STRUCTURAL SUPPORT WITH FILLERS, CELLULAR REVITALISATION WITH POLYNUCLEOTIDES

Dr. Ahmed El Muntasar, British Cosmetic Doctor and GP

Dr Ahmed El Muntasar, born in Libya, is a British doctor specializing in aesthetic medicine. Entering university at just 16, he pursued an exceptional academic path through St Andrews, Manchester, and UCL in London. Passionate about learning, he completed 12 aesthetics courses before opening his first clinic at the age of 26. Initially drawn to plastic surgery, he eventually shifted to aesthetics for its immediate results and scientific rigor.

Founder of three clinics in London, Leeds, and Cheshire, he offers high-end, non-invasive treatments always grounded in reliable clinical data. He rejects unproven wellness trends to focus solely on evidence based techniques.

Still practicing as a GP, he is also a major social media figure with over one million followers. A strong advocate for diversity, he promotes inclusive representation in the aesthetics field. He frequently declines procedures on ethical grounds, placing mental health at the core of his consultations. As a global ambassador for Obaji, he is currently developing a training academy and his own skincare line, continuing to transform the industry through his high standards, expertise, and human-centered approach.

The Eye Contour: A Focal Point of Expression and Aging

The periorbital region is central to facial expression, non-verbal communication, and perceived vitality. It is also the first anatomical zone to show multifactorial signs of aging due to its delicate anatomical composition and continuous exposure to mechanical movement and environmental stressors.

From a psychosocial perspective, patients often associate periorbital aging with fatigue, sadness, or ill health. Hollowness, dark circles, and dermatochalasis can alter the entire facial narrative, even in individuals with preserved dermal quality elsewhere.

Anatomical Vulnerabilities with Age

Anatomically, the periorbital area presents several intrinsic weaknesses:

• Thin dermis: Typically under 0.5 mm, leading to early elastin and collagen degradation.
• Loss of bony support: The orbital rim remodels with age, increasing aperture size, especially medially and laterally.
• Fat pad displacement: Medial and lateral sub orbicularis oculi fat (SOOF) and deep malar fat compartments descend, deepening tear troughs.
• Orbicularis oculi muscle laxity and ligamentous attenuation (particularly the orbitomalar and zygomaticocutaneous ligaments) contribute to periorbital deflation and shadowing.

These changes manifest as infraorbital hollowing, festoons, pseudoherniation of orbital fat, and reduced skin luminosity.

Structural Restoration with Dermal Fillers

The first stage in rejuvenating the periorbital area is the strategic restoration of midface volume using hyaluronic acid fillers (if applicable). Rather than direct infraorbital injection, which carries higher risk and often yields suboptimal aesthetic outcomes, an indirect volumisation approach targeting adjacent zones provides support and softens the transition between lid and cheek.

Understanding Volume Loss

Midfacial deflation is both a cause and amplifier of infraorbital aging. When volume diminishes in the deep medial cheek fat and lateral SOOF, the overlying tear trough appears exaggerated, even in patients with minimal skin laxity.

Key Injection Points:

• Valley of tears (tear trough): For mild to moderate concavity without excess skin or herniation. Use a low-viscosity filler via cannula in a supraperiosteal or deep sub-orbicularis plane.
• Medial and lateral cheeks: Anchoring points for midface lift; volumization here can indirectly support the lower eyelid and reduce the need for direct tear trough correction.
• Temporal hollows: Addressing lateral volume loss re-establishes frame balance and reduces lateral hooding, particularly in older patients.

Technique Considerations:

• Always assess lid-cheek junction length and snap back test to exclude candidates with excessive laxity or pseudoherniation.
• Use a microbolus technique with small aliquots to avoid Tyndall effect, overcorrection, or edema.
• Choose cohesive but soft rheological profiles (e.g. low G’, high stretch) for under-eye suitability.

When executed correctly, results are immediate: the eye appears less tired, the midface more lifted. Crucially, patients retain facial identity without overt signs of intervention.

Illumination and Smoothing with Polynucleotides

Where fillers restore structure, polynucleotides provide regeneration. Polynucleotides, highly purified DNA fragments usually derived from salmon or trout, are injectable biostimulators with a strong safety profile and growing evidence base.

Mechanism of Action:

Polynucleotides promote fibroblast proliferation, angiogenesis, and extracellular matrix remodeling. Their viscoelastic properties allow for sustained hydration, while their molecular signalling supports tissue repair and skin elasticity over time.

Clinical Benefits:

• Improved dermal density: Increased fibroblast activity enhances collagen and elastin networks.
• Reduction in periorbital fine lines and crepiness.
• Brighter skin tone: Likely due to improved microcirculation and reduced inflammation.

Protocol typically involves 2–4 treatments at 2-4 week intervals, with visible improvement beginning after the second session and continuing for up to 3 months.

The Two-Stage Strategy: Structure First, Then Radiance

When used in tandem, fillers and polynucleotides address both macroscopic and microscopic aging processes. The combination is not merely additive—it is synergistic.

• Stage One – Fillers: Rebuild the scaffolding of the midface and orbit. This restores contour, reduces shadows, and sets the foundation.
• Stage Two – Polynucleotides: Once the structure is stabilized, introduce polynucleotides to regenerate dermal quality, reduce pigmentary contrast, and refine skin texture.

Personalised Protocol:

• Timing: Fillers first, then polynucleotides 2–4 weeks later. Maintenance: 1 filler session per 12 24 months (as needed); biostimulators every 6–12 months.
• Patient Selection: Ideal for patients with early to moderate signs of aging, particularly those concerned with skin quality as much as contour.
• Contraindications: Caution in patients with active malar oedema, lymphatic insufficiency, or advanced fat prolapse.

Subtlety is key, true to the Patient

The ultimate goal of periorbital rejuvenation is subtlety. When done well, the patient should look fresher, not “done.” The best aesthetic work is invisible it restores confidence without erasing individuality. By combining structure (via volume) with skin vitality (via cellular regeneration), we offer a tailored, respectful, and evidence-based approach to one of the most emotionally significant areas of the face.

Dr Ahmed’s Tip:

“When treating a person’s undereye area, don’t pigeon hole which treatments they may need. Be a little bit open minded about combination treatments; it is like treating other areas of the face. People can be very worried about treating the under eyes but if they have hollowness, think about adding volume. If the focus is on skin or colour, think about polynucleotides”.