Periorbital Rejuvenation: A Study on the Use of Dermal Threads as Monotherapy, with a Review of Literature

Abstract

The periorbital region, a major impressionable area holds a special place in aging of the face. It reflects chronological aging which are reflected not only as structural changes but also emotive expressions of sadness and tiredness. Dermal threads have been used in combination with other aesthetic procedures, however their use as monotherapy especially in periorbital region needs evaluation.

Aim: To evaluate the improvement in wrinkling and skin texture in the infero-lateral periorbital region with monofilament dermal threads.

Settings and design: A prospective observational study in a tertiary hospital was conducted between January 2019 and February 2020 after institutional ethical clearance and patient consent.

Materials and methods: 25 adults between 40 and 65 years of age reporting for infero-lateral periorbital rejuvenation and opting for dermal threads, with no history of aesthetic treatment in this region for the past three months were included after their informed consent. 10 monofilament dermal threads (5 each in lateral and infraorbital) in either periorbital region were inserted. Cases were assessed with Lemperle's wrinkle scale and visual analog scale (VAS) and photographic record maintained before procedure and after 16 weeks of procedure. Change in wrinkle grade was analysed using paired t-test and VAS was used to assess patient's perception of the result.

Results: 25 cases were included in the study, 21 completed the follow-up and 4 were lost to follow up. The mean preprocedure wrinkle score was 2.29 and postprocedure mean scores were 1. This finding was statistically significant. 16 cases were satisfied with their textural improvement (VAS >+2) while 4 reported mild improvement (VAS 2+) and 1 reported no improvement. Side effects observed were bruising in two cases and thread displacement in one case within 24 hours.

Conclusions: Polydioxanone monothreads offer an alternative aesthetic procedure for periorbital rejuvenation.

Keywords: Periorbital rejuvenation; periorbital wrinkles; polydioxanone thread.

Figure 1

Profile of periorbital region at younger age (left) and aging changes (right) (original drawing)

Figure 2

Lemperle’s wrinkle scale for periorbital region (Grade 0: no wrinkles, 1: just perceptible wrinkle, 2: shallow wrinkle, 3: moderately deep wrinkle, 4: deep wrinkle with well-defined edges, and 5: very deep wrinkle with redundant fold) (original drawing)

Figure 3

Tamura and Odo classification of periorbital wrinkles (Type I: lateral periorbital wrinkle extending from the brow to the zygomatic arch; Type II: wrinkles lateral to the external canthus of the eye, extending from the line of the external canthus of the eye to the zygomatic arch with no wrinkles in the superior lateral region; Type III: wrinkles in the line of the external canthus only; presence of lower eyelid wrinkles B1: lateral; B2: medial and B3: internal canthal wrinkles) (original drawing)

Figure 4

Representational image of thread insertion in the periorbital region with vectors for infraorbital (above) and lateral periorbital (below) region. (original drawing)

Figure 5

Preprocedure (left) and postprocedure (right) A: improvement in wrinkles and periocular pigmentation; B and C: improvement in wrinkles and periocular rejuvenation

Figure 6

Preprocedure (left) and postprocedure (right) A: improvement in scar and wrinkles; B: poor response to treatment; C: improvement in wrinkles and rejuvenation

Figure 7

Sequelae and complications: A: early erythema and edema; B: early linear ecchymosis along thread insertion; C: displaced thread (red arrow)

Figure 8

Periorbital fat pads (above) and transverse section through layers of periorbital region (below) (original drawing)

Figure 9

Periorbital zones (original drawing)