Around the Eyes (periorbital) Fat Injection. How We Do It?

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency delivers a high-frequency electric current—tissue resistance to electrical current results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment. INITIALLY, the FDA approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is reducing fat and tightening the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat mainly in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

The periorbital region is one of the first facial regions to show signs of aging. It is critically important to understand precisely what feature of the periocular area is of the most concern to the patient before making therapeutic recommendations. Aging skin is characterized by the appearance of fine and coarse rhytids (wrinkles), rough and uneven texture, dryness, and changes in pigmentation. Fat atrophy occurs in the upper and lower periorbital region leading to progressive skeletonization of the orbit. Fat atrophy in the lower periorbital complex leads to a more prominent infraorbital rim, increasing the height of the lower eyelid and the overall soft tissue vertical dimension of the orbit. Typically, the nasojugal crease is more evident with aging. The malar fat pad has atrophied, the temples have hollowed, and the brow and upper lid have lost volume. In general, changes in skin texture, tone, laxity, or pigmentation are treated with physician skincare cosmeceuticals, chemical peels, lasers, or energy-based solutions. I can augment volume loss with the use of fillers, Autologous fat injection, and BOTOX A. Hyaluronic acid (HA) is the workhorse for the periorbital area because of its good efficacy and predictability and an excellent choice for correcting static rhytids that cannot be treated with BoNT alone and to recontour. Milli fat, micro fat, and nano fat with the addition of SVF and PRP for more massive volume deficits around the eyes may also be beneficial.

Breast augmentation or enlargement is typically done through silicone breast implants or fat injection Breast implant surgery is tailored to meet a woman's individual needs. The filling type, shape, profile, and size of the implants are discussed thoroughly in the pre-operative consultation. A breast implant will be inserted into a pocket either under or directly over the muscle. Modern breast augmentation is about volume distribution, not just volume addition. The excellent shape should prevail over volume. The technique of autologous fat-graft injection to the breast is applied for the correction of breast asymmetry; breast deformities; congenital disability correction" micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.

Fat transfer has become an increasingly important method of facial rejuvenation both as a standalone procedure and in combination with traditional rejuvenation methods, like face-lifting, brow lifting, and Blepharoplasty. A variety knows fat transfer names, of which the most commonly used are fat transfer, fat injection, and autologous fat grafts. The word autologous means material (fat) is harvested from one area and donated to another in the same individual. Fat transfer is particularly suited for restructuring the proportion of the face. Typical facial structures can also be aided by adding constructive elements to correct a broad range of perceived facial deficiencies. For example, a stronger jawline creates a youthful, more powerful-looking face; eliminating the hollowness of lower lids helps reduce that tired, sad appearance; and fuller lips create a more youthful, attractive appearance. Other indications include congenital, traumatic defects, or surgical defects and scars. Nano fat is applicable in a wide range of indications to improve skin quality; trophic skin changes caused by age and sun damage, pigmentary skin conditions, and scarring non-facial areas such as the neck, the décolleté area, and the hands can also greatly benefit from the use of nano fat grafting, sometimes in combination with micro fat.

Mouth and lips or perioral region fat injection rejuvenation results depend on understanding perioral anatomy and perceived signs of aging. The principal areas of the lower face that benefit from fat augmentation are the pre-jowl sulcus, labio-mandibular recess, labio-mental sulcus, lateral jawline, and anterior central mentum. The perioral region is amended for improvement with millifat, microfat, and nanofat. Besides, pyriform augmentation with millifat will affect the lifting of the upper lip. Buccal atrophy is consistently seen in the fourth decade of life and beyond, as is buccal hollowing caused by previous overzealous excision of buccal fat or human immunodeficiency virus-associated facial wasting. Asymmetrical fat placement is often required on the right and left sides because of the frequent buccal asymmetry seen preoperatively in many patients. Fat transfer can correct age-associated loss of chin volume, loss of chin projection, and loss of vertical chin height, and in some cases, can rival the kind of improvements obtained when small chin implants are placed. Fat transfer of the chin can also correct an atrophic and feeble appearance. When indicated, the button shrinks with age by broadening and strengthening it and filling the labio-mental and submental creases. Fat transfer along the mandible can also correct an atrophic and feeble appearance as the mandibular border shrinks with age by broadening and strengthening it. Treatment of the jawline typically must be undertaken in conjunction with the pre-jowl groove, and the two areas overlap in most cases. However, patients seeking a quick recovery, a specific lip size or shape, or subtle changes are not optimal candidates for the procedure. Patients should also be advised that it is impossible to create the highly stylized cover-girl lip appearance seen in fashion magazines when using fat.

Fat Injection results in satisfactory rejuvenation around the eyes or periorbital region with little recovering time. Fat transfer to the forehead is an excellent method to lift the eyebrows without raising the brow to an unnaturally high position. Micro-fat or nano fat grafting can fill the skeletonized upper lid sulcus. Fat injected into the lower eyelid region will shift the cheek up and build the convexity of the youthful eye. Lower-lid volume replacement is also helpful in treating dark circles under the eyes by reducing shadows and the appearance of blood vessels under the skin. Microfat Injection is also an excellent choice for correcting static wrinkles that it cannot treat with BoNT alone. In most patients, I must undertake the treatment of the infraorbital, cheek, and tear trough areas together. I must combine fat Injection with a skin-only eyelid lift to achieve desirable rejuvenation.

Around the eyes or periorbital region filler vs fat injections results in depend on understanding both perioral anatomy and perceived sign of aging. Volume augmentation can be beneficial for treating deep nasojugal lines (often referred to as "tear trough" defects), the elevation of the temporal brow, and even smoothing fine eyelid wrinkling. It is also an excellent choice for correcting static wrinkles that it cannot treat with BoNT alone and re-contour. Which filler substance is considered "best" or "preferred" for you depends on the doctor's technique, skill, experience, training, facial needs, and risk tolerance? It has nothing to do with headlines in the media; these are often a result of its marketing. While synthetic fillers can smooth out wrinkles and folds, they cannot restore fullness that is naturally lost as fat and bone diminish, and it is not for everyone. Some individuals are allergic to synthetic materials and may develop an allergic reaction. Nevertheless, its use stays limited compared to commercial fillers. It appears that surgically trained and oriented cosmetic practitioners are far more likely to use fat. In large numbers, less surgically dermatologists, non-surgically trained "cosmetic practitioners," and non-physician "extenders" such as physician assistants, nurse practitioners, and even simple registered nurses favor synthetic fillers over autologous permanent fat filling injections.

It is critically important to understand what features around the eyes are of the most concern to the patient before making treatment. Patients can complain of “looking tired” when concerned about losing skin tone, excessive eyelid skin, eyebrow ptosis, dark circles under the eyes, hollowness in the tear trough area, bulging orbital fat pads, or deep lateral canthal rhytides. The best candidates for around-the-eyes BTX injections are those with mild to moderately deep lateral canthal rhytides (smile lines) or crow’s feet wrinkles and those who develop a “roll” as they smile. Botox should be used with caution in patients with dry eyes, weak muscle function, and patients whose eyes do not close well due to earlier nerve palsy, thyroid eye disease, or previous surgery.

Fractional radiofrequency (FRF) is the newest in the nonabrasive approach. FRF uses an array of microneedles arranged in pairs between which bipolar RF energy is delivered. The fractionally delivered energy creates zones of thermally damaged skin adjacent to unaffected areas. The damaged skin stimulates wound healing and deposits new collagen, elastin, and hyaluronic acid formation. The unaffected areas serve as a reservoir of stem cells that accelerate wound healing.  FRF improves acne scars, large facial pores, and skin quality. FRF devices are safe, tolerable, and effective modalities for wrinkles and facial laxity reduction. I may use a topical anesthetic cream before the treatment to minimize pain. Fractional radiofrequency is combined with PRP with significant amounts of growth factor and heal promoting factors to fasten healing. Recently, Nanofat has been combined with fractional radiofrequency to enhance skin quality and stimulate hair follicles. Fractional radiofrequency gives a wake-up call to your skin to remove injured collagen and elastic fibers, encouraging your fibroblast to synthesize new collagen and stimulate hair follicles to stem cells.

Skin rejuvenation laser peel involves the removal of the outer layer of damaged skin. Many ablative skin resurfacing techniques are available at MSI, broadly grouped as mechanical, chemical, and laser abrasion. All ablative techniques result in upper to the mid-dermal wound. Dermabrasion relies on mechanical 'cold steel' injury, acid peels result in a 'caustic' injury, and lasers result in a thermal injury. All ablative resurfacing treatments work the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Superficial or medium resurfacing is limited to the epidermis and papillary dermis. For deeper resurfacing, I can also remove the upper levels of the reticular dermis. Unlike chemical peels and dermabrasion, laser skin resurfacing (LSR) with the CO2 laser generates heat, which results in immediate tightening because of the shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, and a tightening effect that improves the skin's overall appearance. The laser stimulates the growth of healthy new collagen and elastic fibers in the skin continuously for six months after resurfacing. Therefore, any wrinkles or scars will continue to improve for up to one year. Nonablative or minimal ablative fractional CO2 holds great promise in both treatments of skin textural abnormalities (acne scarring, wrinkles, and skin mottling associated with photoaging) and pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia