Periorbital region: correction methods

Author: Oksana Miroshnichenko – dermatocosmetologist of the highest category (Ukraine, Kiev).

Anatomical features

The eyes and the area around them express the entire gamut of human feelings. In addition, the area around the eyes is a kind of marker of a person’s age. However, due to its anatomical, physiological and functional characteristics, it is quite problematic for aesthetic correction.

To professionally perform a procedure in the eye area, it is important to know its anatomical structure and features.

So, in the periorbital zone there are:

• eye;

• an auxiliary device that provides protection and movement of the eyes and consists of:

a) eyelids that protect the eyeball. Anatomically, the upper eyelid is larger than the lower, the upper border is represented by the eyebrow, and moves due to the contraction of the muscle that lifts it. When opened, the lower eyelid lowers under the influence of its own gravity;

b) lacrimal apparatus;

c) eye muscles.

The skin in the periorbital area is very thin. Directly under the skin is the orbicularis oculi muscle, which closes it. The orbital septum is a thin connective tissue membrane that lies under the orbicularis oculi muscle and holds the intraorbital fat, which acts as a shock absorber for the eyeball. The intraorbital fat of the lower eyelid is divided into three portions: medial, median and lateral. The inner side of the skin is covered with thin transparent connective tissue - the conjunctiva. At the base of each eyelid is a dense connective tissue plate. Cartilage serves as the skeleton of the skin around the eye and, due to its slight convexity, gives the eye the appropriate shape. The eye is supplied with blood and nerves through the back of the orbit. The muscles that move the eye are attached to the eyeball and lie on its surface. The nerves that control the muscle that closes the eye are small branches of the facial nerve and enter the orbicularis oculi muscle at the inferior and outer edges.

Each layer of skin in the periorbital region has its own histological characteristics.

The epidermis consists of fewer rows of cells: the number of rows of cells in the stratum spinosum is 2–3 rows (in other areas of the skin - from 3–8 to 15 rows); there is no granular layer; very thin stratum corneum; accumulation of mast cells, which explains the reactivity of the skin of the eyelids and the frequent occurrence of allergic reactions; the sebaceous glands are monolobular and concentrated along the edge of the eyelids and in the corners of the eyes; The pH of the eyelid skin is more alkaline than other areas of the skin. The epidermis is highly permeable to medicinal and toxic substances.

The dermis is quite thin, the papillary layer is poorly defined, there is a relatively small number of collagen fibers, elastic fibers are poorly developed, which explains the early aging of this zone. The dermis is closely connected with connective tissue cords, which ensures its elasticity and protects it from excessive stretching during movements of facial muscles. There is no subcutaneous fat at all.

All of the above indicates the imperfection of the barrier properties of the skin in this area, high tissue permeability and premature aging of the periorbital zone.

Based on age and type

Taking into account these features, the following age-related changes in the periorbital zone can be distinguished:

• facial wrinkles in the corners of the eyes;
• swelling;
• dark circles under the eyes;
• hernias of the upper and lower eyelids;
• ptosis of the upper eyelid;
• contouring of the nasolacrimal and nasobuccal grooves;
• nonspecific external manifestations of aging, such as impaired skin tone (decreased elasticity, turgor and hydration).

Particular attention should be paid to age-related changes in the lower eyelid, since each type of these changes requires special correction.

Type I The changes are limited to the area of the lower eyelids; there is a weakening of the tone of the orbicularis muscle and bulging of orbital fat.

II type. The changes extend beyond the boundaries of the lower eyelids; there is a weakening of the tone of the orbicularis muscle, a weakening of skin tone and the appearance of its excess, slight ptosis of the cheek tissue and the appearance of an eyelid-cheek separation.

III type. The changes affect all tissues bordering the eyelids; ptosis of the tissues of the cheeks and zygomatic region occurs, increasing the eyelid-cheek separation, thinning of the tissues surrounding the orbit, and deepening of the nasolabial folds.

IV type. Further lowering of the eyelid-cheek division, deepening of the nasolacrimal grooves, appearance of “painting bags”, drooping of the outer corners of the eye and exposure of the sclera.

Of course, only plastic surgeons can radically combat some of the listed aesthetic problems. Such conditions include hernias of the upper and lower eyelids, ptosis of the upper eyelid, and contouring of the lower eyelid. Some of these manifestations (swelling, pastiness) are the domain of therapists. The main condition for achieving a positive result is choosing the right tactics.

Possibility of choice

Today, aesthetic medicine has many methods that can significantly improve the condition of the periorbital zone. Thus, Table 1 schematically presents the possibilities for solving problems in this area.

Table 1. Methods for correction of soft tissues of the periorbital region.

Which technique should you choose?

Of course, each technique in this case has its own advantages and disadvantages (Table 2).

Table 2. The mechanism of action of some techniques in the correction of the periorbital region.

Today, in aesthetic medicine, the redermalization technique is widely used to correct age-related changes in the soft tissues of the periorbital zone. The use of this technique allows for intensive restoration and rejuvenation of this area with no side effects and allows patients to maintain full social activity during an intensive course of procedures. The essence of the technique is to restore the dermal layer of the skin by direct action on fibroblasts, which is carried out through succinate. The mechanism of action of succinate is:

• activation of metabolic processes: cellular respiration, ion transport, energy production (ATP);

• powerful antioxidant effect: preventing lipid peroxidation and destruction of the cell genome;

• stimulation of collagen and elastin synthesis;

• stimulation of microcirculation.

Thus, as a result of redermalization when exposed to succinate, age-related changes in the skin of the periorbital area are effectively corrected (Table 3).

Table 3. Possibilities of redermalization in the correction of the periorbital area.

Combined use

In the early stages of aging, the use of the redermalization technique as a single procedure has been proven by multiple clinical trials and practical applications. If age-related changes in the soft tissues of the periorbital zone affect the deep layers of the skin, then the right solution would be a combination of redermalization with other techniques. The use and combination of various techniques depends on:

• patient's age;

• skin type and type of aging;

• degree of severity of age-related changes;

• wrinkles (depth of occurrence, nature of occurrence, localization).

In our practice, we use the following patient management schemes:

Superficial (epidermal) wrinkles:

• redermalization or superficial peeling + redermalization.

Dermal wrinkles:

• redermalization as a single procedure;
• redermalization + chemical peeling;
• redermalization + botulinum therapy + redermalization.

Dermal wrinkles are deep:

• redermalization + botulinum therapy + contouring + redermalization;
• redermalization + plastic surgery + redermalization.

Gravitational ptosis:

• Stage I : redermalization – botulinum therapy – contour plastic surgery – redermalization;
• Stage II – III : redermalization – plastic surgery – redermalization – botulinum therapy – redermalization.

Conclusion

Of course, the result of correcting age-related changes in the periorbital region depends on the correct assessment of age-related changes (severity and degree) and an integrated approach to correcting these changes.

The proposed therapeutic program allows you to effectively combat various aesthetic problems of the periorbital zone. The use of a drug developed specifically for skin restoration, which includes hyaluronic acid and succinate, increases the effectiveness of the procedures and makes them as physiological as possible. The advantage of the combined use of procedures is faster achievement of results. This program can be used to correct other areas of the face.

Source: KOSMETIK international journal, No. 4 (46), 2011, pp. 66-69