Current Approaches in Periocular Rejuvenation: Our 6-year Experience

Introduction: Periocular rejuvenation involves surgical removal of excess skin, fat debulking, or transfer, and optionally includes eyelid ptosis repair or lateral canthal resuspension. Periocular injectables have revolutionized these esthetic treatments, sometimes replacing surgery. We describe our experience with current treatment approaches for periocular rejuvenation of upper and lower eyelids. Methods: We extracted data on treatment types and outcomes of all patients treated for periocular rejuvenation of upper and lower eyelids between 2015 and 2020. All patients were treated by a single surgeon (GBS) at three medical centers. Outcome measures included demographic trends, procedural frequencies, age and gender distribution, as well as age-stratified preferences for surgical versus injectable treatments. Results: In total, 1923 patients (mean age 64 years, 1340 females [70%]) underwent upper eyelid rejuvenation, and 248 underwent lower eyelid rejuvenation. Upper eyelid ptosis correction was the most common surgery (1048 patients [55%]), followed by blepharoplasty (875 patients [45%]). Transconjunctival fat debulking with skin pinch removal was the most common surgical approach for lower eyelids (158 patients [64%]), followed by transconjunctival alone (40 patients [16%], canthopexy, and fat repositioning. Additionally, 154 patients underwent 231 periocular hyaluronic acid injections, mostly for tear-trough deformity and retro-orbicularis oculi fat pad to conceal deep superior sulcus deformity. These latter patients were significantly younger than those undergoing surgical treatment. Based on our clinical experience, hyaluronic acid (HA) injections were typically selected for patients with good skin tone and minimal fat herniation who preferred a non-surgical approach. Conclusions: Ptosis surgery was performed in over 50% of patients undergoing upper eyelid surgery. Transconjunctival fat debulking with skin pinch removal was the most common surgical approach in our experience. HA injection was particularly useful for correcting deep superior sulcus deformity and was often preferred by patients seeking subtle volume restoration without surgery. Periocular fillers may sometimes be better than lower eyelid blepharoplasty. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.