RESUMEN
PURPOSE: This article examines the pathophysiology of periorbital aging and details a technique, autologous fat transfer, to restore a youthful appearance to the periorbital complex. The use of photographs taken of patients in their late teens or early 20s shows that the main changes of periorbital aging are consistent with volume loss more so than gravitational changes. This article reflects on the shortcomings of currently accepted surgical approaches to the rejuvenation of the periorbital region. PATIENTS AND METHODS: After a detailed clinical evaluation of the periorbital region including overall facial aging, brow position, and eyelid laxity, patients underwent autologous fat transfer to the periorbital region. The technique consists of autologous fat harvesting using the senior author's modification of the Coleman technique to the upper brow and lower eyelid region. RESULTS: Detailed clinical evaluations of each subject, and comparisons to a preoperative youthful photograph of each, were made at 1 week, 6 weeks, and 6 months postoperatively. These evaluations included subjective clinical estimations of overall brow fullness, brow position, and upper and lower eyelid laxity; a judgment of the appearance of the supraorbital and infraorbital rim; appearance of a short lower eyelid length, and an assessment of the subject's convex facial profile. While maintaining a natural, "nonsurgical" appearance with this approach and this technique, the patient achieved a more youthful look after autologous fat transfer. CONCLUSIONS: Although there are still indications for brow lift and blepharoplasty in certain patients, neither procedure restores a youthful, rejuvenated appearance to the periorbital complex as well as autologous fat transfer.