Collagen Use in Periorbital Rejuvenation for Chinese Patients: The Restoration Injection for Optimal Rejuvenation Technique

Summary:

Modern periorbital rejuvenation treatments involve a comparison of various injectable materials to optimize therapeutic outcomes. This article highlights the advantages of collagen in periorbital rejuvenation and introduces the restoration injection for optimal rejuvenation (RIO) technique as a precise and safe injection method. Due to the complex anatomical and physiological characteristics of the periorbital area, conventional injectable materials may lead to adverse reactions or suboptimal results. Collagen, however, offers excellent adhesion and minimal migration, and effectively improves both pigmented and structural dark circles. To ensure long-term results and minimize complications, the RIO technique, developed based on the authors’ years of injection experience, optimizes collagen application. This low-cost technique is suitable for personalized customization, is safe and effective, and provides patients with a reliable periorbital rejuvenation solution.

Takeaways

Question: What are the benefits of using collagen and the RIO (rejuvenation injection optimization) technique for periorbital rejuvenation?

Findings: This study highlighted strong adhesive properties, minimal migration, and low bruising rate of collagen, which effectively address both pigmented and structural dark circles without causing the Tyndall effect. The RIO technique further enhances the safety and effectiveness of collagen injections for periorbital rejuvenation.

Meaning: Collagen, combined with the RIO technique, provides a safe, effective, and recommended approach for treating various signs of periorbital aging, offering an optimized solution for clinicians in achieving rejuvenation goals.

INTRODUCTION

The periorbital region significantly influences facial aesthetics, often reflecting early signs of aging due to its delicate skin and complex anatomy.^1–3 Aging signs such as eyelid hollows, fine lines, and pigmentation issues are exacerbated by stress, insufficient sleep, and frequent mask-wearing, making periorbital rejuvenation increasingly important.⁴ In Chinese patients, accurately assessing aging-related changes across muscles, fat, and skin is essential, facilitated by classification tools such as the Fillderm grading system.⁵ Nonsurgical treatments, especially fillers, are commonly used.⁶ Compared with hyaluronic acid, collagen is better suited to the periorbital area due to its superior adhesion, minimal migration, and ability to enhance skin texture and reduce pigmentation.^7,8 Advances in collagen technology have further improved its safety and effectiveness, establishing it as a reliable option for periorbital rejuvenation.

METHODS

The restoration injection for optimal rejuvenation (RIO) technique is specifically designed for periorbital rejuvenation, ensuring uniform filler distribution and natural outcomes. Ideal for challenging areas such as tear troughs and cheekbones, this method addresses irregularities and asymmetries effectively.

Procedure

Prepare undiluted collagen by transferring half of the content into a new 1-mL syringe. Inject 0.1–0.2 mL of collagen at each osteal point (O1–O5).

Diagram Interpretation

Injection sites form an R-shaped pattern around the periorbital region (see Figure 1):

Fig. 1.

Schematic representation of the R-shaped injection outline technique. SOOF, suborbicularis oculi fat.

• R1: Upper edge of the zygomatic arch (initial injection site).

• R2: Below the malar mound (secondary injection site).

• R3: Above the tear trough (third injection site).

• R4 and R5: Auxiliary points ensuring even distribution of filler.

Injection patterns vary by point:

• R1 covers a wide, obtuse-angle area.

• R2 targets a right-angled area toward the inner corner of the eye.

• R3 focuses on superficial subcutaneous pigment regions with an acute-angle distribution.

Detailed entry points, treatment layers, cannula/needle specifications, and injection ranges are summarized in Table 1.

Table 1.

Precise Locations, Treatment Layer, Cannula/Needle, and Injection Range of Each Periorbital Entry Point

Injection Point	Localization of Entry Point	Treatment Layer	Cannula/Needle	Injection Range
R1	Intersection of the upper edge of the zygomatic arch and the orbital O shape	Suborbicularis plane	27G, 70-mm cannula	Obtuse angle/fanning
R2	Intersection of the lateral canthus and the horizontal line passing through the upper notch of the nasal wing	Suborbicularis plane	27G, 50-mm cannula	Right angle/fanning
R3	Intersection of the perpendicular line from the eyebrow arch and the orbital O shape in the infraorbital region	Subcutaneous plane	27/30G, 38-mm cannula	Acute angle/fanning
R4	The intersection point of 15 mm from the lateral canthus on the horizontal line and the orbital O shape	Suborbicularis plane	27G, 38-mm cannula	Obtuse angle/fanning
R5	Supraorbital support ligament: located at the anterior border where the temporal line meets the orbital rim	Suborbicularis/periosteal	27G, 38-mm cannula	Acute angle/fanning
O1	Lateral orbital support ligament: thickening area on the outer aspect of the brow tail	Periosteal plane	30G, 13-mm needle	Microbolus
O2	Infraorbital support ligament: connection between the inner and outer aspects of the SOOF	Periosteal plane	30G, 13-mm needle	Microbolus
O3	Tear trough ligament: intersection of the lid–cheek junction and the mid-cheek junction	Periosteal plane	30G, 13-mm needle	Microbolus
O4	Temporal ligament adhesion/lateral brow thickening: upper outer aspect of the orbital rim	Periosteal plane	30G, 13-mm needle	Microbolus
O5	Supraorbital support ligament/SLA: anterior border of the junction of the temporal line and orbital rim	Periosteal plane	30G, 13-mm needle	Microbolus

SLA, Supraorbital support ligament; SOOF, suborbicularis oculi fat.

Technique

Stretch the skin and puncture deeply with a 27G needle at a 45-degree angle, passing through the superficial musculoaponeurotic system. Introduce a 27G, 50-mm cannula in the suborbicularis plane along the R-shaped path, using fanning, retrograde, and microbolus injection techniques with gentle back-and-forth movements. Place collagen in the preseptal space to reinforce muscle tone and reposition orbital fat posteriorly, ensuring that the cannula remains anterior to the orbital septum. The key objective of collagen injections is to target the subcutaneous layer.

Injection Sequence

The injection sequence (R1→R2→R3) is vital for optimal results. Layer collagen from the lower to the upper parts to achieve a graduated effect. Refine results by injecting into the preseptal space (via R1) or layering subcutaneously (via R3). Uniformly fill the superficial infraorbital region with collagen using a fan-shaped technique through the R3 entry point (0.1–0.3 mL, optionally diluted with tranexamic acid to reduce the possibility of bruising and improve local pigmentation).

R3 Injection

Inject anesthetic superficially into the dermis, creating small white papules. Then, pierce the epidermis and dermis at a 15-degree angle with a 27G sharp needle. Finally, introduce a 27G or 30G blunt cannula into the orbicularis oculi muscle layer, injecting collagen slowly and gently at single points via microbolus injections (Fig. 2). (See Video [online], which displays the RIO technique.)

Fig. 2.

Facial appearance before and immediately after collagen injection. Frontal facial photographs of the subject taken before (A) and immediately after collagen injection (B).

Points to Note

Maintain a Right-angled Backrest

Ensure that the patient is positioned in an upright, right-angled posture during the procedure. This positioning allows for a more precise assessment of the periorbital volume and the degree of lower eyelid protrusion, thereby facilitating a more accurate treatment approach.

Selection of Entry Points

Ensure safety by avoiding important structures or blood vessels. The coverage area must be sufficient to achieve the desired therapeutic effect. Avoid using the malar mound as an entry point, and minimize repeated passage of the blunt cannula through the malar mound to prevent undesired edema. Facilitate easy operation and injection control, considering individual patient differences and specific conditions.

Injection Technique

Not every procedure requires the use of both sharp needles and blunt cannulas, nor are superficial and deep injections in the bilateral infraorbital region always necessary. For areas with thin, highly vascularized infraorbital skin, selectively avoiding injections at points O2 and O3 can help reduce the risk of unnecessary bruising.

Avoiding Complications

When injecting collagen at osteal points (O1–O5), small microboluses (~0.1 mL) are recommended. For the O3 point, a slightly larger amount (up to 0.3 mL) can be used due to its proximity to the infraorbital foramen. A 4-mm sharp needle and a 27G blunt cannula are not recommended. The primary treatment area is within the symbolic R-shaped periorbital region; detachment of tear trough ligament/orbicularis retaining ligament is unnecessary. Excessive dissection or deep injections should be avoided to prevent filler aggregation or lymphatic edema. The injection technique for collagen differs significantly from that for autologous fat or other fillers. Uneven injection can be corrected through gentle palpation and massage. To avoid complications such as white papules and dimpling, do not deposit collagen during needle retraction or layer it within the zygomatic cutaneous ligament plane.

DISCUSSION

The periorbital region is one of the most challenging areas for aesthetic rejuvenation due to its delicate and complex anatomy.^9,10 The RIO technique effectively addresses periorbital aging with proven safety, simplicity, and patient satisfaction. Combined with collagen fillers such as Fillderm, which offer excellent biocompatibility and tissue integration, the technique ensures stable and aesthetically pleasing results, providing immediate volume enhancement and improved skin luminosity. Modern collagen fillers have significantly advanced in safety, demonstrating low immunogenicity and minimal risk of serious complications in clinical practice. Compared with hyaluronic acid, collagen fillers avoid common complications such as the Tyndall effect, bruising, and vascular issues, delivering natural-looking outcomes. Additionally, collagen fillers integrate smoothly with surrounding tissues, minimizing filler migration and stimulating natural collagen regeneration, thereby providing sustained improvement in skin texture and dark circles. These attributes align well with Chinese patients’ preference for natural, temporary enhancements.

The primary benefit of the RIO technique is precise filler placement, reducing risks of overcorrection and complications. This accuracy improves patient outcomes and satisfaction and physician confidence, making the RIO technique a valuable method for periorbital rejuvenation.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

Informed consent was obtained from all patients shown in the figures.

ETHICAL APPROVAL

The authors confirm that the ethical policies of the journal, as noted on the journal’s author guidelines page, have been adhered to. No ethical approval was required as no original research data were provided.

DECLARATION OF HELSINKI

The guidelines of the Declaration of Helsinki were followed throughout.