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Augmentation of the periorbital region is most commonly associated with infraorbital (undereye) and supraorbital (brow bone) areas. By far this is most commonly done with various synthetic injectable materials, such as hyaluronic acid and calcium hydroxyapatite materials, or with fat injections.

There is far less requests and experience for lateral orbital rim augmentation. Although in my practice it is an area that is frequently augmented as part of infraorbital-malar implant with a superior extension along the infraorbital rim or from a brow bone implant with a inferior extension down towards the cheek.  

In the August 2021 issue of the Aesthetic Surgery Journal an article on periorbital augmentation was published entitled ‘Enhancing the Lateral Orbital “C-Angle” With Calcium Hydroxylapatite: An Anatomic and Clinical Study’. The premise of this paper is that the lateral orbital area is an important region in how the eyes are perceived with a C-shaped distribution of fat which creates a distinct angle of the lateral orbit. In that regard an anatomic study was done using cadaver heads where dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit.

A clinical study was also done using a calcium hydroxyapatite filler (Radiesse) into the lateral orbital region which was then assessed on the day of injection, and at 2 weeks and 3 months afterwards using 2D and 3D photographs to quantify the volumetric changes. Other outcomes included Global Aesthetic Improvement Scale score and post injection patient satisfaction. An average of just under 2mls of the injectate was injected into each lateral periorbital region. There was near 100% volume at two weeks after injection and around 75% at three months after injection. Roughly three-quarter of the patients were satisfied at the three month assessment time period.There were no injection complications.

During aging there are well acknowledged changes to many of the facial bones including that of the orbit. Such changes are almost always three-dimensional in their effects. One the orbital bone the remodeling consists of flattening and a more oblique orientation of the orbital floor/rim which creates unaesthetic changes to the tear trough, the lid-cheek junction and an inferior decent of the lateral canthus. When combined with fat loss the bony changes become magnified. I would also point out that young people may have such periorbital bone shapes naturally giving them a premature aged or tired appearance.

Injectable fillers are a good but temporary method of lateral orbital augmentation that is not associated with similar aesthetic complications that can occur in the thinner tissues of the lower eyelid/infraorbital region. 

Dr. Barry Eppley

Indianapolis, Indiana

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