What it means for a patient
- In this study, the groove under the inner eye has its anatomical origin in a ligament that ties the skin to the bone.
- Treatments for the tear trough and midcheek may need to address this ligament.
- Ask your surgeon or injector how their approach to the tear trough takes this ligament into account.
- This is a cadaver anatomy study. It does not report treatment results.
Why this paper matters
It identified the tear trough ligament as the anatomical origin of the tear trough deformity and traced its continuation into the orbicularis retaining ligament. The authors state this affects how procedures for the tear trough and midcheek are designed.
Overview
The anatomical cause of the tear trough, the groove below the inner lower eyelid, had not been defined. The authors dissected 48 cadaver half-faces, reaching the area from the space above and the space below while leaving the cheek skin intact. They isolated the ligament and examined it under the microscope.
Findings
- 48 cadaver hemifaces dissected; the tear trough approached through the preseptal space above and the prezygomatic space below.
- The palpebral and orbital parts of the orbicularis oculi, which sandwich the ligament, were released from the maxilla.
- A true osteocutaneous ligament, the tear trough ligament, was consistently found on the maxilla between the two parts of the orbicularis oculi.
- It starts at the level of the medial canthal tendon insertion, just below the anterior lacrimal crest, and runs to about the mid-pupil line.
- From there it continues outward as the two-layer orbicularis retaining ligament.
- Histology confirmed it is a ligament, with features identical to the zygomatic ligament.
- The authors state this ligament had not been isolated before with standard dissection.
Terms
- Tear trough: the groove running down and out from the inner corner of the eye.
- Osteocutaneous ligament: a ligament that runs from bone to skin.
- Orbicularis oculi: the ring-shaped muscle around the eye, with palpebral (eyelid) and orbital (outer) parts.
- Maxilla: the upper jawbone, which forms the cheek below the eye.
- Medial canthal tendon: the tendon holding the inner corner of the eyelids.
- Orbicularis retaining ligament: a band holding the eye muscle to the bony rim of the eye socket.
- Hemiface: one half of a face.