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New Classification System for Tear Trough Deformity

Turkmani, Mohammed G. MD

doi: 10.1097/DSS.0000000000001056
Original Article

BACKGROUND Tear trough deformities (TTD) refer to a set of conditions leading to different shapes in the junction between the lower eyelid and the cheek. Tear trough deformity is a major aesthetic concern for a lot of individuals seeking periorbital rejuvenation and is one of the most discussed landmarks in facial aesthetic surgery.

OBJECTIVE To describe a new morphologically related classification system, providing an objective means to evaluating the deformity.

METHODS The article proposes a new classification system exhibiting 5 different forms of a TTD based on the author's clinical experience and review of medical literature.

CONCLUSION Five forms of a TTD include a “hill” due to the superficial infraorbital fat pad herniation; a “valley” caused by fat reduction and skin changes; a “hill-valley” resulting from the weakening of the orbital portion of the orbicularis oculi muscle and its retaining ligaments, followed by fat reduction and skin changes; a “hill-valley-hill-valley” formed by a series of changes in portions of the orbicularis oculi muscle and its retaining ligaments; and a “mixed” form depicting a range of any of the 4 deformities. Classification of TTD is of great value to aid the treating physician in choosing the appropriate treating options.

Department of Dermatology, Derma Clinic, Riyadh, Saudi Arabia

Address correspondence and reprint requests to: Mohammed G. Turkmani, MD, Derma Clinic, P.O. Box 20632, Riyadh 11465, Saudi Arabia, or e-mail:

The author has indicated no significant interest with commercial supporters.

© 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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