New hyaluronic acid dermal filler (Intraline, Canada Inc., Kelowna
BC, Canada) was used to perform volumetric eyebrow lifting, due to its
great biocompatibility and scarse post procedure edema. The
formulation of this new dermal filler through its proprietary
spherification technology, combines spherical particles easy to inject
that give natural and smooth results, with low level of hyaluronic acid
cross linking which grants higher biocompatibility and durable results.

Prior lidocaine local anesthesia small vesicle was perform on the
brow tail and a 25 G needle was used for skin penetration prior to the
introduction of a disposable 25 G Gems cannula (Tulip, California,
USA). The cannula allows a gentle and atraumatic advanced through
the tissues without damaging vital regional structures.

A media of 0.8 ml of product was necessary on each side to obtain
the desired result, at a preperiosteal plane. The product was delicately
placed while removing the cannula at three different layers; superior,
inferior and at the eyebrow line to potentiate the lifting effect.

The product was distributed specially on the medial and center
compartment of the brow and tapering was done towards the outer
area.

Dіer the correct brow height was achieved upper blepharoplasty
procedure was performed. Local anesthesia and minor sedation was
used in all cases. Skin removal was done as the only correction for the
majority. Minor fat pad removal was only performed in selected cases
(3) and was limited to a minimum to avoid skeletonization of the eye.
Wound closure was done with interrupted 6, 0 nylon sutures.

Average time for the whole procedure was 70 minutes. Average
upper blepharoplasty alone was 55 minutes. Average volumetric lifting
alone was 25 minutes. Post operatory medication with cryotherapy and
Anti-inflammatory drugs was given for 24-48 hrs. All sutures were
removed by the 5th day.

Swelling and healing time varied from 5 to 12 days for patients
taking blood clot altering drugs.

Brow height median elevation was 1.3 mm at the medial limbus, 1.2
mm at the medial canthus and 1.5 mm at the lateral canthus. These
values were comparable to the volumetric lifting only group, but were
significantly different from the isolated blepharoplasty group, in which
the brow level was maintained or lowered at 2 years’ time in 15% of the
cases.

Minor bruising and swelling was present in the first 48 hours. No
complications were reported. Patient compliance and satisfaction was
excellent at 24 h, 1 w, 1 m and 3 months, achieving higher values for
the majority of the parameters when compared with the isolated
corrections groups. Pre and post pictures are shown in Figures 1-4.

Discussion

Facial beauty is a combination of features that should be harmonic, defined, balanced, elevated/projected, symmetric, characteristic and with volumetric proportion to be appreciated and perceived as beautiful [1].

Periorbital area is recognized as the main facial trait as it takes most
of the attention at the eye of the beholder. Periocular changes are one
of the main features of facial aging. The are characterized by
volumetric variations around the orbit, skeletonization or onset of fat
bags hypertrophy, eyebrow ptosis and dystrophic changes in the eyelids
skin such as blepharochalasis, dyschromia and elastosis [2].