Resumen

Objectives: We propose a novel non-invasive paradigm for "Sunken Eyes," shifting from filling to internal restoration. Traditionally, treatments ignore orbital collapse. Age-related involutional fatty thinning of the orbicularis oculi (OO) compromises the "muscular wall" and intra-orbital pressure. This study utilizes simultaneous HIFES and RF for "Structural Myo-Restoration." Our goal: prove reversing muscle atrophy creates an "Internal Pressure Shift," cranially repositioning orbital fat to fill the superior sulcus. This bio-mechanical approach offers sustainable Introduction: Upper eyelid depression, or "Sunken Eyes," significantly contributes to a fatigued, aged appearance and a loss of vitality. Conventional treatments have primarily focused on masking the hollow through external volumetric filling, such as fillers or fat grafting. However, these methods fail to address the fundamental biomechanical cause: the age-related involutional change of the periorbital unit. Effective rejuvenation requires addressing the biological thinning and fatty infiltration of the OO muscle. A novel, non-invasive approach that restores this structural foundation is essential. Materials / method: We evaluated a treatment delivering Simultaneous High-Intensity Facial Electrical Stimulation （HIFES）and Radiofrequency （RF）to periorbital and midfacial areas. The study focused on the secondary volumetric improvement of the upper eyelid following the structural restoration of the muscular foundation. Patients underwent 4 sessions, with assessments focused on orbital dynamics and sulcus depth. Results: Clinical improvement in upper eyelid sunkenness was observed around the 4th session (increased muscle tone), and was sustained at the 2-month follow-up(sustained restoration). While outcomes varied based on individual anatomical factors and the degree of aging, a reduction in lower orbital fat protrusion was critically observed concurrently. Notably, the use of cheek applicators often induced synchronized contractions of the OO. This confirms that the rejuvenated "muscular wall" induces a holistic internal pressure shift, cranially repositioning orbital fat to naturally fill the upper sulcus. Conclusion: Simultaneous HIFES and RF to the lower orbit offer a promising, needle-free alternative for treating sunken eyes. By re-establishing the anatomical tension of the periorbital muscles and septum, this technique induces a dynamic repositioning of orbital tissues. While long-term durability and the specific impact of skeletal variations require further investigation, this approach represents a significant paradigm shift in non-invasive aesthetics.