Periorbital rejuvenation: a safe subcutaneous approach to forehead, eyebrow, and orbicularis oculis muscle mobilization.

Background: Periorbital rejuvenation constitutes a common and much demanded claim. With aging face, fascial attachments and ligamentous supports become attenuated, and therefore, skin, orbicular muscle, malar fat and lateral eyebrow descend in middle-age women. Conventional facelift and standard blepharoplasty does not give an effective periorbital rejuvenation.

Methods: This technique was applied in 142 patients from 1999 to 2006 to treat periorbital aging. All patients were 35 to 55 years old, and 94.5% were female. Through an incision located in the hair line or inside the temporal portion of scalp, a wide subcutaneous dissection of temporal, forehead and eyelid areas was done. This allows undermining and suspension of the orbicularis oculis muscle with partial denervation and the concomitant treatment of crow's feet, lateral muscular cantoplasty, elevation of the malar fat, superolateral traction of the eyebrow and resection of excess skin. Blepharoplasty or a conventional facelift was included if necessary.

Results: A total of 130 patients (91%) presented satisfactory results. In 16 patients (11 %) , partial infection of the temporal wound was detected; in other 12 (9 %), asymmetry of eyebrows was present, of which 9 (75%) corrected spontaneously after 3 months and in other 3 (25 %), a reoperation was necessary. No major complications were observed.

Conclusions: This technique allows a rational correction of all affected periorbital tissues, including forehead, eyebrow, eyelids, canthal ligaments, orbicularis muscle, malar fat and both periorbital and cheek skin with superior and superolateral vectors of traction. This is a safe and easy technique.