Tear Trough Treatment with Orbicularis Oculi Muscle Suspension

Surgical Correction of Tear Trough Deformity (TTD) with Orbicularis Retaining Ligament Release and Volume Augmentation for Periorbital Rejuvenation: Review of the Literature

BACKGROUND

Tear trough deformity is a hallmark of periorbital aging. It is not, however, an exclusive feature of old age. While protruding orbital fat results in lower lid bags that are traditionally corrected by excision, correction of TTD can constitute a real challenge requiring volume enhancement in addition to addressing prolapse of orbital fat and descent of cheek tissues. Described therapeutic options include minimally invasive soft tissue augmentation with fillers or structural autologous fat transfer as well as invasive surgical procedures concomitantly with lower lid blepharoplasty or other facial rejuvenation procedures.

MATERIAL AND METHODS

Six eponyms have been used in the literature to describe the condition: (1) naso-jugal fold, (2) naso-jugal groove, (3) naso-jugal ditch, (4) tear trough, (5) tear trough deformity, and (6) tear trough depression. A separate PubMed database search of each of the 6 terms was conducted in addition to an advanced literature and systematic PICO searches to identify all described clinical retrospective or prospective, comparative or simple cohort studies related to surgical correction of TTD. An additional screening of references of retrieved clinical studies was performed to identify any missed reports.

RESULTS

A total of 435 publications were identified with the initial search. After excluding all none relevant studies, 44 papers were selected for review. 6 additional studies were identified by screening relevant references.

CONCLUSION

Almost all authors agree on the necessity to release the tear trough retaining ligament together with volume enhancement. Transconjunctival and transcutaneous incisions are reported. Most recommend repositioning of the protruding orbital fat for volume enhancement to mostly subperiosteal, or pre-periosteal pockets. Other reported options include pedicled buccal fat pad transposition, segmental fat grafting, and minced micrografts. Internal as well as external fixation of repositioned fat flaps have been described. Despite lack of solid objective evidence, several of these techniques when properly executed for the proper indication in selected patients are reported to result in a rewarding and long-lasting outcome. Unfortunately, it is difficult to determine the most appropriate technique that would universally yield the most pleasant and harmonious facial contour without creating an unnatural puffy appearance. It remains for the surgeon to identify the safe surgical approach that does not compromise lower eyelid function and achieves the most pleasing aesthetic outcome with the least complications and downtime.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Tear Trough Ligament Release and Autologous Fat Injection as a New Method for Tear Trough Deformity Correction

BACKGROUND

Even though the tear trough (TT) deformity is only 2 cm in length, it can give a worn, even haggard appearance on the face. The authors developed a novel approach and presented findings from the clinical effect.

METHODS

Between February 2018 and January 2021, the medical records of patients treated with autologous fat injection for TT deformity were researched. The fat was placed under the orbicularis oculi muscle with a sharp cannula. During that period, the TT ligament was also released with the cannula. After the fat was injected entirely, we still needed to repeatedly puncture this ligament to release it until there was no puncture resistance. Improvement was evaluated by measuring patients' and investigators' global aesthetic improvement scale.

RESULTS

152 of 173 patients completed the follow-up plan and were enrolled in this study. The most common complications reported were temporary swelling and lumpiness. At 1 month, 3 months, 6 months, 12 months, and 24 months, the satisfaction rate of patient self-assessment was 93.4%, 89.5%, 86.8%, 84.3%, and 82.4%, respectively. The Investigator Global Aesthetic Improvement Scale showed 94.1% of patients' improvement after one month, 83.6% after three months, 78.3% after six months, 75% after 12 months, and 71.8% after 24 months.

CONCLUSION

Fat injection based on TT ligament release to correct TT deformity is a novel, easy and effective treatment that deserves to be further used.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .