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Volumetric considerations for lower eyelid and midface rejuvenation

Montes, José R.

Current Opinion in Ophthalmology: September 2012 - Volume 23 - Issue 5 - p 443–449
doi: 10.1097/ICU.0b013e3283560ab5

Purpose of review With the accepted understanding of volume loss as one of the main factors in facial aging, oculofacial surgeons are embracing the concept of ‘removing’ less and ‘filling’ more. The purpose of this review is to present an update of the different alternatives and techniques for lower eyelid and midface restoration/rejuvenation using filler agents.

Recent findings When a filler agent is chosen, the aim is to provide some lift, support and sculpting to the treated area. Nonpermanent or semi-permanent fillers are most widely accepted by physicians mainly because there is a lower possibility of complications. The involutional changes in the facial structures are a continuous process; this requires reassessment and variation in techniques in addition to choosing different products at different ages.

Safety, support capability, ease of injection and cost are the factors to consider when choosing an injectable implant. But, physicochemical structure or rheological properties, such as viscosity and elasticity, enable the clinician to objectively select the most appropriate injectable implant depending on the specific anatomical area. An injectable with low viscosity may be ideal for lip enhancement wherein softness is required, whereas a higher viscosity filler or a harder filler may be better indicated for structure and support in the midface.

Summary Given the wide variety of filler materials available, clinicians and surgeons must be able to select products based on safety, lifting or sculpting capability and rheological properties, such as viscosity and elasticity. These factors provide an objective parameter of how the filler agent will perform in a specific area.

Ophthalmology Department, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico, USA

Correspondence to Dr José R. Montes, MD, 735 Ponce de León Ave., Suite 813, San Juan, PR 00917, USA. Tel: +1 7877770003; fax: +1 7877770005; e-mail:;

© 2012 Lippincott Williams & Wilkins, Inc.