Neuromodulators and Fillers for Periorbital Rejuvenation

  • Corey S. MaasEmail author
  • Kenneth C. Y. Yu
  • Kartik D. Nettar


The periorbital region is at the pinnacle of conferring youth and vitality to the face. Facial lines, furrows, and hollows can signify fatigue and aging, while smooth skin and convexities convey a cherubic, youthful impression. Surgical rejuvenation of the periorbital region continues to play a large role in achieving the latter. However, in patients with hyperfunctional lines and tear trough or other contour deformities, neurodmodulators and injectable soft-tissue fillers play a substantial, growing role in their treatment. With the advent of newer technology, the armamentarium of products available to cosmetic surgeons continues to expand. Keeping abreast of these products, their indications and nuances are paramount to achieving a safe and successful result.


Cervical Dystonia Frontalis Muscle Orbital Septum Corrugator Supercilii Periorbital Region 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Aoki KR, Guyer B. Botulinum toxin type A and other botulinum toxin serotypes: a comparative review of biochemical and pharmacological actions. Eur J Neurol. 2001;8 Suppl 5:21.CrossRefGoogle Scholar
  2. 2.
    Aoki KR. A comparison of the safety margins of botulinum ­neurotoxin serotypes A, B, and F in mice. Toxicon. 2001;39:1815.CrossRefGoogle Scholar
  3. 3.
    Carruthers J, Glogau RG, Blitzer A. Advances in facial rejuvenation: botulinum toxin type A, hyaluronic acid dermal fillers, and combination therapies – consensus recommendations. Plast Reconstr Surg. 2008;121(Suppl):5S–30.CrossRefGoogle Scholar
  4. 4.
    Ramirez AL, Reeck J, Maas CS. Botulinum toxin type (MyoBloc) in the management of hyperkinetic facial lines. Otolaryngol Head Neck Surg. 2002;126(5):459–67.CrossRefGoogle Scholar
  5. 5.
    Ramirez AL, Reeck J, Maas CS. Preliminary experience with botulinum toxin type B in hyperkinetic facial lines. Plast Reconstr Surg. 2002;109(6):2154–5.CrossRefGoogle Scholar
  6. 6.
    Brandt FS, Cazzaniga A. Hyaluronic acid fillers: Restylane and Perlane. Facial Plast Surg Clin North Am. 2007;15:63–76.CrossRefGoogle Scholar
  7. 7.
    Lowe NJ, Maxwell A, Lowe P, et al. Hyaluronic acid fillers: adverse reactions and skin testing. J Am Acad Dermatol. 2001;45:930–3.CrossRefGoogle Scholar
  8. 8.
    Micheels P. Human antihyaluronic acid antibodies: is it possible? Dermatol Surg. 2001;27:185–91.PubMedGoogle Scholar
  9. 9.
    Maas CS, Yu K, Egan KK. Neuromodulators and injectable soft tissue substitutes. In: Papel I, editor. Facial plastic and reconstructive surgery. New York: Thieme; 2009. p. 346.Google Scholar
  10. 10.
    Ahn M, Catten M, Maas CS. Temporal browlift using botulinum toxin. Plast Reconstr Surg. 2000;105:1129–35.CrossRefGoogle Scholar
  11. 11.
    Maas CS, Kim EJ. Temporal browlift using botulinum toxin A: an update. Plast Reconstr Surg. 2003;112 Suppl 5:109S–12.CrossRefGoogle Scholar
  12. 12.
    Macdonald MR, Spiegel JH, Raven RB, et al. An anatomical approach to glabellar rhytids. Arch Otolaryngol Head Neck Surg. 1998;124:1315–20.CrossRefGoogle Scholar
  13. 13.
    Rostan E. Collagen fillers. Facial Plast Surg Clin North Am. 2007;15:55–61.CrossRefGoogle Scholar
  14. 14.
    Born T. Hyaluronic acids. Clin Plast Surg. 2006;33:525.CrossRefGoogle Scholar
  15. 15.
    de Boulle K. Management of complications after implantation of fillers. J Cosmet Dermatol. 2004;3:2.CrossRefGoogle Scholar
  16. 16.
    Carruthers J, Carruthers A. Complications of botulinum toxin type A. Facial Plast Surg Clin North Am. 2007;15:51.CrossRefGoogle Scholar
  17. 17.
    Schanz S, Shippert W, Ulmer A, et al. Arterial embolization caused by injection of hyaluronic acid (Restylane). Br J Dermatol. 2002;146:928.CrossRefGoogle Scholar
  18. 18.
    Finn JC, Cox S. Fillers in the periorbital complex. Facial Plast Surg Clin North Am. 2007;15:123–32.CrossRefGoogle Scholar
  19. 19.
    Alam M, Dover JS, Klein AW, et al. Botulinum A exotoxin for hyperfunctional facial lines: where not to inject. Arch Dermatol. 2002;138:1180.CrossRefGoogle Scholar
  20. 20.
    Bailin PLBM. Collagen implantation: clinical applications and lesion selection. J Dermatol Surg Oncol. 1988;14:49.CrossRefGoogle Scholar
  21. 21.
    Northington ME, Huang CC. Dry eyes and superficial punctate keratitis: a complication of treatment of glabelar dynamic rhytides with botulinum exotoxin A. Dermatol Surg. 2004;30:1515–7.PubMedGoogle Scholar
  22. 22.
    Aristodemou P, Watt L, Baldwin C, et al. Diplopia associated with the cosmetic use of botulinum toxin A for facial rejuvenation. Ophthal Plast Reconstr Surg. 2006;22:134–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Corey S. Maas
    • 1
    Email author
  • Kenneth C. Y. Yu
    • 2
  • Kartik D. Nettar
    • 3
  1. 1.The Maas ClinicUniversity of California-San FranciscoSan FranciscoUSA
  2. 2.Department of Otolaryngology-Head and Neck SurgeryWilford Hall Medical CenterLackland Air Force BaseUSA
  3. 3.The Maas ClinicSan FranciscoUSA

Personalised recommendations