Background: The tear trough and palpebromalar groove are of increasing interest to plastic surgeons, but their mechanisms of formation remain unclear. This study evaluated the anatomical foundation for tear trough and palpebromalar groove.
Methods: Sagittal dissection and layered dissection were performed on 20 elderly cadaveric hemifaces with obvious tear troughs and palpebromalar grooves and on 16 young cadaveric hemifaces without obvious tear troughs and palpebromalar grooves. Cross-sectional specimens and tissue sections were compared between the two groups to identify the differences.
Results: The malar fat pad becomes atrophic and descends with aging. The orbicularis retaining ligament arose from the inferior orbital rim and ended at the junction of palpebral and orbital portions of the orbicularis oculi muscle. The ligament limited the descent of the orbicularis oculi muscle. The orbicularis retaining ligament continued with the origin of the orbicularis oculi muscle and the dense muscular attachment arose from the maxilla. Histologic evaluation confirmed the ligamentous features of the orbicularis retaining ligament.
Conclusions: The orbicularis retaining ligament plays an important role in formation of the tear trough, and atrophy and descent of the malar fat pad make the tear trough and palpebromalar groove more obvious with aging. These findings may be of value in blepharoplasty and midfacial rejuvenation.
Shanghai, People’s Republic of China
From the Department of Plastic Surgery, Changhai Hospital, Second Military Medical University.
Received for publication September 18, 2012; accepted April 9, 2013.
The first two authors contributed equally to this article and should be considered co–first authors.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
Xin Xing, M.D., Department of Plastic Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, People’s Republic of China, firstname.lastname@example.org