INTRODUCTION
Thinner than other regions of the face, possessing fewer oil glands, and subject to repetitive contractions, skin around the eyes is particularly susceptible to environmental factors and accelerated skin aging.1-5 Consequently, the periorbital region is among the first areas to experience intrinsic age-related changes and, thus, one of the first areas for which patients seek treatment advice. Thinning and drying of periorbital skin can manifest as early as the third decade of life.1,3,5,6-8 Anatomical alterations to tissue structures of the face that occur with aging arise from volume loss, deflation, and atrophy of malar fat and soft tissue. Additionally, underlying changes to bony structures, including enlargement of the orbital bony space, results in a more pronounced, concave tear trough deformity. Under-eye hyperpigmentation is a common, sometimes hereditary change that may be related to ethnicity and the result of thinning periorbital skin and can be particularly challenging to ameliorate.9 Extrinsic aging, owing to chronic exposure to ultraviolet radiation and other environmental stresses, compounds the consequences of intrinsic aging and can lead to fine lines and wrinkles, poor skin texture, and skin discoloration.10 As a result of both intrinsic and extrinsic aging of the periorbital region, individuals may develop
