Decoding Periorbital Aging: A Multilayered Analysis of Anatomical Changes

Abstract

Background: Periorbital aging is a complex phenomenon that involves multiple layers of facial anatomy, including bone, fat, and globe. While previous studies have predominantly focused on age-related changes in facial fat compartments, this research aims to provide a comprehensive understanding of all periorbital components, including upper and lower orbital fat, orbital cavity volume, globe volume, and globe position, in the context of aging.

Methods: We conducted a retrospective study involving 118 patients (236 subjects) aged 18-99 years who underwent brain MRI using a 3 Tesla MR system. Baseline demographics and various parameters pertaining to periorbital aging were collected, and comprehensive measurements were obtained through meticulous radiological analysis.

Results: Our findings revealed distinct patterns of age-related changes in the periorbital region. Upper orbital fat remained stable with age, while lower orbital fat exhibited a substantial increase in both anterior and posterior compartments. Notably, orbital cavity volume expanded with bony resorption, while eye globe volume decreased, contributing to an enophthalmic appearance. We observed no vertical displacement of the globe with aging.

Conclusion: This study provides a comprehensive overview of the multifaceted anatomical changes that occur in the periorbital region with aging. The insights gained from this research offer important clinical implications for addressing the signs of periorbital aging, guiding surgical interventions, and ultimately enhancing patient outcomes.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Orbital aging; Orbital fat; Periorbital rejuvenation.

Fig. 1.

Measurement from axial view of MRI and formula for volume calculation

Fig. 2.

Sagittal view of MRI and globe position in anteroposterior and vertical positions

Fig. 3

Relationship between upper orbital fat volume and age

Fig. 4

Relationship between lower orbital fat volume and age

Fig. 5

Relationship between total orbital fat volume and age. (Left) Relationship between orbital cavity volume and age. (Right)

Fig. 6

Relationship between eye globe volume and age. (Left) Relationship between globe position in AP dimension and age. (Center) Relationship between globe position in vertical dimension and age. (Right)

Fig. 7

A photograph of a 69-year-old female patient illustrates all the periorbital aging changes identified in our findings, including superior sulcus hollowness, baggy eyelids, and an enophthalmic appearance. a Frontal view. b Oblique view