Table 1. Open in new tab Periorbital...

Region

Score
0 = no change between photographs,
1 = only 1 change noted in this region,
2 = more than 1 change noted in this region, or presence of a “grade 2” feature

Upper lid
1. Preseptal region (ie, central sub-brow region)
- Volume loss: preseptal (or central sub-brow) skin appears less full, hollowing of the superior sulcus
- Associated increase in skin fold height
- Associated increase in lid show

0 1 2

2. Pretarsal region
- Volume loss: pretarsal skin appears less full
- Flattening of the convex curvature of the pretarsal skin

0 1 2

3. Lateral sub-brow region
- Volume loss: flattening of the normal convex contour, appears less full
- Increased reveal/skeletonization of the superior/superolateral orbital rim (grade 2, even if only feature present)

0 1 2

4. Brow
- Descent of the brow (either of the entire brow or portions of the brow)

0 1 -

Lower lid
5. Pretarsal region
- Volume loss: pretarsal skin appears less full
- Flattening of the convex curvature of the pretarsal skin (ie, above the inferior border of the tarsal plate)
- Increased angulation/deepening of the lower eyelid crease hollow or septal confluence hollow

0 1 2

6. Tear-trough
- Volume loss: hollowing or deepening of the tear trough
- Medial fat pad loss

0 1 2

7. Lid-cheek junction/palpebromalar junction
- Flattening of natural convexity ± development of concavity

0 1 -

8. Lower lid height
- Increase in inferior scleral show

0 1 -

9. Rhytids
- Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids

0 1 -

Medial canthus
10. Medial canthal tendon
- Increased reveal of medial canthal tendon due to surrounding volume loss

0 1 -

Lateral canthus
11. Orbital rim
- Increased reveal/skeletoniation of the lateral orbital rim (Grade 2)

0 - 2

12. Lateral raphe region
- Volume loss in lateral raphe region
- Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids

0 1 2

Total

Score = __________ out of 19

Table 1.

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Periorbital Fat/Volume Loss Grading System

Region	Score 0 = no change between photographs, 1 = only 1 change noted in this region, 2 = more than 1 change noted in this region, or presence of a “grade 2” feature
Upper lid 1. Preseptal region (ie, central sub-brow region) - Volume loss: preseptal (or central sub-brow) skin appears less full, hollowing of the superior sulcus - Associated increase in skin fold height - Associated increase in lid show	0 1 2
2. Pretarsal region - Volume loss: pretarsal skin appears less full - Flattening of the convex curvature of the pretarsal skin	0 1 2
3. Lateral sub-brow region - Volume loss: flattening of the normal convex contour, appears less full - Increased reveal/skeletonization of the superior/superolateral orbital rim (grade 2, even if only feature present)	0 1 2
4. Brow - Descent of the brow (either of the entire brow or portions of the brow)	0 1 -
Lower lid 5. Pretarsal region - Volume loss: pretarsal skin appears less full - Flattening of the convex curvature of the pretarsal skin (ie, above the inferior border of the tarsal plate) - Increased angulation/deepening of the lower eyelid crease hollow or septal confluence hollow	0 1 2
6. Tear-trough - Volume loss: hollowing or deepening of the tear trough - Medial fat pad loss	0 1 2
7. Lid-cheek junction/palpebromalar junction - Flattening of natural convexity ± development of concavity	0 1 -
8. Lower lid height - Increase in inferior scleral show	0 1 -
9. Rhytids - Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids	0 1 -
Medial canthus 10. Medial canthal tendon - Increased reveal of medial canthal tendon due to surrounding volume loss	0 1 -
Lateral canthus 11. Orbital rim - Increased reveal/skeletoniation of the lateral orbital rim (Grade 2)	0 - 2
12. Lateral raphe region - Volume loss in lateral raphe region - Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids	0 1 2
Total	Score = __________ out of 19

Region	Score 0 = no change between photographs, 1 = only 1 change noted in this region, 2 = more than 1 change noted in this region, or presence of a “grade 2” feature
Upper lid 1. Preseptal region (ie, central sub-brow region) - Volume loss: preseptal (or central sub-brow) skin appears less full, hollowing of the superior sulcus - Associated increase in skin fold height - Associated increase in lid show	0 1 2
2. Pretarsal region - Volume loss: pretarsal skin appears less full - Flattening of the convex curvature of the pretarsal skin	0 1 2
3. Lateral sub-brow region - Volume loss: flattening of the normal convex contour, appears less full - Increased reveal/skeletonization of the superior/superolateral orbital rim (grade 2, even if only feature present)	0 1 2
4. Brow - Descent of the brow (either of the entire brow or portions of the brow)	0 1 -
Lower lid 5. Pretarsal region - Volume loss: pretarsal skin appears less full - Flattening of the convex curvature of the pretarsal skin (ie, above the inferior border of the tarsal plate) - Increased angulation/deepening of the lower eyelid crease hollow or septal confluence hollow	0 1 2
6. Tear-trough - Volume loss: hollowing or deepening of the tear trough - Medial fat pad loss	0 1 2
7. Lid-cheek junction/palpebromalar junction - Flattening of natural convexity ± development of concavity	0 1 -
8. Lower lid height - Increase in inferior scleral show	0 1 -
9. Rhytids - Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids	0 1 -
Medial canthus 10. Medial canthal tendon - Increased reveal of medial canthal tendon due to surrounding volume loss	0 1 -
Lateral canthus 11. Orbital rim - Increased reveal/skeletoniation of the lateral orbital rim (Grade 2)	0 - 2
12. Lateral raphe region - Volume loss in lateral raphe region - Increase in area of skin with evident rhytids, number of rhytids, or depth of rhytids	0 1 2
Total	Score = __________ out of 19

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