The Tear Trough Ligament

Wong, Chin‐Ho; Hsieh, Michael Ku Hung; Mendelson, Bryan C.

doi:10.1097/prs.0b013e31824ecd77

Cited by 172 publications

(82 citation statements)

References 24 publications

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“…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] . Our dissections proved that the attachment is of muscle origin [22] and not a specific ligament.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Tear trough – Anatomy and treatment by autologous fat grafting

Chia

2016

J Surg Dermatol

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“…This fat is separated by the superfi cial lamina of the deep temporal fascia (layer 5) from the fat within the prezygomatic space (layer 6) overlying the periosteum (layer 7) [52][53][54] . The inferior boundary of both the SOOF and of the prezygomatic space is the zygomatico-cutaneous ligament and the superior boundary is the bilaminar orbicularis retaining ligament (Table 3 ) [ 55 ] . The SOOF is connected via the temporal tunnel to the lower temporal compartment, since both are located in layer 4 and reside on top of the superfi cial lamina of the deep temporal fascia [ 44 ] .…”

Section: Infraorbital Region: Tear Trough and Sub-orbicularis Oculi Fmentioning

confidence: 99%

Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery

Cotofana

Lachman

2019

J Deutsche Derma Gesell

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Summary Objective There has been a significant shift in the understanding of facial anatomy during the last decade. Newer minimally invasive therapeutic options for facial rejuvenation procedures are increasing the need for a better knowledge of anatomy. Material and Methods The current literature is summarized, analyzed and presented along with the experience of the author for this narrative review, which summarizes the current understanding of the superficial and deep facial fat compartments and their relevance for minimally invasive facial procedures. A schematic facial model was created in order to facilitate a better understanding of the complexity of facial anatomy. Results The face is arranged in five layers as follows: layer 1: skin; layer 2: subcutaneous fat including the retinacula cutis (composed of fibrous connective tissue); layer 3: superficial musculo‐aponeurotic system (SMAS); layer 4: deep fat; and layer 5: periosteum or deep fascia. This arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The facial fat compartments are located in layers 2 and 4; each layer has unique characteristics and spatial relationships with the surrounding tissues. Conclusions The concept of the layered arrangement is a new way to understand the spatial relationship and functional interplay of the soft tissues of the face. Understanding the layers, the precise location of the superficial and deep facial fat compartments and their boundaries is crucial for the conduct of safe and effective minimally invasive facial procedures.

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“…Dieses Fettkompartiment wird vom oberflächlichen Blatt der Fascia temporalis profunda (Schicht 5) vom Fettkompartiment im präzygomatischen Raum (Schicht 6) getrennt, der dem Periost aufliegt (Schicht 7) . Die untere Grenze sowohl des SOOF als auch des präzygomatischen Raums ist das Ligamentum zygomatico‐cutaneum und die obere ist das bilaminäre Rückhalteband des M. orbicularis oculi (orbicularis‐retaining ligament) (Tabelle ) . Das SOOF ist über den temporalen Tunnel mit dem unteren temporalen Kompartiment verbunden, da sich beide in Schicht 4 befinden und über dem oberflächlichen Blatt der Fascia temporalis profunda liegen .…”

Section: Infraorbitale Region: Tränensäcke Und Soof (Suborbicularis Ounclassified

Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie

Cotofana

Lachman

2019

J Deutsche Derma Gesell

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Zusammenfassung Ziel In den letzten zehn Jahren hat sich unser Verständnis der Gesichtsanatomie gewandelt. Neuere minimalinvasive Eingriffe zur Gesichtsverjüngung erfordern bessere anatomische Kenntnisse. Material und Methoden In dieser narrativen Übersichtsarbeit wird die aktuelle Literatur mit den Erfahrungen der Autoren zusammengefasst und analysiert. Sie resümiert den aktuellen Wissenstand zu oberflächlichen und tiefen fazialen Fettkompartimenten und deren Bedeutung für minimalinvasive Eingriffe am Gesicht. Ein schematisches Modell zum besseren Verständnis der komplexen Anatomie des Gesichts wurde erstellt. Ergebnisse Das Gesicht ist aus den folgenden fünf Schichten aufgebaut: Schicht 1: Haut; Schicht 2: subkutanes Fettgewebe mit Retinacula cutis (aus fibrösem Bindegewebe), Schicht 3: superfizielles muskuloaponeurotisches System (SMAS), Schicht 4: tiefes Fettgewebe und Schicht 5: Periost oder tiefe Faszie. Dieser Aufbau unterscheidet sich je nach Region, insbesondere, wenn die Ligamente in das Modell einbezogen werden. Die fazialen Fettkompartimente sind in den Schichten 2 und 4 lokalisiert. Jede Schicht hat einzigartige Merkmale und spezielle räumliche Beziehungen zu den umgebenden Geweben. Schlussfolgerungen Das neue Konzept des geschichteten Aufbaus erklärt die räumlichen Beziehungen und das funktionale Zusammenwirken der Weichteilgewebe im Gesicht. Die Kenntnis der Schichten sowie der genauen Lage der oberflächlichen und tiefen Fettkompartimente des Gesichts und ihrer Begrenzungen ist entscheidend für die sichere und effektive Durchführung minimalinvasiver Eingriffe am Gesicht.

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The Tear Trough Ligament

Cited by 172 publications

References 24 publications

Tear trough – Anatomy and treatment by autologous fat grafting

Tear trough – Anatomy and treatment by autologous fat grafting

Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery

Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie

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