Abstract

Objectives: 1. Evaluate improvements in skin quality, volume restoration, and tear trough deformities. 2. Assessing the longevity of results and patient satisfaction. 3. Classifying patients using Hirmand's tear trough grading system to tailor treatments. Introduction: One of the earliest areas to exhibit signs of aging is the periorbital region due to volume depletion, skin laxity and decrease in collagen. The common concerns are tear trough deformities, hollowness, fine lines, and skin thinning. While blepharoplasty, a surgical option, offer long lasting results, some patients prefer nonsurgical treatments with minimal downtime. This study evaluates the efficacy and safety of PDO threads, hyaluronic acid dermal fillers, and biostimulators for periorbital rejuvenation, incorporating Hirmands's tear trough classification for treatment selection. Materials / method: A prospective study was conducted with nine adults 9 (3 in each group) between 30 and 80 years of age with periorbital aging concerns, with no history of aesthetic treatment in this region for the past three months were included after their informed consent. Treatment was tailored based on Hirmand's tear trough grading classification. Grade 1 and 2 hyaluronic acid fillers for volume restoration, grade 2 and 3 HA fillers, biostimulators (poly-D L-Lactic Acid), grade 3 hyaluronic acid fillers, biostimulators and PDO threads. Standardized photography and Lemperly wrinkle scale were used. Results: Hirmand's Grade 1 classification patients showed the best response to fillers and an immediate Lemperle 2 point reduction. Grades 2 and 3 achieved an immediate 1.5 point reduction with more improvement in 2 weeks. Conclusion: Nonsurgical periorbital rejuvenation using PDO threads, dermal fillers, and biostimulators is a safe and effective alternative to surgery. Combination therapies yield superior results by addressing volume loss, skin laxity, and collagen depletion. Further studies with larger sample sizes and longer follow-up periods are recommended to refine treatment protocols and improve outcomes.