The Tear Trough and Lid/Cheek Junction: Anatomy and Implications for Surgical Correction

Haddock, Nicholas T.; Saadeh, Pierre B.; Boutros, Sean; Thorne, Charles H.

doi:10.1097/prs.0b013e31819f2b36

Cited by 155 publications

(117 citation statements)

References 29 publications

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“…The following characteristics were found and are in agreement with Haddock et al [16,17] , Hirmand [12] , Yang et al [18] , and Yang et al [19] : (1) The tear trough and lid-cheek junction are not located at the bony orbital rim but are situated several millimeters caudally; (2) The sulcus corresponds to the abrupt transition from the thin palpebral skin, without underlying subcutaneous fat, to the thicker orbital skin, with the presence of malar fat compartment ( Figure 10); (3) This transition is at the cranial limit of malar fat compartment; (4) The tear trough is not caused by the volume of nasal alar and upper lip elevator muscle, which is more caudal and medial; (5) The tear trough is located at the transition of the palpebral and orbital part of the orbicular muscle; medially, the bone attachment is the muscle origin with no ligaments found (Figure 11). …”

Section: Anatomical Studysupporting

confidence: 81%

“…Several explanations have been formulated for the cause of tear trough such as bony orbital rim; depression between the OOM, nasal alar and upper lip muscle; tissue descent by gravity, etc. [16] . The few anatomical studies in fresh cadaver dissections revealed that the main problem is subcutaneous fat [16][17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

“…[16] . The few anatomical studies in fresh cadaver dissections revealed that the main problem is subcutaneous fat [16][17][18][19] . The existence of a ligament was in doubt [21] .…”

Section: Discussionmentioning

confidence: 99%

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Tear trough – Anatomy and treatment by autologous fat grafting

Chia

2016

J Surg Dermatol

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Tear trough is the main irregularity at midface, of which treatment is difficult. There is no agreement in literature about its anatomy and best treatment. The author presented an anatomical study and personal autologous fat grafting technique for tear trough treatment. Anatomical dissections were done on two fresh cadavers to examine the skin, subcutaneous, muscle and bone layers, spaces, and attachments. Safety and efficacy were evaluated via retrospective analysis of the last 200 consecutive procedures performed by the author. Tear trough is caused by the abrupt transition of the palpebral orbicular oculi muscle (OOM) (i.e., thin skin without subcutaneous fat compartment) to the orbital OOM (i.e., thicker skin with malar fat compartment). The tear trough region is located at the OOM bony origin at the medial canthus where no specific ligament was found. The grafted fat volume stabilized at two or three months after the procedure, instead of six months as stated in literature, with excellent results and no severe complications. Tear trough is a personal characteristic, a natural anatomical depression caused by subcutaneous irregularity and can worsen with age. The lack of volume is not effectively corrected by surgeries and thus it must be filled. Fat grafting has several advantages over alloplastic fillers, although it may be more difficult. Fat graft is autologous and abundant, and tissue transplantation could enhance skin quality. Fat grafting is a simple, safe, and effective solution for adding extra volume to correct the deflation phenomenon of the midface aging process. There is no specific anatomical plane for volume injection; the fat graft must be evenly distributed in the deep and superficial plane for uniformity.

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Section: Anatomical Studysupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Tear trough – Anatomy and treatment by autologous fat grafting

Chia

2016

J Surg Dermatol

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“…Meanwhile, in a cadaver dissection study [8], it was claimed that LCJ is unlikely to descend downward with age because of its fixation to the bone via orbital retaining ligaments. However, according to another study [13], it has been known that the orbital retaining ligaments become attenuated due to aging, and that the intra-ligamental fat of the retaining ligaments also decreases.…”

Section: Discussionmentioning

confidence: 99%

“…On the subcutaneous plane, this is the area where the junction of the palpebral-orbicularis oculi muscle and superior border of the malar fat pad meet. On the submuscular plane, it is fixed to the orbital rim by the orbital retaining ligaments, the protruded orbital fat placed on the ligaments, and the SOOF located beneath the ligaments [8][9][10]. LCJ descends gradually with aging, because the vertical length of the lower lid is increased by skin and muscle laxity, protruded orbital fat, and resorption of bone [2].…”

Section: Discussionmentioning

confidence: 99%

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Kang¹,

Yang²,

Chai

2017

J Cosmet Med

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Background: Transconjunctival lower blepharoplasty (TCLB) and traditional subciliary incision blepharoplasty (TSIB) are most commonly used to improve the appearance of an aged lower eyelid. The lid/cheek junction (LCJ) is located between the lower lid and midface, where structural changes caused by aging associated with both areas occur simultaneously. Thus, it may be a landmark that reflects the rejuvenation effects of lower blepharoplasty. However, there is no research-based proof yet.Objective: The purpose of this study was to investigate the rejuvenation effects of these two lower blepharoplasty procedures by observing changes in LCJ length and shape. Methods:The changes in LCJ length and shape in 32 patients with good follow-up among patients who underwent lower blepharoplasty between 2012 and 2016 were investigated. The patients were categorized as either TCLB (Group 1) or TSIB (Group 2) patients. Each group was further divided into the subgroups G1p, G1n, G2p, and G2n, according to the positive/negative globe-toskeletal relationship. Results:The shape of LCJ changed from a V-shape to a round shape, and its length decreased in G1p, G2p, and G2n, but increased in G1n. The pattern of LCJ was also affected, corresponding to the partial deformity of the zygomaticomaxillary bone. Aged lower lids were significantly improved in all groups, but infraorbital hollowness was not improved, and indeed was even worse, in G1n. Conclusion:Patients undergoing TCLB and TSIB surgeries significantly showed rejuvenation effects for fat protrusion, skin laxity, and wrinkles without any volume restoration, and particularly, G1n showed a worse result. Therefore, TCLB should not be recommended in G1n, and combination procedures that change a negative vector into a positive vector and improve infraorbital hollowness are necessary to achieve better outcomes.

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Surgical Anatomy of the Forehead, Eyelids, and Midface for the Aesthetic Surgeon

Tan

Priel

et al. 2011

Master Techniques in Blepharoplasty and Periorbital Rejuvenation

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The Tear Trough and Lid/Cheek Junction: Anatomy and Implications for Surgical Correction

Cited by 155 publications

References 29 publications

Tear trough – Anatomy and treatment by autologous fat grafting

Tear trough – Anatomy and treatment by autologous fat grafting

Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty

Surgical Anatomy of the Forehead, Eyelids, and Midface for the Aesthetic Surgeon

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