Assessing the Lower Eyelids

Dr. Sheila Barbarino shares her approach to assessing the periocular region for tear trough rejuvenation with dermal fillers.

In her presentation, “Periocular Fillers: Right or Wrong—What I Do in My Practice,” at the recent virtual meeting of the American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS), Sheila Barbarino, MD, FAAO, FAACSS, FACS, says addressing the hills and the valleys of the face can be challenging, but there is a way to bridge the gap between the midface and the periocular area with careful planning.

Dr. Barbarino examines the periocular area from several angles during assessment, having the patient animate and move her chin up and down. She also strongly recommends examining the midface before addressing the periocular area. The face is generally discussed in three distinct areas—upper, mid, and lower—in medical school, residency, and fellowship, she says, but you need to consider them collectively to create overall facial harmony.