Periorbital Contour Abnormalities: Hollow Eye Ring Management with Hyalurostructure

Purpose: A new technique for treating "periorbital hollowing" with hyaluronic gel filling using a unique cannula designed specifically for periorbital use. Method: The study was conducted from December 2008 to July 2009. All the patients presenting to the Alcazar aesthetic and Orbital clinic for periorbital contour abnormality complains where included. A total of 26 patients (52 injections) in both functional and aesthetic categories were identified. The inclusion criteria where contour abnormalities in the periorbital area. These included contour abnormalities of the periorbital and brow region that presented clinically as: "hollow eye ring" and "hollow cavities" and "deflated eyebrow". The aim was to evaluate a new technique with a cannula specific for periorbital injections. This was designed in consultation with the author and was manufactured by the Thiebaud Company. Treatments where performed using local anaesthesia ;(emla 5% and an injection of 1% Xylocaine adrenalised to 32-gauge needle) using the same protocol as Coleman lipostructure but using hyaluronic acid gel. The hyaluronic acid gel used in each case was Restylane (Q-Med-Sweden). Follow-up was over 6 months and performed photographically and with a patient self-evaluation questionnaire. The clinical postoperative assessment examined for bruising or swelling postinjection. The rates of complication were compared to published results and the authors own series before switching to the new cannula. Results: After analysis of the patient responses 24 patients (92%) with a 6 months' follow-up were satisfied or very satisfied of aesthetic result after hyalurostructure of periorbital region. The use of the specially designed cannula led to less complication. There were 3 cases of bruising (3/52) and 4 cases of lymphatic stasis (4/52). We also noted fewer surface irregularities and a better distribution of the product as the injection was a retro orbicular pre periosteal plane). Conclusion: Treatment of the periorbital region and tear trough by hyaluronic acid injection has been described previously. But often the risks of this delicate anatomic region and bruises caused by needles followed by the appearance of hollow eye ring due to deposition of haemosiderin have limited the development of this technique. We propose a new treatment for hollow eye rings and for peri orbital region adapted from Lipostructure but with hyaluronic acid and facilitating treatment protocol of that region with improved aesthetic results: hyalurostructure.