Dr François Prunièras
As they age, certain patients notice a loss of volume in the outer, lateral part of the eyebrow arch, as well as drooping in the tail of the eyebrow. This gives the face a sad-looking appearance.
What we want to do is to open up the expression with some aesthetic medicine injections.
Aging in the eyebrow area is the result of several things, including a loss of retro-orbicularis oculus fat (ROOF). The ROOF is a fat store located on the outer part of the eyebrow that stretches over the eyebrow arch, with fibrous adherences in the middle, between the area’s different muscles, i.e. the orbicularis oculi, the occipitofrontalis and the corrugator supercilia.
In women, the eyebrow usually lies above the rim of the eye socket and the tail of the eyebrow is lifted. In men, the eyebrow sits lower down in comparison to the rim of the eye socket and has a more horizontal position.
Before carrying out the treatment, it is best to ask the patient to apply an anaesthetic cream, such as EMLA, to the treatment site 90 minutes prior to the procedure to reduce any potential discomfort.
The treatment involves injecting hyaluronic acid. These hyaluronic acid injections are carried out in two stages:
First of all, we reshape the outer, lateral part of the eyebrow area. To do this, we use a fairly volumising hyaluronic acid, avoi- ding products that create too much volume. We only treat the outer third of the eyebrow.
There are two different approaches:
- Either using a needle, which is fairly risky because of the risk of intravascular injection (this area is relatively well vascularised)
- Or using a cannula, which is the recommended technique (flexible or rigid cannula).
In any case, it is best to treat the ROOF with a little product then move onto the second ROOF before coming back to touch up the first, if necessary. This allows us to leave the product to act for a few minutes so that we can see its effects before adding any more product. By adding a little product at a time, the risk of over-correction is reduced.
In this way, we are able to recreate the fat pads that have diminished with age.
Next, if we want to lift the tail of the eyebrow, we tend to use botulinum toxin. However, since this approach requires two different products, it can prove costly. In addition to this, some patients are reluctant to have treatments that use botulinum toxin.
This is why some doctors offer an alternative, which involves injecting the same type of hyaluronic acid as we used before. After marking out the treatment site, we inject the product above the periosteum into the frontotemporal ridge, which lifts the tail of the eyebrow. We then gently massage the area to smooth out the ball of hyaluronic acid.
Combining these two approaches enables us to lift the outer edge of the eyebrow and open up the eye area, which tends to brighten up the expression.
Dr Prunièras performs only aesthetic medicine and medical laser treatments. Qualifications: International College of Aesthetic Medicine, European Medical Lasers, Aesthetic Dermatology Procedures, Filler and Injection Techniques in Dermatology and Plastic Surgery, and finally Filler and Injection Techniques in Maxillofacial Surgery. Practice in Chaville.
