DOI QR코드

DOI QR Code

Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler

  • Lee, Ji-Hyun (Department of Anatomy, Gachon University School of Medicine) ;
  • Hong, Giwoong (Samskin Plastic Surgery Clinic)
  • Received : 2017.07.14
  • Accepted : 2018.01.25
  • Published : 2018.05.22

Abstract

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.

Keywords

References

  1. Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg 2010;125:699-708. https://doi.org/10.1097/PRS.0b013e3181c82f90
  2. Haddock NT, Saadeh PB, Boutros S, et al. The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg 2009;123:1332-40. https://doi.org/10.1097/PRS.0b013e31819f2b36
  3. Costa CR, Kordestani R, Small KH, et al. Advances and refinement in hyaluronic acid facial fillers. Plast Reconstr Surg 2016;138:233e-236e. https://doi.org/10.1097/PRS.0000000000002008
  4. Whitnall SE. The anatomy of the human orbit and accessory organs of vision. 2nd ed. London: Oxford University Press; 1932.
  5. Loeb R. Naso-jugal groove leveling with fat tissue. Clin Plast Surg 1993;20:393-400.
  6. Flowers RS. The tear trough deformity and its correction. Presented at the Annual Meeting of the California Society of Plastic Surgeons; 1970; Monterey, USA.
  7. Hwang K. Eponym of naso-jugal fold and tear trough. J Craniofac Surg 2016;27:1350-3. https://doi.org/10.1097/SCS.0000000000002750
  8. Yang C, Zhang P, Xing X. Tear trough and palpebromalar groove in young versus elderly adults: a sectional anatomy study. Plast Reconstr Surg 2013;132:796-808. https://doi.org/10.1097/PRS.0b0133182a0539e
  9. Hwang K, Kim HJ, Kim H, et al. Origin of the lower orbicularis oculi muscle in relation to the nasojugal groove. J Craniofac Surg 2015;26:1389-93. https://doi.org/10.1097/SCS.0000000000001617
  10. Wong CH, Hsieh MK, Mendelson B. The tear trough ligament: anatomical basis for the tear trough deformity. Plast Reconstr Surg 2012;129:1392-402. https://doi.org/10.1097/PRS.0b013e31824ecd77
  11. Muzaffar AR, Mendelson BC, Adams WP Jr. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Plast Reconstr Surg 2002;110:873-84. https://doi.org/10.1097/00006534-200209010-00025
  12. Flowers RS. Periorbital aesthetic surgery for men: eyelids and related structures. Clin Plast Surg 1991;18:689-729.
  13. Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 2002;110:885-96. https://doi.org/10.1097/01.PRS.0000019706.34235.E5
  14. Stutman RL, Codner MA. Tear trough deformity: review of anatomy and treatment options. Aesthet Surg J 2012;32: 426-40. https://doi.org/10.1177/1090820X12442372
  15. Kim HJ, Seo KK, Lee HK, et al. Botulinum filler clinical anatomy. Seoul: Hanmi Medical Publishing Co.; 2015.
  16. Yang HM, Lee JG, Hu KS, et al. New anatomical insights on the course and branching patterns of the facial artery: clinical implications of injectable treatments to the nasolabial fold and nasojugal groove. Plast Reconstr Surg 2014;133: 1077-82. https://doi.org/10.1097/PRS.0000000000000099
  17. Koh KS, Kim HJ, Oh CS, et al. Branching patterns and symmetry of the course of the facial artery in Koreans. Int J Oral Maxillofac Surg 2003;32:414-8. https://doi.org/10.1054/ijom.2002.0372
  18. Bosniak S, Cantisano-Zilkha M, Purewal BK, et al. Defining the tear trough. Ophthal Plast Reconstr Surg 2007;23:254-5.
  19. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76. https://doi.org/10.1097/01.prs.0000279348.09156.c3
  20. Mendelson BC, Hartley W, Scott M, et al. Age-related changes of the orbit and midcheek and the implications for facial rejuvenation. Aesthetic Plast Surg 2007;31:419-23. https://doi.org/10.1007/s00266-006-0120-x
  21. Scheuer JF 3rd, Sieber DA, Pezeshk RA, et al. Anatomy of the facial danger zones: maximizing safety during soft-tissue filler injections. Plast Reconstr Surg 2017;139:50e-58e. https://doi.org/10.1097/PRS.0000000000002913
  22. Pessa JE, Rohrich RJ. Clinical anatomy of the face. Kim IH, Yoon ES, Translators. Seoul: Jeong woo Medical Book; 2012.
  23. Carruthers J, Carruthers A, Humphrey S. Introduction to Fillers. Plast Reconstr Surg 2015;136(5 Suppl):120S-131S. https://doi.org/10.1097/PRS.0000000000001770
  24. Flynn TC, Thompson DH, Hyun SH, et al. Ultrastructural analysis of 3 hyaluronic acid soft-tissue fillers using scanning electron microscopy. Dermatol Surg 2015;41 Suppl 1:S143-52. https://doi.org/10.1097/01.DSS.0000452647.14389.a7
  25. Cotofana S, Schenck TL, Trevidic P, et al. Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg 2015;136(5 Suppl):219S-234S. https://doi.org/10.1097/PRS.0000000000001837
  26. Stern CS, Schreiber JE, Surek CC, et al. Three-dimensional topographic surface changes in response to compartmental volumization of the medial cheek: defining a malar augmentation zone. Plast Reconstr Surg 2016;137:1401-8. https://doi.org/10.1097/PRS.0000000000002066

Cited by

  1. Pretarsal roll augmentation with dermal hyaluronic acid filler injection vol.42, pp.3, 2018, https://doi.org/10.1007/s00238-018-1468-2
  2. A Prospective Study on Safety, Complications and Satisfaction Analysis for Tear Trough Rejuvenation Using Hyaluronic Acid Dermal Fillers vol.8, pp.4, 2018, https://doi.org/10.1097/gox.0000000000002753
  3. Treatment of the tear trough and infraorbital hollow with hyaluronic acid fillers using both needle and cannula vol.33, pp.3, 2018, https://doi.org/10.1111/dth.13353
  4. Novel technique for infraorbital groove correction using multiple twisted polydioxanone thread vol.19, pp.8, 2018, https://doi.org/10.1111/jocd.13269
  5. Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery vol.33, pp.8, 2018, https://doi.org/10.1002/ca.23556
  6. Complications associated with infraorbital filler injection vol.22, pp.6, 2018, https://doi.org/10.1080/14764172.2021.1909067
  7. Fan-Shaped Thin Fat Pedicles for Tear Trough Correction Through a Layer-Level Fixation: A Modified Transconjunctival Blepharoplasty vol.32, pp.6, 2018, https://doi.org/10.1097/scs.0000000000007572
  8. Recommendations for the treatment of tear trough deformity with cross‐linked hyaluronic acid filler vol.20, pp.1, 2021, https://doi.org/10.1111/jocd.13475
  9. Whole-Face Approach with Hyaluronic Acid Fillers vol.14, pp.None, 2018, https://doi.org/10.2147/ccid.s292501
  10. “WAY”: A practical means to identify and treat the aging process vol.20, pp.6, 2018, https://doi.org/10.1111/jocd.13782
  11. Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening vol.34, pp.5, 2018, https://doi.org/10.1111/dth.15045
  12. Supraperiosteal application of hyaluronic acid with cannula: Is it possible? vol.20, pp.10, 2018, https://doi.org/10.1111/jocd.14241
  13. Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review vol.11, pp.23, 2018, https://doi.org/10.3390/app112311489