Correction of age-related changes in the periorbital area, in particular with hyaluronic acid fillers, – quite a broad topic. Work with this area is not limited to smoothing nasolacrimal, palpebromalar, nasobuccal grooves, crow's feet, correction of overhanging eyelids, fatty hernia of the eyelids, improving the texture and quality of the skin. So, atrophy of the upper edge of the orbit is often not taken into account by cosmetologists, estheticians and even plastic surgeons. However, this aspect is very important for the successful rejuvenation of the periorbital region, since working with the upper eyelid does not always mean "something to remove."
In the article estet-portal.com, using the example of a clinical case, Dr. Oleg Lependin - a plastic surgeon, doctor of aesthetic medicine, a trainer in facial contouring and volume plastic surgery of the ANC, presents a technique for correcting the area around the eyes with a hyaluronic filler acids Yvoire Classic.
- Description of the problem and choice of technique for correction of the periorbital area with hyaluronic acid
- Choosing a hyaluronic acid filler for periorbital correction
- Protocol for correction of the periorbital region with hyaluronic acid
Description of the problem and choice of technique for correction of the periorbital area with hyaluronic acid
Photo: Oleg Lependin - plastic surgeon, doctor of aesthetic medicine, contour and facial volume plastic trainer of ANK.
A 32-year-old female patient complained of an unsatisfactory condition of the periorbital region. The evaluation revealed signs of atrophy of the upper edge of the orbit, presented in the form of retractions above the upper eyelid, closer to the head and body of the eyebrow. All recesses, areas of tissue depression, as is known, give darkening. And the more such shadows, the older and more tired the face looks.
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To correct the problem area, the technique of recreating the volume along the upper edge of the orbit was chosen. This technique called UEFA (Upper Eyelid Filling Approach) , presented at international congresses of aesthetic medicine (in Paris, Monaco), involves filling the upper eyelid with hyaluronic acid filler.
Choosing a hyaluronic acid filler for the correction of the periorbital area
Oleg Lependin: In my practice, I perform correction in technique UEFA using filler Yvoire Classic (Ivor Classic) manufactured by the well-known South Korean company LG Chem from the official distributor «ANK».
This product is a sterile, pyrogen-free, clear, colorless gel that comes in a 1.0 ml pre-filled syringe. Yvoire Classic is intended for correction:
- superficial brow wrinkles;
- nasolacrimal and palpebromalar sulci;
- "crow's feet"
- purse-string wrinkles in the perioral region;
- upper eyelid.
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The preparation is ideal for correcting the periorbital region because it has minimal hydrophilicity and good ability to integrate with tissues, and also does not migrate provided that the procedure is carried out correctly. Plastic hyaluronic acid gel gently fills the injection area without damaging delicate skin. Due to its high viscosity, the gel perfectly compensates for lost volumes, smoothes the skin and smooths depressions.
Protocol for correction of the periorbital area with hyaluronic acid
Photos before and after the procedure should be taken when the patient is in an upright position, with uniform illumination like daylight, in different angles: full face, profile, three/quarters, looking straight, up, down .
Photo before and after correction of the upper eyelid with hyaluronic acid filler Yvoire Classic (photo provided by ANK)
Marking: with a marker we outline the area of correction, the zone of lost volume (it is possible to show this lost volume if the patient provides a photo of the face taken about 10 years ago or more). We mark the anatomical danger zones, and these are exits of the supratrochlear, supraorbital neurovascular bundles. These exits are most often possible to find by palpation (the notch (incisura) is felt), while the patient will experience pain. Outputs of these neurovascular formations: the supratrochlear bundle is located at the upper medial edge of the orbit, and laterally, at a distance of 1.5 cm, the supraorbital bundle passes.
Care must be taken with the cannula to avoid damage to the supratrochlear and supraorbital neurovascular bundles.
The entire periorbital correction procedure takes 15-20 minutes and is performed with the patient in a semi-upright position.
The entry point for the cannula can be pained with a local anesthetic if necessary. Cannula selection: 22, 23, 25 G, length 38 & ndash; 40 mm. At the initial stages of this correction, it is worth choosing a larger caliber cannula. It is always recommended to treat the skin with an alcohol solution before entering the cannula into the soft tissues.
Entry point: located about 5-7 mm above the superolateral edge of the orbit, most often coincides with the lower edge of the tail of the eyebrow.
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The specialist performing the procedure must clearly understand in which layer the filler should be applied. Considering the aging anatomy of this area at the upper edge of the orbit, the optimal space is a layer between the septum (connective tissue septum) of the orbit at the bone edge and the circular muscle of the eye.
The filler is injected into the septum under the muscle.
Cannula passes in layers:
- skin;
- circular muscle of the eye;
- glides medially along the periosteum up to 1 cm;
- passes the orbital supporting ligament (ORL – orbicularis retaining ligament);
- The end of the cannula advances in the right space, in the preseptal fat pack (ROOF – retro orbicularis oculi fat) under the orbicular muscle of the eye.
Photo before and after correction of the periorbital area with filler Yvoire Classic (photo provided by by ANK)
It is important that the end of the cannula is not over the muscle. It is necessary to control the depth of the filler insertion. The skin should not have a metallic tint from the cannula.
The drug is injected fan-shaped, retrograde.
The optimal amount of filler is 0.15-0.3 ml per side.
UEU Technique with the use of Yvoire Classic hyaluronic acid filler from the official distributor «Academy of Scientific Beauty»– a fast and effective way to correct upper eyelid atrophy, which gives a pronounced and long-term result without excessive trauma to the delicate periorbital area.
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