Anatomical Characterization Andage-related Changesof The Tear Trough And The Lid-Cheek Junction

[Research background]The literature presents controversial anatomical explanations for the tear trough and lid-cheek junction.Since the muscle and ligamentsare delicate and vulnerable,traditional gross anatomy is not enoughto explore the anatomy of the tear trough and lid-cheekjunction.In addition,surgery involving the suborbital region is common in clinical work.Understanding the fine anatomical structure of the suborbital region is important for plastic surgeons.[Objective]To explore the complex spatial structure relationship of suborbital tissue,and to explore the anatomy and age-related changes of the tear trough and lid-cheekjunction[Materials and methods]Twelve non-embalmed human cadaver specimens and two abortedfetuseswere obtained from our anatomy department.Iodine staining and high-resolution micro-computed tomography(CT)was used to observe the anatomy of the suborbital area.Anatomic and histologic studies were also performed.[Results]The tear trough ligament does not exist.The palpebral component of the orbicularis oculi attached directly to the bone along the medial half of the tear trough.The orbicularis retaining ligament located along the lateral half of the tear trough is a septal structure originating from the periosteum and anchoring the palpebral component of the orbicularis oculi.The ligament continued as a tree model of multilayered fiber platesat approximately the medial-pupil line and integrated into the lateral canthusligament at last.The zygomatic orbicularis oculi muscle was found and named,and its morphology and function were clarified.The structure and boundary of the midfacialfat compartments wereclearly observed.The region of medial cheek fat compartment was redefined.We observed the arrangement of the fibreboard in the fat compartments.The occurrence and development of face aging generally follow the order from the outside to the inside,the first is the skin layer,followed by subcutaneous superficial fat compartments,deep fat compartments and bone.The length of the orbicularis retaining ligament did not change significantly.According to the aging changes of the suborbital region and the Barton grading of the tear trough and lid-cheek junction,different treatment suggestions were proposed.[Conclusions]Iodine staining and high-resolution micro-CT scanning can be used for non-destructive and high-resolution observation of specimens.The anatomical structure of the tear trough and lid-cheek junction have been clarified.The arrangement of the fiberboard in the midfacialfat compartments can predict the age-related morphology and capacity change of the fatcompartments,which provides a novel way to explore the age-related changes of the midfacial fat compartments.Tear trough and lid-cheek junctionis the border of various tissues and the border is fixed by theorbicularis retaining ligament.With aging,the surroundingtissues change,which making the groove more obvious.The integrity of orbicularis retaining ligament should be protected as far as possible to avoid the prolapse of orbicularis oculi muscle and related adipose compartments.