Resumen

Objectives: To present a layer-based approach to periorbital anti-aging in Japanese patients, focusing on how structural, textural, and pigmentation-related changes are assessed and addressed in clinical practice. This session highlights practical decision-making in selecting and combining surgical and non-surgical treatments based on anatomical findings and patient preferences. Introduction: Periorbital aging is a major concern among Japanese aesthetic patients and involves multiple layers, including structural decline, skin quality deterioration, and pigmentation changes. Concerns regarding downtime and scarring often influence treatment selection, increasing demand for non-surgical and combined approaches. A single-modality strategy is frequently insufficient, requiring a layer-based approach for natural and lasting outcomes. Materials / method: This clinical review presents representative periorbital anti-aging cases from real-world practice to illustrate key decision-making processes across different aging patterns and patient preferences. Surgical procedures address structural concerns, while non-surgical modalities, including energy-based and injection treatments, target skin quality and pigmentation. Treatment selection is discussed based on anatomical findings, degree of laxity, pigmentation characteristics, and patient tolerance. Results: Surgical procedures effectively addressed structural changes, improving eyelid contour and reducing heaviness. However, surgery alone showed limited effects on skin texture and pigmentation. Non-surgical treatments improved skin quality and tone and were particularly useful for patients preferring less invasive approaches. In cases with combined concerns, integrated treatment strategies provided more comprehensive outcomes. Treatment decisions were influenced not only by anatomical factors but also by patient expectations and tolerance. Conclusion: Periorbital anti-aging in Japanese patients requires a layer-based approach addressing structural, textural, and pigmentation-related changes. Surgical and non-surgical treatments should be considered complementary rather than competitive. Integrating anatomical assessment with patient preference allows for individualized strategies. A sequential approach provides a practical framework for achieving natural outcomes while minimizing overtreatment.