Aging is a complex, biological process with its own laws in human tissues and organs. The earliest aging occurs in the skin, which starts to happen in about 20s, and the most intuitively valued is the aging of the facial skin. The eyes are the center of facial appearance, and when people talk, the place where both parties focus their gaze is located in the center of each other’s face, and the inverted triangle with the eyes and their connecting line as the bottom edge and the upper lip arch as the apex is called the “central triangle of facial orientation perception”. Therefore, the aging performance of the eyes is an important factor that affects the beauty of the face and is becoming more and more concerned by beauty lovers. At present, the request to make the eye “rejuvenation” of the consultation increased year by year, for oculoplastic surgeons, should be for different eye performance and consultation requirements, to take the appropriate surgical or non-surgical methods to restore eye beauty. 1, the eye age-related changes in the performance and examination of the skin, subcutaneous tissue and muscle and other tissue aging pathological changes with age is progressive aggravation. Generally speaking, after about 30 years of age, the upper and lower lid skin begins to relax, gradually forming triangular eyes and lid bags, and the outer canthus forms crow’s feet; after about 40 years of age, the lid skin relaxation increases, the nasolabial folds become obvious, and wrinkles begin to appear between the eyebrows and forehead and gradually increase; after 50 years of age, the eye joint jaw, chin, and neck skin shows relaxation and sagging, and wrinkles become more obvious. Most oculoplastic surgeons believe that upper lid cosmetic surgery includes the upper lid, brow and forehead, while lower lid cosmetic surgery includes the midface and cheeks. Therefore, the scope of the examination for eye aging includes the upper face and midface. First, the eye and facial aging is evaluated by close observation: the texture and elasticity of the eyelid and facial skin, the location and extent of wrinkles, the distribution and rearrangement of fat, the atrophy of muscles and bones, the position of the eyebrows, the forehead lines, the presence of hyperpigmentation and expression lines, and other signs of aging. Next, the height, length and curvature of the lid fissure, the position of the inner and outer canthus, the position of the lid margin in relation to the cornea, the shape, position and relationship of the eyebrow to the eyelid, and the laxity of the skin and lid margin are measured and evaluated. The results are compared with normal head measurements to determine the extent and nature of the aging of the eye. In addition, a thorough evaluation of the eye condition must be accompanied by a thorough communication of the patient’s mental state and psychological status to clarify his or her motivation for eye rejuvenation before a treatment plan can be developed. 2. Surgical treatment for eye rejuvenation mainly includes upper lid laxity correction, eye bag correction, brow ptosis and midface ptosis correction, etc. (1) Upper lid laxity correction Upper blepharoplasty is the most commonly performed cosmetic eye surgery and can be divided into two main categories: the first is the double lid done by young people; the second is the upper lid laxity correction surgery for older people. There is no significant difference between these two procedures, except that upper blepharoplasty in the elderly requires more skin to be removed, while younger patients may wish to have their inner canthus corrected at the same time. In those patients with associated brow ptosis and skin laxity as well as ptosis, which can result in a loss of vision or obstructed vision, upper lid laxity correction surgery is often both a cosmetic and functional procedure. Sometimes patients claim that their primary goal is to improve visual function, but in reality they want to achieve a cosmetic result with upper blepharoplasty. A thorough understanding of the patient’s needs is a prerequisite for a successful procedure. Upper lid laxity correction is central to the rejuvenation of the upper third of the face. The key to the procedure is to remove the right amount of skin and muscle and to remove some fat depending on the degree of fat prolapse to create a good upper lid crease. The main postoperative complications are inadequate excision of the upper lid skin and excessive excision resulting in incomplete eyelid closure; depression of the superior orbital area due to excessive excision of the orbicularis oris muscle or fat; and cat’s ear phenomenon due to failure to excise a triangle of skin toward the superior temporal direction at the temporal end of the upper incision or inadequate excision. Mild cases can not be dealt with, and those who obviously affect the appearance can be surgically corrected. (2) Eye bag correction surgery Eye bags, also known as lower eyelid skin sagging, are the first manifestation of aging in the middle of the human face, and are due to pathological changes such as degeneration and relaxation of the lower eyelid skin, orbicularis oculi muscle, orbital septum, displacement and prolapse of orbital fat, resulting in different degrees of bloating, bulging or sagging of the lower eyelid tissue, forming a bag-like abnormal form. Blepharoplasty has a very significant role in the rejuvenation of the middle 1/3 of the face. As the understanding of lower eyelid aging and the mechanisms of eyebag formation has grown, so has the number of eyebag revision procedures, which are not just removing excess skin and fat from the lower lid as traditionally thought, but rather a rejuvenation procedure that aims to aesthetically reconstruct the lower lid to present a youthful appearance while preserving function. Currently, there are two main types of eyebag revision surgery, namely, the skin-incision eyebag revision (external approach) and the conjunctival pathway eyebag revision (internal approach). The external approach can correct skin, orbicularis muscle laxity and orbital fat prolapse at the same time, and it has wide indications and is suitable for patients with various types of bags, but the operation is more demanding. The internal approach avoids the complications of lower lid ectropion, lower lid retraction, and lower lid scarring, but only the orbital fat is removed and the lax skin and orbicularis muscle cannot be corrected at the same time, so the indications are narrow and only applicable to those who do not have significant skin laxity and only have bulging orbital fat. Lower blepharoplasty is often combined with other cosmetic procedures such as midface lift and facelift to achieve a more complete rejuvenation of the lower lids and face. Sometimes adjunctive treatments such as local Botox injections and subcutaneous hyaluronic acid injections can round out the treatment. Therefore, according to the patient’s age, the cause of onset and the form of expression, the use of personalized surgery and reasonable choice of eyebag revision is the premise of preventing postoperative complications and ensuring good results of eyebag revision. (3) Eyebrow ptosis and midface ptosis correction surgery Broadly speaking, eye beauty includes eyelid, eyebrow, forehead and cheek, that is, involving the upper face and midface beauty, building on the basis of mid and upper face lift eye rejuvenation to achieve the most desirable results. Traditional face lift surgery is open surgery, although it has a long history, easy to operate and does not depend on instruments and equipment, there are many complications, such as large surgical scars, excessive hairline raising, local baldness, long surgery and recovery time, etc. With the development of endoscopic technology and equipment and instruments, the image of the operating area is converted to the monitor in real time, and the operator can operate under direct vision. The following advantages exist: small and hidden surgical incisions, less trauma, quick recovery and less scar formation, and the technique is now widely used for head and facial wrinkle removal. The upper face is more active and expressive than other parts of the face, and is the focus of emotional expression and personality, and is often the first area to experience aging changes. An upper face lift involves the active, functional repositioning of the eyebrows and forehead. It is clinically important to effectively address brow ptosis before dealing with excessive eyelid or skin laxity, which can be caused by frontal muscle weakness, so upper face lifts primarily include forehead, frontotemporal and brow lift surgery. Brow height and bilateral symmetry should be determined before the end of surgery and ensure that the patient is suspended firmly in the standing position. As patients age, they often begin to experience midface ptosis and more prominent cheekbones, resulting in projection of the lateral orbital rim as well as deepening of the nasolabial folds. Suborbital fat pad prolapse under the orbicularis oculi likewise dislocates the infraorbital rim and periorbital tissues, and the orbital septum fat protrudes, creating two contour lines and resulting in a double projection. The suborbicularis oculi fat pad (SOOF) can be elevated to varying degrees via a lower lid incision (submascara or conjunctival incision) or in combination with transoral mucosal or temporal endoscopic surgery and restores a smooth contour to the patient’s lower lid and midface, a process that also reduces the nasolabial folds and lip and cheek wrinkles. 3. Non-surgical treatment for eye rejuvenation Prevention and delay of skin aging has become one of the hot spots in medical science research. Eye wrinkle removal can include cosmetic makeup, cosmetic injections, laser and radiofrequency wrinkle removal. These skin surface treatments can be combined with deep tissue surgical lifting to achieve better eye rejuvenation results. Over the past 20 years, topical injections of Botulinum toxin type A and hyaluronic acid have been widely used in eye aesthetics because of their high efficiency, safety and minimally invasive features. At the same time, many new treatments have emerged in the field of ocular aesthetic treatment. Radiofrequency technology is increasingly being used in ocular aesthetic surgery, providing advanced techniques for minimally invasive, safe and rapid procedures. (1) Botulinum toxin injection Cosmetic application of botulinum toxin belongs to biological wrinkle removal surgery. In 1989, BTXA was officially approved by FDA for the clinical treatment of strabismus, blepharospasm and hemifacial spasm. The BTXA was approved in 2002 for the removal of frown lines between the eyebrows, the forehead, the outer canthus (crow’s feet), and around the lips. Its application is now extended to facial contouring alone or in combination with other cosmetic treatments, and is more commonly used for full facial tightening. Botulinum toxin injections can also temporarily treat sagging eyebrows by injecting into the descending brow muscle. A thorough preoperative evaluation of the patient can avoid some of the postoperative complications. The cosmetic efficacy of botulinum toxin depends on the physician’s accurate knowledge and understanding of its pharmacology and target muscle anatomy. Clinical effects generally occur 48-72 hours after injection when muscle strength decreases significantly. The efficacy of the drug is around 6 months and requires several repeated treatments with the drug. Botulinum toxin is an immunogenic protein, and its antibody production is related to the frequency and dose of injection. The larger the injection dose and the higher the frequency, the greater the possibility of antibody production, so it should be controlled at less than 100 units and at intervals of more than 3 months. After more than ten years of application, from a wide range of statistics and summaries, the regular approval of botulinum toxin A preparation application so far, is still very safe and effective. (2) Hyaluronic acid injection Since 1980, when bovine collagen was first introduced abroad as a subcutaneous filler to treat age-related skin wrinkles and skin depressions, injection of biodegradable dermal fillers has become a common treatment for facial plastic surgery to remove wrinkles. Since 2004, hyaluronic acid has become the number one dermal filler used worldwide, indicating that injectable cosmetic surgery has entered a new stage of development. Hyaluronic acid used as a subcutaneous filler has enhanced water absorption and elasticity through cross-linking, and the subcutaneous maintenance time can be from 6 months to 3 years. It also has many advantages such as non-immunogenic, no need for skin testing, and no need for refrigeration. Hyaluronic acid is mainly used as a subcutaneous filler to treat wrinkles around the eyes and lips. The therapeutic effect of dermal fillers is closely related to the injection technique. Hyaluronic acid is mainly injected into the middle and deep layers of the dermis to correct moderate and severe facial wrinkles and depressions. If the injection is too deep or even reaches the muscle layer, the absorption of hyaluronic acid will be accelerated, and if the injection is too shallow, nodules or abnormal facial skin tone will be easily formed. The amount of hyaluronic acid injected is only needed to correct the depressions and does not need to be overkill. As a temporary dermal filler, hyaluronic acid usually requires repeated injections, and the dose of repeated injections should be less than the previous one, and the interval of repeated injections should be gradually extended with time, and the interval of repeated injections should generally be more than 2 weeks. When hyaluronic acid is combined with botulinum toxin, the therapeutic effect is better than that of the treatment alone. The effect of hyaluronic acid injection in most parts of the face (70%) can be maintained for more than half a year, but the maintenance time is shorter in the parts where the expression movement is more developed. (3) Radiofrequency cosmetology Radiofrequency technology refers to the use of high-frequency electric waves to cut, hemostasis, ablation, vaporization, removal or contraction of tissue and other operations. The ablative effect of RF technology can be used to lift and tighten the skin around the eyes and midface and reduce wrinkles. The principle of radiofrequency skin tightening lies in the collagen remodeling achieved by the electrical waves emitted through the dermis and subcutaneous tissue resistance heat production, the shape of the collagen fibers change from a crystalline triple spiral to a coil-like structure, the collagen fibers become shorter and contracted, resulting in tissue contraction and a tissue tightening effect. RF technology offers a new option for patients with mild to moderate periocular wrinkles and skin laxity and adds a new non-invasive treatment for oculoplastic surgeons. In addition, RF technology cuts through tissue with minimal damage to surrounding tissue. The RF knife does not need to apply any directional force to the cutting tissue, and there is basically no contusion to the surrounding tissues, and its lateral width is only 15 μm, while the ordinary electric knife is generally in the range of 500 to 650 μm, which is 30 to 40 times of the RF knife. When using RF knife for eye cosmetic surgery, muscle and fat can be removed with almost no bleeding, which ensures clear tissue levels and saves surgical operation time. Postoperative incision pain and swelling are minimal, scarring is small, and there is no hyperpigmentation.