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A novel histologic description of the fibrous networks in the lid-cheek junction and infraorbital region

  • Sang-Hee Lee (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Kyu-Ho Yi (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Jung-Hee Bae (Yonsei Severance Dental Clinic) ;
  • You-Jin Choi (Department of Anatomy, College of Medicine, Konkuk University) ;
  • Young-Chun Gil (Department of Anatomy, Chungbuk National University) ;
  • Kyung-Seok Hu (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry) ;
  • Eqram Rahman (Department of Plastic and Reconstructive Surgery, Royal Free Hospital) ;
  • Hee-Jin Kim (Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry)
  • 투고 : 2023.11.09
  • 심사 : 2023.11.23
  • 발행 : 2024.03.31

초록

The aim of this study was to identify the anatomical feature of retaining ligament and fat compartment on the lower eyelid and infraorbital region using a histological method, and to investigate clear definitions for them which could be used generally in the clinical area. Eighteen specimens from eight fresh Korean cadavers were stained with Masson trichrome or hematoxylin and eosin. The ligamentous and fascial fibrous tissue were clearly identified. The ligamentous fibrous tissue which traversed in the superficial and deep fat layer was skin ligament and orbicularis retaining ligament (ORL). The fascial fibrous tissue enclosed the orbicularis oculi muscle (OOc) and circumferencial adipose tissue. Based on the ligamentous and fascial structure, three fat compartments, septal, suborbicularis oculi and infraorbital fat compartment, could be identified. The OOc attached to orbital rim and dermis by ORL and skin ligament, and the muscle fascicle and fat fascicle provided the connection point to the ORL and skin ligament as enclosing all muscle and fat tissue. The combination of the force made by the skin ligament in the lower eyelid and ORL may decide the level and form of the infraorbital grooves.

키워드

과제정보

I thank Hwi Eun Hur from Davidson College for editing the paper. The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude.

참고문헌

  1. Haddock NT, Saadeh PB, Boutros S, Thorne CH. 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
  2. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 1992;89:441-9; discussion 450-1. https://doi.org/10.1097/00006534-199203000-00007
  3. Wong CH, Hsieh MKH, 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
  4. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989;83:11-6. https://doi.org/10.1097/00006534-198901000-00003
  5. Nash LG, Phillips MN, Nicholson H, Barnett R, Zhang M. Skin ligaments: regional distribution and variation in morphology. Clin Anat 2004;17:287-93. https://doi.org/10.1002/ca.10203
  6. 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
  7. Moss CJ, Mendelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 2000;105:1475-90; discussion 1491-8. https://doi.org/10.1097/00006534-200004040-00035
  8. Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg 2000;26:1107-12. https://doi.org/10.1046/j.1524-4725.2000.00270.x
  9. Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2008;121:1804-9. https://doi.org/10.1097/PRS.0b013e31816c3c1a
  10. Ghavami A, Pessa JE, Janis J, Khosla R, Reece EM, Rohrich RJ. The orbicularis retaining ligament of the medial orbit: closing the circle. Plast Reconstr Surg 2008;121:994-1001. https://doi.org/10.1097/01.prs.0000299941.62645.4e
  11. Hwang K, Nam YS, Kim DJ, Han SH. Surgical anatomy of retaining ligaments in the periorbital area. J Craniofac Surg 2008; 19:800-4. https://doi.org/10.1097/SCS.0b013e31816b6c5e
  12. Byrd HS, Burt JD. Achieving aesthetic balance in the brow, eyelids, and midface. Plast Reconstr Surg 2002;110:926-33; discussion 934-9.
  13. Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 2002; 110:885-96; discussion 897-911. https://doi.org/10.1097/00006534-200209010-00026
  14. 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; discussion 897-911. https://doi.org/10.1097/00006534-200209010-00025
  15. 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
  16. Kim HJ, Seo K.K, Lee HK, Kim J. Clinical anatomy of the face for filler and botulinum toxin injection. Springer; 2016.
  17. Standring S, Gray H. Gray's anatomy: the anatomical basis of clinical practice. 40th ed. Churchill Livingstone/Elsevier; 2008.
  18. Davison SP, Iorio ML, Oh C. Transconjunctival lower lid blepharoplasty with and without fat repositioning. Clin Plast Surg 2015;42:51-6. Erratum in: Clin Plast Surg 2017;44:xv.
  19. Furnas DW. The orbicularis oculi muscle. Management in blepharoplasty. Clin Plast Surg 1981;8:687-715. https://doi.org/10.1016/S0094-1298(20)30398-9
  20. Mendelson BC. Anatomic study of the retaining ligaments of the face and applications for facial rejuvenation. Aesthetic Plast Surg 2013;37:513-5. https://doi.org/10.1007/s00266-013-0066-8
  21. Nassif PS. Lower blepharoplasty: transconjunctival fat repositioning. Facial Plast Surg Clin North Am 2005;13:553-9, vi. https://doi.org/10.1016/j.fsc.2005.06.006
  22. Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg 1991;88: 215-20; discussion 221. https://doi.org/10.1097/00006534-199108000-00006
  23. Rohrich RJ, Ghavami A, Mojallal A. The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg 2011;128:775-83. https://doi.org/10.1097/PRS.0b013e3182121618
  24. Yoo DB, Peng GL, Massry GG. Transconjunctival lower blepharoplasty with fat repositioning: a retrospective comparison of transposing fat to the subperiosteal vs supraperiosteal planes. JAMA Facial Plast Surg 2013;15:176-81. https://doi.org/10.1001/jamafacial.2013.749