Examining Periocular Aging: A Narrative Review of its Causes and Aesthetic Interventions

Abstract

Importance

The periocular area is crucial for facial aesthetics and communication, significantly impacting perceptions of youth and vitality. Understanding its aging mechanisms and refining intervention strategies are essential for optimal outcomes. This review integrates clinical insights from multidisciplinary practice to address gaps in personalized decision-making.

Observations

Contemporary literature and clinical experience identify key periocular aging factors, including sequenced fat compartment deflation, bony resorption, and skin quality decline. Novel findings include a structured algorithm for injectable sequencing, emphasizing deep medial cheek volumization before tear trough correction to mitigate complications. Clinical pearls highlight hybrid techniques (e.g., microdroplet botulinum toxin with HA fillers) for dynamic wrinkles. While hyaluronic acid fillers remain central, case examples demonstrate synergistic outcomes when combined with surgical referrals (e.g., ptosis repair). Emerging ultrasound-guided approaches enhance precision in high-risk zones.

Conclusions and Relevance

Periocular rejuvenation demands a holistic, individualized strategy. The proposed algorithm, supported by complication management protocols and a surgery-injectables decision framework, optimizes outcomes. Clinicians must balance volume restoration with anatomical stability, leveraging multidisciplinary insights to address both aesthetic and functional decline.