOF. DMC undergoes atrophy with aging, making the transition between orbital fat compartments and buccal fat compartments more prominent, making the tear trough deeper.
DMC Volume Restoration Filler rejuvenates the middle third of the face and reduces the transition between the lower eyelid and the cheek, reducing dark circles under the eyes.
Relationship between internal (I), medial (M) and external (E) intraorbital fat pads with medial (MSOOF) and lateral (LSOOF) suborbicular fat pad and deep medial cheek fat pad (DMC)
The malar septum plays an important role in the correction of the nasolacrimal sulcus with fillers. This fine facial structure prevents the diffusion of pigments and fluids from the periorbital region to the cheek region.
Read also: Lacrimal trough fillers: simple and effective
Incorrect location of the filler relative to the malar septum is fraught with chronic lymphedema.
Fillers for the correction of the nasolacrimal sulcus are preferably injected below the malar septum: for this, the filler is injected supraperiosteally.
Vascular anatomy of the periorbital zone
When filling the nasolacrimal sulcus, two main arteries must be taken into account: infraorbital and angular.
The exit point of the infraorbital artery is medial to the pupil line and approximately 1 cm below the edge of the orbit.
Angular artery, which is a branch of the facial artery, runs along the internal canthus and anastomoses with the supratrochlear and supraorbital arteries.
These arteries should be avoided. An infraorbital hematoma will increase pressure on the soft tissues and may cause lymphatic insufficiency and zygomatic lymphedema.
Angular artery embolism can have catastrophic blindness if it causes occlusion of the ophthalmic artery or the central
In order to correct
dark circles under the eyesas effectively and safely as possible, the following recommendations should be followed:
Inject the filler supraperiosteally to reduce the risk of lymphatic compression, lymphedema, ecchymosis and embolism.- Inject small boluses of filler (0.05 ml) to avoid nodules.
- It is not recommended to vigorously massage the area after the injection because this may result in incorrect placement of the product.
- The procedure should not be performed on patients with periorbital lymphatic insufficiency.
- Correction product must have low elasticity.
- The choice between a cannula or a needle is a matter of clinician preference, but cannula handling is less likely to cause bruising and minimize the risk of intravascular injection and embolism.
- Knowledge of anatomy is the key to
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