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Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: 1. Recognize the 11 major signs of periorbital aging. 2. Realize the benefits of laser techniques applied to periorbital rejuvenation surgery. Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 333. Although blepharoplasty and coronal foreheadplasty have been the traditional methods for improving the periorbital region, in our opinion these techniques together can address only three of the 11 major signs of periorbital aging. We found no improvement with skin-muscle flap type blepharoplasty and coronal lift in the wrinkling and pigmentation changes in the infrabrow, crow’s-foot, lower lid, and malar regions, and no improvement in malar bags, “dark circles” under the eyes, or the apparent lengthening of the vertical height of the lower lid and its associated sharp transition between cheek and lid skin. CO2 laser resurfacing can improve these signs of periorbital aging and permits the laser transconjunctival approach if blepharoplasty is necessary, thus eliminating a visible lower lid incision. When brow ptosis is present, we prefer endoscopic brow lift to minimize dysesthesia and incision size. We evaluated 174 patients and contrasted the results of the traditional approach versus laser resurfacing with or without laser blepharoplasty and endoscopic brow lift. The mean time to evaluation was 9 months, ranging up to 2 ½ years. We found that the laser approach can address almost all of the 11 major signs of periorbital aging at one procedure. It is minimally invasive, technically simple and fast, offers lasting improvements, and yields high patient satisfaction and better results with fewer persistent problems than the traditional surgical approach. |
