Applied Anatomy of the Lower Eyelids’ Preseptal Space for Treating Ectropion and Retraction with Soft Tissue Fillers

Background: Lower eyelid malposition can result from age-related changes such as ectropion or post-surgical changes like retraction following lower lid blepharoplasty. The current accepted treatment is surgical, but previously it was indicated that soft tissue fillers can be used as well with good outcome. However, the underlying anatomy is incompletely described when guiding practitioners toward minimally invasive injections of the lower eyelid. Objective: To describe a minimally invasive injection technique adjusted to the complex anatomy of the lower eyelid for the treatment of ectropion and retraction of the lower eyelid. Methods: A total of n = 39 periorbital regions of n = 31 study participants were retrospectively analyzed using photographs prior and post to reconstruction of the lower eyelid with soft-tissue fillers. Two independent raters assessed the degree of ectropion and lower eyelid retraction (DELER; 0 - 4, best-to-worst) before and after the reconstruction and the overall aesthetic improvement using the Periorbital Aesthetic Improvement Scale (PAIS). Results: The median DELER score improved statistically significantly from 3.00 (1.5) to 1.00 (1.0) with p <0.001. The mean volume of soft tissue filler material applied per eyelid was 0.73 cc (0.5). The median PAIS following the treatment was rated as 4.00 (0.5) indicating improvement of the periorbital functional and aesthetic appearance. Conclusion: Anatomic knowledge of the lower eyelid and of the preseptal space is of clinical relevance when trying to reconstruct the lower eyelid with soft-tissue fillers. The targeted space provides optimal lifting capacities for improved aesthetic and functional outcome.