Understanding Periorbital Aging

Anatomical Changes with Age

Periorbital aging is a multifactorial process involving structural and soft tissue changes:

• Volume Loss: Loss of subcutaneous fat in the infraorbital area and upper cheek results in hollowing, particularly noticeable in the tear trough and lid-cheek junction.
• Skin and Septum Changes: Thinning skin and a weakened orbital septum contribute to under-eye bags and shadowing.
• Bone Resorption: Gradual loss of bone in the orbital rim and midface exacerbates the hollowed appearance.

Beyond the Tear Trough

Focusing solely on tear troughs overlooks the broader periorbital complex:

• Lid-Cheek Junction: The transition between the lower eyelid and upper cheek becomes more defined with age, creating a stark demarcation.
• Lateral Periorbital Area: Subtle hollowing near the lateral canthus can lend a gaunt or tired appearance.
• Midface Deflation: Volume loss in the midface accentuates periorbital hollowing by reducing structural support for the eyes.

Restylane Eyelight: Properties and Suitability

Restylane Eyelight leverages Non-Animal Stabilized Hyaluronic Acid (NASHA) technology, offering key advantages for periorbital applications:

• Firm Gel Consistency: Provides structural support while maintaining a smooth, natural feel.
• Moderate Lifting Capacity: Ideal for delicate areas requiring precise correction.
• Low Water Affinity: Minimizes post-treatment swelling, crucial for the thin-skinned periorbital region.

Expanding Indications: Treating the Broader Eye Area

While Restylane Eyelight is FDA-approved for correcting infraorbital hollows, its unique properties, such as a firm gel consistency and low water affinity, enable cosmetic medical professionals to address volume loss and aging signs across the broader periorbital region.

Lid-Cheek Junction Smoothing

• Indication: Softening the pronounced demarcation between the lower eyelid and upper cheek.
• Technique: Use a cannula for subdermal placement, injecting 0.2-0.5 mL per side. This method reduces contour irregularities and ensures a smooth blend.
• Clinical Tip: Target the medial lid-cheek junction, where volume loss is most evident, and avoid overcorrection to preserve natural contours.

Lateral Periorbital Support

• Indication: Correcting subtle hollowing near the lateral canthus to reduce a tired appearance.
• Technique: Deliver micro-boluses with a 30G needle, using 0.1-0.2 mL per side. Precision is essential to prevent puffiness from overfilling.
• Clinical Tip: Assess orbital bone structure and skin thickness to determine optimal depth.

Complementary Volume Restoration

• Indication: Enhancing outcomes in patients with midface deflation, where periorbital hollowing is worsened by cheek volume loss.
• Rationale: Restylane Eyelight can bridge to cheek fillers like Restylane Contour, offering subtle upper midface support.
• Clinical Tip: Stage treatments—address midface deflation first if significant, then refine the periorbital area with Eyelight.

Combining with Adjunctive Treatments

• Benefit: Lasers improve skin texture and laxity post-filler, enhancing overall rejuvenation.
• Timing: Perform filler injection first, followed by laser resurfacing after 2-4 weeks to avoid filler displacement or inflammation.
• Clinical Tip: Use lower energy settings near the filler site to protect the HA gel.

Platelet-Rich Plasma (PRP)

• Benefit: PRP boosts skin quality and may prolong filler longevity by stimulating collagen production.
• Case Example: A 50-year-old patient received PRP under the eyes one week after Restylane Eyelight, achieving a brighter, refreshed look.
• Clinical Tip: Use a 32G needle for superficial PRP injections to avoid disturbing the filler.

Neuromodulators

• Benefit: Pairing with Botox for crow’s feet or a brow lift addresses both static and dynamic concerns, optimizing periorbital harmony.
• Clinical Tip: Administer neuromodulators 1-2 weeks before or after filler to prevent unintended diffusion.

Clinical Tips for Success

Achieving optimal outcomes with Restylane Eyelight in the periorbital region requires a meticulous blend of precision and individualized care. The delicate, thin skin and intricate anatomy surrounding the eyes demand a conservative yet strategic approach to volume restoration, where subtlety is key to natural enhancement.

Next, we will review essential clinical insights across three vital areas: dosage and layering, managing risks, and patient assessment.

Dosage and Layering

• Start Conservatively: Begin with 0.5 mL total (both sides), reassessing at two weeks to avoid overfilling, especially in thin-skinned patients.
• Layering Technique: For significant volume loss, use small increments over multiple sessions for gradual correction.

Managing Risks

• Swelling Mitigation: Apply cold compresses post-treatment and inject at the appropriate depth to reduce edema.
• Reversibility: Keep hyaluronidase available as a precaution, though precise technique rarely necessitates its use.

Patient Assessment

• Midface Evaluation: Check for midface deflation, as correcting this first can lessen the need for excessive periorbital filler.
• Staged Treatments: Plan multi-session corrections for complex cases (e.g., deep hollows or prior filler history) to ensure natural results.

Outcomes and Patient Impact

Restylane Eyelight’s efficacy is backed by strong clinical data:

• Phase 3 Trial Results: 87% patient satisfaction at 3 months, with effects lasting up to 18 months.
• Safety Profile: Low adverse event rates, with most side effects (e.g., bruising, swelling) resolving within 7-10 days.

Real-World Feedback

• Case Example: A 45-year-old female with moderate lid-cheek junction hollowing achieved a “rested” look after 0.5 mL of Restylane Eyelight per side, praising the subtle eyelid-cheek blending.
• Minimal Downtime: Most patients experience just 24-48 hours of mild swelling, appealing to those with busy schedules.

Conclusion

Frequently Asked Questions