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Lee et al. Plast Aesthet Res 2018;5:43 Plastic and
DOI: 10.20517/2347-9264.2018.39 Aesthetic Research

Review Open Access

Periocular rejuvenation with neurotoxin and dermal
filler

Wendy W. Lee, Alexandra E. Levitt

Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.

Correspondence to: Wendy W. Lee, Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA.
E-mail: wlee@med.miami.edu

How to cite this article: Lee WW, Levitt AE. Periocular rejuvenation with neurotoxin and dermal filler. Plast Aesthet Res 2018;5:43.
http://dx.doi.org/10.20517/2347-9264.2018.39

Received: 26 May 2018 First Decision: 28 Jul 2018 Revised: 11 Oct 2018 Accepted: 16 Oct 2018 Published: 23 Oct 2018
Science Editor: Raúl González-García Copy Editor: Cai-Hong Wang Production Editor: Zhong-Yu Guo

Abstract

The periocular area is one of the first regions of the body to show signs of aging, which include static and dynamic rhytids
as well as subcutaneous volume loss. The complex anatomy and dynamic underlying muscles of facial expression make
this region particularly difficult to treat. Botulinum toxins and fillers, especially when used in combination, offer an
excellent approach to minimally invasive rejuvenation of this area. This article aims to present a basic overview and
clinical primer for the use of these injectables along with advice on avoiding and managing common complications.

Keywords: Botox, botulinum toxin, fillers, hyaluronic acid, rejuvenation, periorbital, aesthetics

FEATURES OF AND FACTORS AFFECTING PERIOCULAR AGING
Typical features of facial aging include changes in skin pigmentation, increased skin laxity, rhytid formation,
[1,2]
and volume loss . The periorbital region is particularly vulnerable to the effects of aging based on intrinsic
[3]
properties of these tissues. For one, eyelid skin is among the thinnest in the body, at around 0.3-0.5 mm .
It lacks underlying subcutaneous fat to mitigate the contour defects and fat prolapse attendant with age.
The delicate nature of this tissue also readily transmits underlying pigments, including blood products,
muscle, and vessels. There is less collagen and elastin than surrounding skin, rendering periorbital skin less
resilient and prone to early rhytid formation. In addition, eyelid and periocular skin is dynamic and subject
to constant tension from the surrounding muscles of facial expression including the orbicularis oculi,
corrugators, and procerus, which likely accelerate rhytid development.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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