Surgical Anatomy of the Ligamentous Attachments of the Lower Lid and Lateral Canthus

Abstract

Description of the surgical anatomy of the superficial fascia of the face must include its deep attachments. These attachments have been mapped out for the forehead, temple, and cheek as retaining ligaments. The deep attachments of the orbicularis oculi of the lower lid and lateral canthus have long been recognized in canthopexy surgery but have yet to be properly defined. Six fresh cadavers were dissected with histologic support, and the results were correlated with surgical observations. The fascia of the deep aspect of the orbicularis is attached to the periosteum of the orbital rim by an orbicularis retaining ligament. This attachment is weakest centrally and tightest over the inferolateral orbital rim. The retaining ligament fuses with an expanded fibrous attachment beyond the lateral canthus, the lateral orbital thickening, which extends over the lateral orbital rim onto the adjacent deep temporal fascia. Aging changes are associated with attenuation of the ligamentous support provided by the orbital thickening and the orbicularis retaining ligament, which then allows inferior displacement of the lower boundary of the lid and contributes to the typical effects of age in this region. The superficial fascia of the lateral orbital region has a continuous connective tissue structure linking the temporoparietal fascia and orbicularis fascia to the lateral canthal tendon by means of the tarsal plate connection. Release of the deep ligamentous attachments (lateral orbital thickening and orbicularis retaining ligament) of the orbicularis fascia is important in some canthopexy and in rejuvenation procedures. The release allows effective redraping and upward mobilization of the orbicularis of the lower lid and the premalar soft tissues.

Cosmetic Lower Eyelid Blepharoplasty With Fat Repositioning via Intra-SOOF Dissection: Surgical Technique and Initial Outcomes

“…In a cadaver study, Muzaffar et al 9 define the orbicularis-retaining ligament to be more lax medially than laterally, contributing to greater midface descent and, specifically, greater central fat pad descent, leading to an enhanced tear trough appearance.…”

Management of the Lower Lid in Male Blepharoplasty

“…In addition, increased distance between the lower lid margin and inferior orbicularis oculi muscle attributable to attenuation of the ligamentous support produces skeletonization of the orbital area and exposure of the inferior bony rim. 1,2 The lower lid margin normally rests at the inferior limbus, with its low point just lateral to the pupil. 3 The malar and nasojugal folds represent the cutaneous insertion of the orbitomalar ligament, a unique bony attachment of the orbicularis oculi.…”

Evaluation of Elastic Lift for Facial Rejuvenation

“…Facial aging is the progression of three processes: skin and soft tissue laxity, superficial skin changes, and volume loss [1][2][3][4][5]. Understanding these processes is essential when intending to achieve natural results for the aging face.…”