Periorbital treatment, 2 major contributions: Botulinum toxin and volumetric fillers

Botulinum toxin, by creating a „biological section“, produces a very efficient, safe and durable treatment of the dynamic periorbital wrinkles. Indeed, those lines are usually treated with much more risks and less durability by procedures as face lifts and other surface medical treatments. In other hands, in this peiorbital area: If a loose of volume is existing, volumetric fillers, as fat grafting and other effective exogenous products, are the best approach.

If a muscles, fat, and skin relapse is existing facelift and/or blepharoplasties stay the most avcailable procedures.

It is necessary to evaluate the efficacy and safety of these following procedures.

Botulinum Toxin A – Surgery combination: advantages/disadvantages: Laterally, in case of ptosis: the fronto-temporo-malaris lifting, under cold light control, remain the best procedure. In the glabella and crow's feet areas: the botulinum toxin injections seem to be the most effective treatment, being always done 3 weeks before, or minimum 3 months after the surgery procedure. Advantages: associated to surgery, the BTX injections produce a substant reduction of the operative time, follow-up and side effects risks. It is optimising the inadequate surgery results. No real disadvantages? In fact, this step by step procedure is a real advantage. Lipofilling – Surgery combination: advantages/disadvantages: Face lift alone, disadvantages: in case of volume loss associated or non associated to the ptosis of the tissues, the fat graft techniques allows a better periorbiatal and jugo-malar areas remodeling, and rejuvenation. Lipofilling alone, disadvantages: A better anatomical knowledge of the concerned lipoatrophy area and our technique improvement involving, have produced a much greater efficacy and durability of this process. In other hands, the recovery period is no less than 2 weeks. Anesthesia and operating room are necessary during the fat taking and injection, and the orbital and glabellar lipofilling are difficult and risky. Because of all these data, this technic is more indicated for motivated and well prepared patients. For these reasons, the effective alternative technics are the exogenous fillers injections with safe, and durable products. Among the available one, the resorbable fillers as Hyaluronic Acid (Sub-Q), and Polylactic Acid (New fill), could be considered are one of the most safe, and effective. Conclusion: Botulinum toxin injections and volumetric fillers are not coming at all in opposition with upper, mid, face lifts and blepharoplasties; indeed, they optimize and maintain those surgery results. These injections are a fundamental process in producing a long lasting result. The nowadays and future evolution is first of all towards a minutious, natural and minimally invasive face lift, and blepharoplasties also towards a combination with an effective and low side effects procedure such as the botulinum toxin and volumetric fillers one. This medico-surgical combination is perfectly illustrating the evolution of our aesthetic field in 2004.