By Dr Benjamin Cozanet

The periorbital area is very fragile and is the area that suffers most from premature aging. Though eyelid surgery is the first operation in terms of the average patient age, combined treatments can provide a non-invasive and tailored solution for every problem, without changing the expression or shape of the eye. A long-lasting and holistic approach to treat the “windows to the soul” while preserving their integrity. 

Repositioning the eyebrows with micro-focused ultrasounds

The eyebrows frame the periorbital area, some even compare them to “a cap” that gives the expression its character. This is why, when I perform a complete rejuvenation of the periorbital area, I always start by repositioning the eyebrow using a micro-focused ultrasound device, as it restructures the deep tissues, where neocollagenesis will boost the skin’s density while lifting any sagging features. I start the session with a light local anaesthetic with micro-injections of xylocaine/adrenaline, which allows me to work without causing the patient any pain and helps them stay still when the ultrasound beams are fired. The result is greater precision when firing the ultrasounds and optimum results. I fi rst treat the area underneath the eyebrow by sending lines of micro-focused ultrasounds in the pattern the patient wishes. I increase the number of shots around the head of the eyebrow in order to open up the glabellar area and make the expression more radiant.

I then move to the sides to lift the tail of the eyebrow, which gives a dynamic and rejuvenating effect. In the case of patients with heavy, sagging eyebrows, I can lift the eyelid using my hand, as high as possible, then fire a line of ultrasounds, which enables me to safely lift and revive the expression. As for the lower eyelid and crow’s feet wrinkles, depending on the patient’s requirements, I adapt my pattern of shots around the eye socket for a real tightening, densifying and smoothing effect.

I also discovered that malar bags can be treated using micro-focused ultrasounds, with a protocol of 3 to 4 sessions spaced a month apart. In this case, I use a 4.5mm ultrasound probe then a 3mm probe in the same session, to cause the swelling to be resorbed and to achieve a firming and smoothing effect in the lower eyelid.

Once this repositioning work has been done, we wait two weeks before topping it up, if required. The results of this treatment are visible from the first month post-treatment, and the final results are achieved after 3 to 6 months, depending on the patient’s age and skin type. They last 24 months on average, perhaps even more.

Sparkly eyes

We might compare rejuvenating the expression with highlighting, erasing any areas of shadow caused by the skeletonisation of the face. First, I fill the hollowed temporal fossae with a volumising filler that will stay put. If necessary, I also treat the forehead with subtle injections of medium cross-linked HA, which softens the expression while restoring the lost volumes. Next, I inject the Charpy fat pad with a medium cross-linked HA to plump and highlight it. If the eye area is hollow, a small quantity of weakly-cross-linked HA is injected into the upper inner corner, which makes the expression less tired and fresher. In the case of a collapsed tear trough and hollow under-eye area, I use a cannula to inject right to the bone, underneath the muscle, with medium-density HA that will provide a supple yet long-lasting filling effect, with good tissue induction that will adapt perfectly to the facial expressions. For superficial wrinkles, we can smooth them using the blanching technique, where I use a needle to inject quantities as large as a pin head of weakly cross-linked HA into the superficial dermis, in order to fill the wrinkles and achieve as much hydration as possible.

This is a work of artistry, fi nesse, and the results in this area of very fine skin are stable for 24 months. I really like this subtle work, carried out in lots of little touches, which enables us to attract light to areas of shade and erase signs of fatigue and anxiety to make the expression young, fresh and optimistic.

Dr Benjamin Cozanet : Award-winning graduate of the Paris Medical Faculty, former registrar at Paris Descartes University. Graduated from the International College of Aesthetic Medicine. Member of the French Society of Morphological and Anti-Aging Medicine, and the French-speaking Society of Medical Lasers.

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