References

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Periorbital-Facial Volume Rejuvenation for Focal Deficits

John R. Burroughs and Richard L. Anderson

Management of focal volume deficits of the face has traditionally been a difficult problem, especially following trauma. We have found good success with the use of various materials. We have found fat and orbicularis tissue removed at the time of blepharoplasty or myectomy surgeries to be useful for filling volume deficits of the nasolabial folds, lips, glabellar folds, and for the lateral hollowing in myectomy patients following aggressive removal of the lateral orbicularis fibers of the upper and lower eyelids. Radiesse is an outstanding volumizer in HIV—or age-related fat atrophy. Four to 5 vials of Radiesse may be needed. It can also be used in the correction of enophthalmos. 1

Lip enhancement is most commonly done by filler agents. We prefer the synthetic hyaluronic acid fillers for the lips as they do not carry the risk of infectious disease transmission (HIV, hepatitis, etc.) and are well tolerated and accepted by most patients. Our preferred fillers are Restylane for volume enhancement and Juvederm for fine perioral wrinkles and enhancement of the vermillion border.

In the glabellar folds, we prefer Radiesse, as it can most often be placed deep to the dermis and provides a long-lasting effect. We have used fat and orbicularis for the glabellar folds, but fixation to keep it in place is more problematic than in the lips. For more superficial glabellar folds, Restylane or the other hyaluronic acids may be injected closer to the surface.

In patients with posttraumatic bony defects, we have found good success with the use of Enduragen® acellular dermis material. This material comes in both 0.5-mm and 1-mm thickness, and it can be trimmed, shaped, stacked, and sutured to itself for deeper volume deficit restoration. Radiesse may also be injected deep into these areas or into bony deficits to raise large areas of overlying tissue for volume restoration.

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