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Page 4 of 6 Pignata et al. Plast Aesthet Res 2018;5:23 I http://dx.doi.org/10.20517/2347-9264.2018.28

Figure 1. Pre-treatment and 6 months post-treatment views of a 53-year-old woman treated with MIVEL and SEFFI in her cheeks,
periocular and perioral regions combined with four-lid blepharoplasty

Figure 2. Pre-treatment and 6 months post-treatment views of a 51-year-old woman treated with MIVEL and SEFFI in her cheeks,
periocular and perioral regions combined with four-lid blepharoplasty

deformities and fat pads descent or atrophy in variable combinations without a systematical approach. The
knowledge of the events taking place in the ageing process has evolved and the authors believe that a para-
digm change in the approach of the ageing of the periocular region as a single aesthetic unit is in order. Liew
[7]
and Nguyen recognised two types of patients, those showing signs of tissue descent and those showing
signs of volume depletion. The authors believe that, as surgeons, we should consider this two aspects of age-
ing as both present in a certain degree and analyze the effect of both in the different complexes of the peri-
ocular region in the preoperative evaluation of our patients, in order to offer a systematic and global solution
to our patients demands. In the periocular unit, the SC is affected by both descent and deflation, the IC is af-
fected by deflation and descent in a leer degree and the LC is predominantly affected by deflation. A system-
[8,9]
atic approach to the aesthetic unit carries a high satisfaction rate . MIVEL is a scarless technique that as-
sesses the vertical vector of tissue descent that occurs in the SC. However, for as much as tissue can be lifted,
a 3-dimensional rejuvenation of the periocular esthetic unit can be only achieved if associated with volume
restoration [10,11] . SEFFI and M-SEFFI allow for the correction of volume depletion in the finer and more su-
perficial areas closer to the eyes and lips as well as the deeper areas of the forehead, eyebrows, temples and
cheeks, assessing not only volume depletion, but also adding skin rejuvenation due to its content of adipose-
derived stem cells, with a lower rate of complications compared to traditional fat grafting techniques [12-14] .
The authors believe that the main advantage of these techniques used in combination is that they assess the
mayor consequences of aging in one integral surgical act, thus achieving more natural results than the previ-
ous horizontal tightening procedures.