| Objective: To investigate the prevalence of tear trough and palpebromalar groove among Han population of different ages and different gender aged 15~94 in Shanghai.Methods: The multi-stage stratified and isometric random sampling was used to select 3200 Han population aged from 15 to 94 in Shanghai, 1600male,1600femal .The investigation was conducted based on original "Second-Generation Resident ID Card Photo". According to their age, they were devided into 16 age groups by per 5 years . Each photo are observed by three person independently, and the cases those were considered had tear trough or palpbromalar groove by all observers were positive. As further investigate,the controversial photos would be identified by two experienced plastic surgeons independently, and the cases those were considered had tear trough or palpbromalar groove by four or three out of all five observers were positive. Statistical analysis was executed by SPSS 17.0 and SPSS 18.0 software ,and the results were tested and analyzed by matching t test, chi-square test, McNemar test and Kappa coefficient, Spearman rank correlation, curve-fitting statistical methods,etc.Results: 1 The standardized prevalence rate of tear trough among Han population aged 15-94 in Shanghai was 57.20%, which in male is 55.63% and in female is 58.74%.The standardized prevalence rate of palpebromalar groove and ipsilateral coexistence of both signs were 21.84% and 21.20%,which in male were 21.38% and 20.88% and in female were 22.52% and 21.72%.2 There was no significant difference between male and female in all three parameters: the prevalence of tear trough , palpebromalar groove and ipsilateral coexistence of both signs (t = 0.484,0.171,0.172 , P > 0.05).3 The prevalence of tear trough was significantly higher than palpebromalar groove among male, female and total population (t = 10.127, 7.420, 8.873, P <0.001;statistic (S) were 468.2927, 460.1361, 928.2973,P <0.001).There was not a good concordance between tear trough and palpebromalar groove among male, female and total population from Kappa coefficient ,0.4307 (0.3958,0.4655); 0.4130 (0.3779,0.4481); 0.4219 (0.3971, 0.4466).4 The prevalence of all three parameters among male, female and total population had a positive correlation with age (P <0.001) . with age, the incidence increased.5 According to the curve, the prevalence of tear trough, palpbromalar groove and ipsilateral signs of both were increased with age. The prevalence of tear trough was increased significantly after the age of 25 years, and showed gently increasing trends after the age of 45 years; The prevalence of palpebromalar groove and ipsilateral coexistence of the two signs were increased significantly after the age of 35 years, and showed a gently increasing trend after the age of 60 years.6 About half of the male or female population had tear trough at the age of 33 years, palpebromalar groove at the age of 59 years ,and ipsilateral coexistence of the two signs at the age of 61 years respectively. More than eighty percent of them had tear trough after the age of 52 years.Conclusion: There were no significant gender differences between male and female when the prevalence of tear trough and palpebromalar groove were concerned in Han population in Shanghai. The prevalence of tear trough was higher than that of palpebromalar groove, and the former appeared earlier than the latter. The prevalences of all signs were increased gradually with age.Objective: To study the anatomic mechanism of tear trough and palabromalar groove.Methods: 6 old cadavers (3 male,3 female, an average age of 67.2 years) with obvious tear trough deformity and palpbromalar groove deformity and 6 young cadavers (3 male, 3 female, an average age of 23.5years) without tear trough deformity and palpbromalar groove deformity were slected,dissection and histological observation were performed on lower eyelid and periorbital region.Results:1 Layered dissection :Tear trough and palabromalar groove locate at the junction of thin eyelid skin and thick cheek skin. Skin is closely attached to the orbicularis oculi muscle. The superior border of the malar fat pad covers the junction of the palpebral and orbital portions of the orbicularis muscle, and does not desend with malar fat pad, which is also corresponded to the location of tear trough and palpbromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle is not correspond to tear trough. The orbicularis retaining ligament arises from the orbital rim and ends at the junction of the palpebral and orbital portions of the orbicularis muscle, and the ligament connects with the deep part of the orbicularis muscle which directly attachs to the infraorbital rim. Suborbicular oculi fat pads locate at the inferolateral of the orbital region, thin and flabby. Orbital septal arises from the infraorbital rim, and the orbital fat extrudes anteriorly and inferiorly.2sagital dissection: Compared to young specimens,the skin and orbicularis oculi muscle of old specimens are atrophy and relaxation.Tear trough deformity and palabromalar groove deformity overlay the junction of thiner eyelid skin and thicker cheek skin. The superior border of the malar fat pad covered the junction of the palpebral and orbital portions of the orbicularis muscle,and correlated with the tear trough and palpbromalar groove,but the superior border of the malar fat pad in young cadavers was found above the tear trough and palpbromalar groove line.The orbicularis retaining ligament arose from the orbital rim and caudal to the junction of the palpebral and orbital portions of the orbicularis muscle,and it's relax in old group than in young group.No obvious difference about suborbicularis oculi fat was found between these two groups.Conclusions: Tear trough deformity and palabromalar groove deformity result from combination of age-related relaxation, atrophy and descent of layers of tissues .The orbital septal and the orbicularis retaining ligament prevent tissues from descending, which make tear trough and palabromalar groove more visible.
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