Stick with me on this one. The October 2013 issue of the Plastic and Reconstructive Surgery Journal had an article “Tear Trough and palpebromalar Groove in Young versus Elderly Adults: A sectional Anatomy Study.”
Woah. What a snooze, yes?
No. In English, what they are looking at is the junction of the lower eyelid and the cheek. If you aren’t 40 yet, you can ignore this post. If you are 40, this area is one which plagues us all, and leads to the common complaint of “I always look tired.” ” I have circles under my eyes.”
This is the most common area I put filler into. Not the lip, or the nasolabial lines, or the “11” between your eyebrow. I fill the junction of the lower eyelid to the cheek. The reason you form deeper nasolabial lines as we age (the “parenthesis around your mouth” lines) is because you have lost cheek volume.
SO. We do care about this. This study was interesting as it looked at 20 adult and 16 young cadavers. They did cross sections and tissue sections.
What did they find?
- The malar fat pad descends and atrophies with age. (English translation: your cheek fat pad loses its volume and sags)
- The skin adheres to the palpebral portion of the orbicularis oculi muscle (translation: at the part of the eyelid close to the cheek there is little subcutaneous tissue and the muscle attaches to the skin, though in young people there tends to be more fat between the muscle and skin than in the elderly.)
- Young individulas had thicker skin, with more collagen and fewer wrinkles. (translation: young people have thicker skin and better collagen, so the skin of the lower eyelid looks better)
- The orbicularis retaining ligament limits the descent of the orbicularis oculi muscle. This ligament starts at the inferior orbital rim and ends at the junction of palpebral and orbital portions of the orbicularis oculi muscle.
So for the overall study English translation: When trying to address aging of the lower eyelid, we want to restore what we have lost.
*To restore the loss of volume in the malar fat pad, we can add volume. We can do this through in office fillers like juvederm, restylane, or sculptra or through in surgery procedures like fat grafting.
*For the loss of the fat just under the skin, we cannot restore the volume to exactly where it was lost, as subcutaneous injection can have issues, so deeper injection is frequently used. During lower eyelid surgery, the fat of the lower eyelid should not be removed; it should be moved to help fill in the depression of the inferior orbital rim (the tear trough). This is the technique I use.
*To raise the malar fat pad, we need to lift the tissues. We do that with facelifts.
*To improve the skin quality, we can use products like Retin A or retinol, and procedures like chemical peels or some lasers. (Not all lasers target the same things.)
*To improve the tension of the lower lid, we can try to tighten the overlying layers like the muscle and skin during lower eyelid surgery. They suggest doing lateral canthal anchoring or lateral muscle suspension, a technique I employ.
Good to know, though I have believed all these points for years. Nice to have science backing me up. I’ll keep reading those journals.