What it means for a patient
- The groove under the eye follows the points where the eyelid muscle attaches to bone and to a ligament, with skin and fat on top.
- The authors attribute the deeper groove with age to thinning of skin and fat. They consider sagging of this area unlikely because it is fixed to bone.
- Bulging lower eyelid fat makes the groove look deeper.
- The authors suggest different depths for fat or filler at the tear trough and at the lid/cheek junction.
- Limits: an anatomy study of 12 dissections from 6 cadaver heads. It reports no patient outcomes.
Why this paper matters
It described the layered anatomy under the tear trough and the lid/cheek junction and named placement planes for fat or filler in each.
Overview
With age, the tear trough and the lid/cheek junction become more visible, and in some patients they form one continuous groove below the lower orbital rim. Many procedures, often conflicting, have been described to correct them. The authors dissected cadavers to describe the anatomy under these landmarks and to evaluate the procedures used to treat them.
Findings
- 12 fresh cadaver lower lid and midface dissections from 6 heads, dissected in layers and photographed.
- Just under the skin, both landmarks lie over the junction of the palpebral and orbital parts of the orbicularis oculi muscle and the upper border of the malar fat pad.
- Under the muscle, the two landmarks differ.
- Along the tear trough, the orbicularis muscle attaches directly to bone.
- Along the lid/cheek junction, the muscle attaches through a ligament, the orbicularis retaining ligament.
- Atrophy of skin and fat is the most likely explanation for their visibility with age.
- "Descent" of this region with age is unlikely, because the structures are fixed to bone.
- Bulging orbital fat makes these landmarks more visible.
- Treatments must extend well below the infraorbital rim.
- Fat or synthetic filler may be best placed within the orbicularis muscle at the tear trough, and beneath the muscle at the lid/cheek junction.
Terms
- Tear trough: the groove running down and out from the inner corner of the eye.
- Lid/cheek junction: the line where the lower eyelid meets the cheek.
- Infraorbital rim: the bony lower edge of the eye socket.
- Orbicularis oculi: the ring-shaped muscle around the eye that closes the eyelids.
- Palpebral and orbital portions: the inner part of the orbicularis muscle over the eyelid, and the outer part over the bone.
- Malar fat pad: the fat of the upper cheek.
- Orbicularis retaining ligament: a band that attaches the orbicularis muscle to the bone of the orbital rim.
- Intraorbicularis plane: within the orbicularis muscle.
- Suborbicularis plane: beneath the orbicularis muscle.
- Atrophy: thinning or loss of tissue.