The youthline is located at the lower eyelid close to the eyelash and is mainly formed due to the thickening of the orbicularis oculi muscle. It gains its name as it looks like a silkworm pupa flatly lying at the lower eyelid. Because the orbicularis oculi muscles contract and pop up along with eye movement or facial expression, the youthline is more obvious when smiling, thus giving your eyes a more charming look; therefore, this is also called “love band surgery.” Nevertheless, as the youthline is close to the lower eye bag, they are often confused by patients. In fact, the youthline belongs to a part of the ocular muscle, measuring no more than 0.5 cm, and becomes distinct and prominent on squinting or eye straining, while the lower eye bag is made up of bulging fats and is located at a lower position than the youthline near the tear-trough groove, which becomes less obvious when patients strain the eyes as the fats are squeezed inward. Such features help differentiate the youthline from the eyebag in a simple way. Generally, the youthline is less visible in patients with an eye bag, and in clinics, the youthline becomes more prominent after eye bag removal in most patients, so the lower eye bag should be excluded or treated prior to this surgery.
Youthline sculpting is available in both nonsurgical and surgical managements. The nonsurgical method is based on the injection of hyaluronic acids to remodel the size and shape of the youthline. Its advantages are the high reversibility and natural results, but the disadvantages are that the results can only be maintained for 6 months and that the shapes may differ after each injection. If patients want to sculpt the youthlines with surgeries and thus attain consistent results, autologous dermal fat, allograft fascia, or Gore-Tex prosthesis implantation is considered. Dr. Chuang first makes a small incision of approximately 3–4 mm at the inner and outer corners of the lower eyelid and detaches the skin from the inferior muscles with special devices to form a continuous subcutaneous path and then inserts the well-trimmed tubular dermal fat or Gore-Tex prosthesis into the path and stitches the medial and lateral ends. Generally, this surgery needs to be independently conducted to accurately evaluate and predict the surgical results. If patients have concurrent eye bag bulging, they need to correct the eye bag first before undergoing youthline surgery.