Anatomy ~ Dr. Patrick Treacy

 Anatomy     https://ailesburyclinic.ie/

Tear trough deformity and palabromalar groove deformity are located 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 descend with the malar fat pad, which corresponds to the location of the tear trough and palphromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle does 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 attaches to the infraorbital rim. Suborbicular oculi fat pads locate at the inferolateral of the orbital region, are thin and flabby. The orbital septal arises from the infraorbital rim and the orbital fat extrudes
anteriorly and inferiorly (7).
In 2010, Hirmand proposed a classification system of the tear trough deformity based on clinical evaluation.

Class I patients have volume loss limited medially to the tear trough. These patients can also have mild flattening extending to the central cheek.
Class II patients exhibit volume loss in the lateral orbital area in addition to the medial orbit and they may have moderate volume deficiency in the medial cheek and flattening of the central upper cheek.
Class III patients present with a full depression circumferentially along the orbital rim, medial to lateral. #teartrough