Effectiveness of comprehensive approach in rejuvenating the aging lower periorbita.

[PURPOSE] To investigate the efficacy of a comprehensive surgical approach for rejuvenation of the aging lower periorbita.

[METHODS] Between February 2018 and January 2023, 80 eyes of 40 patients with lower lid dermatochalasis (LLD), lower lid laxity (LLL) or orbicularis laxity of the lower lid (OL) admitted to the oculoplastic surgery department of our clinic were included in the study. 18 eyes had LLD, 14 eyes had LLL, 18 eyes had LLD and LLL, and 30 eyes had LLD, LLL and OL. Patients were re-evaluated preoperatively, postoperatively at 1st week, 1st month and 6th month. In the LLD scoring, skin laxity was evaluated as 1 point for skin laxity, 2 points for fat prolapse, 3 points for tear trough deformity, 1 point for LLL and 1 point for OL. Patients with a total score below 3 points were defined as mild, and patients with a score of 3 and above were defined as advanced.

[RESULTS] Of the 40 patients, 30 were female (75%), 10 were male (25%) and the mean age was 56.7 years (45.67 years). Eighteen (22.5%) eyes underwent lower lid blepharoplasty (LLB) only, 14 (17.5%) eyes underwent lateral retinacular suspension (LRS) only, 18 (22.5%) eyes underwent LLB and LRS, 30 (37.5%) eyes underwent LLB, LRS and orbicularis muscle suspension (OMS).78 (97. 5 eyes with upper lid dermatochalasis underwent concomitant upper lid blepharoplasty (ULB) and 42 eyes (52.5%) with brow ptosis underwent additional browpexy. As a result of scoring, 34 eyes (42.5%) had mild and 46 eyes (57.5%) had severe lower periorbital aging. As a result of combined surgical treatments for each sign of aging of the lower periorbita in all patients, complications such as lid malpositioning, corneal exposure, orbital hemorrhage were not seen in any eye and surgical and cosmetic success was achieved.

[CONCLUSION] In patients with varying degrees of lower periorbital aging, a comprehensive surgical treatment can provide effective and safe results in rejuvenating the lower periorbital area. Additional treatments such as LRS and OMS have the advantage of providing a comprehensive approach to skin and muscle tightening while maintaining support to the lateral canthus and improving the lid-cheek junction.