Lower Lid Rejuvenation Combing Laser CO2, Fractioned Microneedling Radiofrequency and Lipofilling

Goals/Purpose: Periorbital ageing process is due to photoaging and early volume loss. Sensitive anatomical region and particular physiology with risk of water retention limits the treatment options. Combining regenerative proprieties and volume restoration of fat transfer, collagen production of fractioned radiofrequency and skin resurfacing with CO2 laser target all causes of periorbital ageing.

Methods/Technique: A cohort of 53 patients with a median age of 45,2 years were treated in a private practice accredited facility from January to December 2021. Treatment protocol included only one surgery performed under local anesthesia including the following: fractioned radiofrequency, lipofilling and laser resurfacing. Fat transfer included mili and nanofat with fat harvested from inner thigh or lower abdomen with Colleman canula. CO₂ Laser was performed as a resurfacing procedure depending on skin conditions. Fractioned radiofrequency was done to promote subcutaneous fat remodeling. For the patients with previous hyaluronic acid injection hyaluronidase was injected and ultrasound control was performed.

Results/Complications: All the patients reported the surgery as completely painless except the local anesthesia and as a good experience they would repeat it if needed. The overall complication rate was 3%. Three patients had prolonged edema for 3 months after the surgery and 2 patients reported small micronodules on palpating the lower orbital margin without aesthetic concern. No complications related to fat donor site.

Conclusion: Combing fractioned radiofrequency and laser resurfacing together with lipofilling for selected cases scarless surgery with minimal downtime may be achieved. With technical refinements and tissue stimulation with energy based devices a natural look is created with high grade of satisfaction among patients.