OBJECTIVETo explore the reasonable therapeutic strategy for different types of epicanthus.

METHODSPatients with epicanthus were classificated according to the shape, extent and inner canthal distance and treated with different methods appropriately. Modified asymmetric Z plasty with two curve method was used in lower eyelid type epicanthus, inner canthus type epicanthus and severe upper eyelid type epicanthus. Moderate upper epicanthus underwent '-' shape method. Mild Upper epicanthus in two conditions which underwent nasal augumentation and double eyelid formation with normal inner canthal distance need no correction surgery. The other mild epicanthus underwent '-' shape method.

RESULTSA total of 66 cases underwent the classification and the appropriate treatment. All wounds healed well. During 3 to 12 months follow-up period, all epicanthus were corrected completely with natural contour and unconspicuous scars. All patients were satisfied with the results.

CONCLUSIONSClassification of epicanthus hosed on the shape, extent and inner canthal distance and correction with appropriate methods is a reasonable therapeutic strategy.

Blepharoplasty ; methods ; Cicatrix ; Eyelids ; anatomy & histology ; surgery ; Humans ; Nose ; surgery

OBJECTIVETo study the anatomic mechanism of tear trough deformity and palabromalar groove deformity.

METHODSSix cadavers (12 sides, 3 male, 3 female, an average age of 67.2 years) with tear trough deformity and palpbromalar groove deformity underwent lower eyelid and periorbital area dissection.

RESULTSTear trough deformity and palabromalar groove deformity locate at the junction of thin eyelid skin and thick cheek skin. Skin is closely attached to the orbicularis oculi muscle. The superior horder of the malar fat pad covers the junction of the palpebral and orbital portions of the orbicularis muscle, and does not descend with malar fat pad, which is also corresponded to the location of tear trough and palphromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle is 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, thin and flabby. Orbital septal arises from the infraorbital rim, and the orbital fat extrudes anteriorly and inferiorly.

CONCLUSIONSTear trough deformity and palabromalar groove deformity are resulted from combination of age-related relaxation, atrophy and ptosis of layers of tissues. The orbital septal and the orbicularis retaining ligament prevent tissues from descending, which makes tear trough deformity and palabromalar groove deformity more visible.

Aged ; Cadaver ; Eyelids ; anatomy & histology ; Female ; Humans ; Male ; Orbit ; anatomy & histology ; Skin Aging

PURPOSE: To identify the anatomy of the levator aponeurosis (LA) and Whitnall's ligament (WL) in Korean subjects using cadavers. METHODS: Orbital exenteration was performed in ten cadavers (20 eyeballs) that had no history of trauma near the eyeball. We observed characteristics of WL (tension, density, and shape) and the relationship between the superior rectus muscle (SR) and the levator palpebrae superioris. We measured the distance from both the eyelid margin and the upper border of the tarsal plate to the insertion of the LA medially, centrally, and laterally. RESULTS: The WLs we observed showed several shapes. In 12 eyes, we saw clear, white fibrotic bands, while in four others, we found thin, less taut bands. In four eyes, we were unable to identify the precise shape of the band. The insertions of the LA showed nasal dehiscence in 13 eyes and parallel attachment in seven eyes. The distances from the eyelid margin to the insertion of the LA medially, centrally, and laterally were 8.31 mm, 5.57 mm, and 5.15 mm, respectively. The distances from the upper border of the tarsal plate to the insertion of the LA medially, centrally, and laterally were 2.75 mm, 4.82 mm, and 4.29 mm, respectively. CONCLUSIONS: This study examined the anatomy of WL and the LA in Korean subjects and may be helpful as a reference in levator muscle surgery.
Adult ; Aged ; Aged, 80 and over ; Cadaver ; Eyelids/*anatomy & histology ; Female ; Humans ; Ligaments/*anatomy & histology ; Male ; Middle Aged ; Muscle, Skeletal/anatomy & histology ; Oculomotor Muscles/anatomy & histology ; Tendons/*anatomy & histology

OBJECTIVETo discuss the midface aging mechanism through anatomic study of malar fat pad.

METHODS10 fresh adult cadaveric heads (20 sides) fixed by vascular perfusion of formalin were used for anatomic study with microsurgery technique under microscope. The midfacial ligament and connective tissue between skin and subcutaneous fat were observed carefully in different parts of midface. The location, shape and extent of malar fat pad was also recorded and photographed.

RESULTSThe malar fat pad has a triangle shape. The bottom is a curve along the orbicularis retaining ligament at the lower eyelid. The fat pad is extended internally to the nasolabial fold and labiomandibular fold, externally from the major zygomatic muscle end point at the malar surface to the angulus oris and submandibular edge. (2) The malar fat pad is composed of meshed fibrous tissue, with big fat particles in it. It becomes tight when being stretched in horizontal direction along nasolabial fold and loosen when being stretched in vertical direction. (3) There is tight connection between skin and fat pad, which is divided into four areas as I, II, III, IV. The areas I, II, III are strip-shaped parelled to the nasolabial fold. The area IV is a irregular quadrilateral. (4) There are six fixation ligaments between malar fat pad and deep tissue: orbicularis retaining ligament upper layer of lower eyelid, orbicularis retaining ligament substratum of lower eyelid, zygomaticus ligament, zygomatic cutaneous ligament, zygomatic cutaneous ligament substratum, platysma There are four closely connected areas cutaneous forward ligament, cheek maxilla ligament.

CONCLUSIONSbetween the facial skin and malar fat pad which makes malar fat pad and skin keep relatively consistent. The malar fat pad moving down mainly resulted from slack of ligaments support which is one of the reasons for aging face.

Adipose Tissue ; anatomy & histology ; physiology ; Cadaver ; Cheek ; Eyelids ; anatomy & histology ; physiology ; Face ; anatomy & histology ; physiology ; Facial Muscles ; anatomy & histology ; physiology ; Head ; Humans ; Ligaments ; anatomy & histology ; physiology ; Lip ; anatomy & histology ; physiology ; Skin ; anatomy & histology ; Skin Aging ; pathology ; physiology

OBJECTIVETo explore the mechanism of the aging deformity of tear trough through the anatomic study of the tear trough region.

METHODS13 adult cadaveric heads (26 sides), including 9 male heads (18 sides) and 4 female heads (8 sides), aged 22-78 years old, were used. Anatomic study was performed around the orbital, especially tear trough region, with microsurgery instrument under microscope( x 10 times). The lower orbicularis retaining ligament was dissected and exposed. The anatomic location was recorded and photographed.

RESULTS(1) The anatomic layers of the tear trough region contains skin, subcutaneous tissue, orbicularis oculi muscle, periosteal membrane. There is no subcutaneous fat above the tear trough, while it exists below the tear trough, called malar fat pad. (2) There is a natural boundary between the septal and the orbital portions of the orbicularis oculi muscle of lower eyelid at surface of the orbital bone. The natural boundary, projected on the body surface corresponds to tear trough. The width of boundary is (2.06 +/- 0.15) mm on the vertical line through inner canthus and (3.25 +/- 0.12) mm on the vertical line through the lateral margin of the ala. The septal portion and the orbital portion of the orbicularis oculi muscle began to merge in (16.56 +/- 0.51) mm to inner canthus. (3) There is ligament attachment in the medial, upper and lower orbital and no ligament attachment in the lateral orbital. Orbicularis retaining ligament of lower eyelid is divided into two layers. (4) The medial of the upper layer of the orbicularis retaining ligament in lower eyelid originates from orbital margin and from preorbital walls laterally in (16.10 +/- 0.43) mm to the medial of lateral orbital margin, through orbicularis oculi muscle and ends at the skin. The lower layer of the orbicularis retaining ligament of lower eyelid originates from preorbital walls through orbicularis oculi muscle and its superficial fat, then ends at the skin.

CONCLUSIONSThe length of tear trough is (16.56 +/- 0.51) mm, the width of tear trough is (2.06 +/- 0.15) mm and (3.25 +/- 0.12) mm on the vertical line through inner canthus and the lateral margin of the ala nasi respectively. The main reason of the aging deformity of tear trough attributes to the increased distance between the upper and lower layers of the orbicularis retaining ligament in lower eyelid, which is caused by loose of the orbicularis retaining ligament and its underlying fat atrophy or decline.

Adult ; Aged ; Aging ; Cheek ; anatomy & histology ; Eyelids ; anatomy & histology ; Facial Muscles ; anatomy & histology ; Female ; Humans ; Lacrimal Apparatus ; anatomy & histology ; Male ; Middle Aged ; Young Adult

PURPOSE: To identify the microscopic characteristics of lower eyelid retractors in Korean individuals and to elucidate age-related changes in lower eyelid retractors. METHODS: Eighteen Korean lower eyelids from formalin-fixed cadavers were stained with Masson's trichrome. Specimens were divided into two groups based on age at death (group A, < or =65 years; group B, >65 years), and the microscopic findings were analyzed and compared by light microscopy. RESULTS: The capsulopalpebral fascia (CPF) had distinct junctions and no fusion with orbital septum in 14 eyelids (77.8%). The CPF was fused with the orbital septum in only two eyelids (11.1%). Although not significant, the inferior tarsal muscle was closer to the tarsus in group A (1.24 +/- 0.71 mm) than group B (2.14 +/- 1.18 mm, p = 0.07), and the tarsal height tended to be longer in group B (4.71 +/- 0.55 mm) than group A (4.16 +/- 1.01 mm, p = 0.20). Tarsal fatty infiltration was more evident in group B. CONCLUSIONS: The CPF was rarely fused with the orbital septum in our sample of Korean lower eyelids. Although we did not identify any remarkable age-related changes in lower eyelid structures, there was a tendency for the lower retractor to loosen from the tarsus and for increased fatty infiltration in the lower eyelids from elderly individuals.
Aged ; *Aging ; *Asian Continental Ancestry Group ; Cadaver ; Eyelids/*anatomy & histology ; Female ; Humans ; Male ; Oculomotor Muscles/anatomy & histology ; Republic of Korea

PURPOSE: To identify the microscopic characteristics of lower eyelid retractors in Korean individuals and to elucidate age-related changes in lower eyelid retractors. METHODS: Eighteen Korean lower eyelids from formalin-fixed cadavers were stained with Masson's trichrome. Specimens were divided into two groups based on age at death (group A, < or =65 years; group B, >65 years), and the microscopic findings were analyzed and compared by light microscopy. RESULTS: The capsulopalpebral fascia (CPF) had distinct junctions and no fusion with orbital septum in 14 eyelids (77.8%). The CPF was fused with the orbital septum in only two eyelids (11.1%). Although not significant, the inferior tarsal muscle was closer to the tarsus in group A (1.24 +/- 0.71 mm) than group B (2.14 +/- 1.18 mm, p = 0.07), and the tarsal height tended to be longer in group B (4.71 +/- 0.55 mm) than group A (4.16 +/- 1.01 mm, p = 0.20). Tarsal fatty infiltration was more evident in group B. CONCLUSIONS: The CPF was rarely fused with the orbital septum in our sample of Korean lower eyelids. Although we did not identify any remarkable age-related changes in lower eyelid structures, there was a tendency for the lower retractor to loosen from the tarsus and for increased fatty infiltration in the lower eyelids from elderly individuals.
Aged ; *Aging ; *Asian Continental Ancestry Group ; Cadaver ; Eyelids/*anatomy & histology ; Female ; Humans ; Male ; Oculomotor Muscles/anatomy & histology ; Republic of Korea

The aim of this review is to familiarize the reader with the critical lower eyelid anatomy as is related to lower blepharoplasty or a midface lift. The contents include 1) the lacrimal canaliculus in the lower eyelid: the depth and width (diameter) of the vertical portion were 2.58+/-0.24 mm and 0.44+/-0.07 mm, respectively. A vertical portion of the canaliculus was about 1 mm (1.11+/-0.16 mm) deep, and the horizontal portion was about 2~3 mm (2.08+/-2.74 mm) long 2 mm below the mucocutaneous junction, which is where an incision may be made when performing epicanthoplasty. 2) Motor innervation to the lower orbiculis oculi muscle: the pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31+/-0.29 cm (range: 1.7~2.7 cm) and the vertical distance was 1.20+/-0.20 cm (range: 0.8~1.5 cm). 3) Sensory innervation of the lower eyelid skin: the majority of the terminal branches (93.8%) of the ION were distributed to the medial to the lateral canthus. Most (99.4%) of the terminal branches of the ZFN were distributed to lateral to the lateral canthus. 4) Retractor of the lower eyelid; capsulopalpebral fascia (CPF): the orbital septum blended with the CPF most closely at 3.7~5.4 mm beneath the lower tarsal border and differently at 3.7+/-0.7 mm on the medial limbus line, 4.3+/-0.8 mm on the midpupillary line and 5.4+/-1.0 mm on the lateral limbus line. 5) Arcuate expansion (AE): The AE was a fibrous band expanding from the inferolateral orbital rim to the medial canthal ligament. A sector (fan-shaped) of the AE originated in the angle of 5 to 80 degrees at the circumference of the inferolateral orbital rim circle, falling within the range of 3 to 5.5 o'clock, and then it tapered and attached to the inferior border of the medial canthal ligament. 6) Suborbicularis oculi fat (SOOF) in the lower eyelid: the SOOF was located in the inferolateral side of the orbit within a range between medial +15 and lateral -89 degrees to a vertical midpupillary line. Histologically, the SOOF was situated deep to the Orbicularis oculi muscle and superficial to the orbital septum and periosteum. The SOOF consisted more of fibrofatty tissue rather than being the pure fatty nature like orbital fat. I hope surgeons can achieve desirable outcomes with the knowledge reviewed in this article.
Anatomy, Regional ; Blepharoplasty ; Eyelids ; Facial Nerve ; Fascia ; Ligaments ; Muscles ; Orbit ; Periosteum

OBJECTIVETo investigate the route and scope of the facial nerve in the temporal region for clinical applications.

METHODSTemporal region dissection was performed on 12 cadavers (24 sides) under light microscope.

RESULTSThere are two branches of the facial nerve in the temporal region from the superior margin of the parotid: the temporal branch and the zygomatic branch. Each of them has two to five branches, which run in the deep layer of the superficial temporal fascia. The temporal branch crosses the zygomatic arch to the temporal region, innervating the frontal muscle, the orbicularis oculi muscle, the corrugator supercilii muscle, and the muscle surrounding the ear, etc. The zygomatic branch goes to the lateral canthus, innervating the orbicularis oculi muscle, the upper and lower eyelid and zygomatic muscles. There are communicating branches among the temporal branches, the zygomatic branches and the supraorbital and lacrimal nerves of the ophthalmic nerve.

CONCLUSIONThe temporal branches and zygomatic branches of the facial nerve run between the deep zone of the superficial temporal fascia and the superficial layer of the profound temporal fascia, where dissection should be avoided during rhytidectomy in order not to damage the facial nerve branches.

Cadaver ; Dissection ; Eyelids ; innervation ; Facial Muscles ; innervation ; Facial Nerve ; anatomy & histology ; Fascia ; innervation ; Humans ; Parotid Gland ; anatomy & histology ; Rhytidoplasty ; Subcutaneous Tissue ; innervation ; Temporal Bone ; Zygoma

OBJECTIVETo explore the eyelid's characteristics of outpatients who visited the plastic surgery clinic in 3rd Hospital of Peking University.

METHODSFrom Jan. 2007 to Feb. 2011, we collected facial images and general data of 2,183 outpatients, and divided them into groups according to their genders. The eyelid images were analyzed and epicanthus or foldless eyelid were recorded. Then the incidence rates of epicanthus and foldless eyelid were calculated.

RESULTSIn 2,183 patients (4,366 eyes), the incidence rate of epicanthus is 86.1% (3,760/4,366), and the incidence rate of foldless eyelid is 35.3% (1,541/4,366). In 178 males (356 eyes) and 2,005 females patients (4,010 eyes), the incidence rates of epicanthus are 78.4% (279/356) and 86.8% (3,481/4,010), respectively. The incidence rates of foldless eyelid are 48.0% (171/356) and 34.2% (1,370/4,010), respectively.

CONCLUSIONSThe incidence rates of epicanthus and foldless eyelid are relatively high for the outpatient population in the plastic surgery clinic of Third Hospital of Peking University.

Beijing ; Eyelids ; anatomy & histology ; Female ; Humans ; Male ; Outpatients ; statistics & numerical data ; Sex Factors ; Surgery, Plastic ; statistics & numerical data