The eye area (upper and lower eyelids, eyebrows, eyelashes) is one of the most important cosmetic units of the face. The main facial muscle of this area is the muscular layer of the orbicularis.
The aging of this zone will lead to a tired aspect with a reduced eye size, excess skin or eyelid severity, some wrinkles (craters) and a hollow lower eyelid area.
Dr. Claude le Louarn (1) showed that one of the most important causes of facial aging is the re-contraction of facial muscles, which results in some fat being spent on the adjacent area. This is due to the increased resting tone of the facial muscles, which leads to contraction and straightening of these muscles.
Straightening and shortening of orbicularis oculi will attract the eyebrows down, which creates an excess of skin and a heavy upper eyelid.
At the level of the lower eyelid, recurring contractions of the orcicularis oculi will change the fat layer and displace some fat into the medial palmar pocket, thereby creating a void area.
Because muscular involvement in this aging process is so important, Botox (botulinum toxin A) is naturally the best way to control and prevent aging in the peri-orbital region.
To rejuvenate the periorbital region, we use Botox, performing three to four injections in the transverse direction on the orbital portion of the orbicularis muscle. Each point is 2.5 units (2 ml of saline solution in a bottle of Botox per 100 units). We also introduce another point in the lateral part of the orbicular region. This last moment is very advanced.
We start right under the tail of the eyebrow. This first item is the highest. The exact injection sites are determined by asking the patient to smile. These segments follow the curve of the orbital rim. The last site is located on the same vertical line as the first. This last item is located on the paired Malaris orbicularis muscle.
The most remarkable moment - the one that makes this procedure more advanced, will be made in the palpebral, atrial part of the upper eyelid. This will slightly raise the lateral angle (the angle of the eye). This moment was first described by Dr. Le Loarn in 2006 (2).
From 1 to 2 units injected along the lash line, holding the needle horizontally. This injection is performed very concretely, in the subdermal plane above the muscle, creating a small blister visible on the surface of the skin. Muscle is not directly imposed.
This moment is done only for female patients, because it enhances the female form of the eye, raising the lateral wedge (this is the effect of the "eye eye").
This method will open the tired eye again and ease the severity of the upper eyelid. Eyelashes are well improved, and the beautiful almond shape is underlined.
We began to introduce similar in 2006. Today, after several hundred of such substaking injections, we have not seen any side effects, such as ptosis, dryness, or diplopia. Side effects are rare and limited to minimal bruising of the upper eyelid.
To see photos after this improved rejuvenation of Botox rejuvenation, click on this link.
1 Claude Le Louarn, Bathias, Buis: structural aging: the concept of facial regeneration Aesth Plast Surg: 31: 213-218, 2007.
(2) C.Le Louarn: Botulinum Toxin and the Face Recurve Concept: Decreased Tonus and Muscle Regeneration. Ann Plast Chir Estet. 2006; 52: 165-176
