The relationship between lacrimal groove and orbital buccal junction will become more and more obvious with age. Near these landmarks, the lower edge of the track will form a continuous notch or groove. Because many treatments for the appearance of this area are often contradictory, this time, a systematic anatomical study was made on the junction of lacrimal groove and orbit and cheek.
The connection between lacrimal groove and orbital cheek is explained by the facial anatomy of the surface. The shrinking of skin and fat will make these landmarks become obvious with age, and it is impossible for this area to decline with age. Because the facial structure is fixed on the bone, swollen orbital fat makes these marks more obvious, so the treatment must extend to the lower edge of the orbit, and the filled fat or other fillers must be placed in the inner plane of orbicularis oculi muscle and the lower plane of orbicularis oculi muscle. Lacrimal groove and orbital-buccal junction are often mentioned in plastic surgery literature. It is generally believed that these signs will become obvious with the increase of age, but the related anatomical explanations and methods of diagnosis, improvement or correction have not been unified.
Lacrimal sulcus, also known as nasozygomatic sulcus or orbital buccal sulcus, is a natural depression extending downward and outward from the inner canthus. It is congenital, but it is not obvious when you are young. When the patient becomes obvious due to aging, it is considered as lacrimal groove malformation. Most of the lacrimal groove is less than 3㎝, which stops at the middle line of the pupil, and then extends outward from this point, roughly parallel to the lower edge of the lower orbit. This is another depression that becomes obvious with age. With the swelling of orbital fat, the deformity of lacrimal groove is more obvious, which is also the reason for patients to seek cosmetic surgery. But removing the bags under the eyes can't improve the lacrimal groove, and it won't aggravate it. We must find other ways to solve it.
In many literatures, there have been many anatomical explanations about lacrimal groove malformation, including the arc-shaped edge of orbital septum connected with orbital margin, the groove between alar muscle of levator palpebrae superioris and orbicularis oculi muscle, and the fat swelling above the groove.
Although there are many explanations for the periocular and midfacial fascia system, there are many contradictory explanations for the deepening of the orbital-buccal junction. Some people think that the orbital-buccal junction will decline with age, but lambros thinks that the orbital-buccal junction will not actually decline with age by taking pictures of the same patient all his life. Anatomical factors are inconsistent with the behavior of these important symbols in a person's life, and the existence of lacrimal groove and orbital-buccal junction is clearly explained: the explanation of these existence has nothing to do with the lower orbital margin or sulcus margin, and the lacrimal groove and orbital-buccal junction extend below the orbital margin.
Due to the differences in anatomical interpretation, there are various surgical and injection methods in the treatment of lacrimal groove malformation and orbital-buccal junction, which often conflict. The treatment of lacrimal groove includes heterogeneous filling, uniform intraorbital fat, uniform fat injection and other materials such as hyaluronic acid injection. There are many treatments for deepening the orbital-buccal junction, including midfacial lifting, re-suspension and orbicularis oculi muscle traction. Intraorbital fat transplantation; Injection of fat or other substances. In addition, the traditional method of treating orbital lipocele, orbital lipoidectomy, can cover up the boundary between lacrimal groove deformity and eyelid and cheek to some extent.
Anatomically, there is no difference between lacrimal groove and orbital buccal junction on subcutaneous plane, which is related to the combination of eyelid and orbit of orbicularis oculi muscle. In addition, the skin located in the eyelid of orbicularis oculi muscle is the thinnest and there is no subcutaneous fat. The skin located in the orbit of orbicularis oculi muscle is relatively thick and separated from the orbicularis oculi muscle below it by buccal fat pad.
Although the anatomy of lacrimal groove is the same as its lateral continuation, and the orbital-buccal junction is the same on the subcutaneous plane, no one will go deep into the orbicularis oculi muscle. Along the lacrimal groove, there is no separable anatomical plane as deep as orbicularis oculi muscle. Of course, the eyelid of orbicularis oculi muscle is firmly connected with the original zygomatic part, but on the outside, the connection between orbicularis oculi muscle and its lower bone tissue along the orbital-buccal junction is ligament-like. The ligament of orbicularis oculi muscle is connected with the arch margin from the tail of zygomatic arch to the lower edge of orbit. The detention area of orbicularis oculi muscle is farthest (4-6mm) at the middle line of the pupil at the orbital margin, and the end gradually approaches the orbital margin (2-4mm). It needs to be repeated that the ligament of orbicularis oculi muscle does not rise from the orbital margin, but, like the skin mark on it, the tail is several millimeters away from the orbital margin.
Finally, the orbital septum of orbital fat swelling is weakened, which is conducted through the orbicularis oculi muscle with relatively loose eyelids and the lacrimal groove is weakened. This is particularly evident on the medial side, where the powerful orbicularis oculi muscle starts. On the subcutaneous plane, the joint of lacrimal groove and orbital cheek is connected with the joint of eyelid and orbit of orbicularis oculi muscle. Along the lacrimal groove, there is a particularly obvious crack between these two parts of orbicularis oculi muscle. In addition, the joint area between skin and muscle is virtually free of fat, which explains its visibility as a skin marker. It is more conducive to external visibility. The eyelid skin on this landmark is obviously different from the cheek skin under the landmark in texture and thickness. The buccal fat pad starts at the same muscle junction, providing a further boundary.
On the lower plane of orbicularis oculi muscle, the lacrimal groove is different from the orbital-buccal junction. Along the lacrimal groove, the eyelid of orbicularis oculi muscle is closely connected with the bone surface, and does not go deep into the anatomical plane of the muscle. It is technically impossible to separate along the periosteum and muscle. However, along the orbital-buccal junction, the orbicularis oculi muscle is connected to the bone surface through the orbicularis oculi muscle retaining ligament. Different from the lacrimal groove area, it has a muscle-deep plane into which materials can be injected or separated by surgery. Although it is a major orbicularis oculi reserved ligament, there are several weak ligaments between the orbital margin and the junction of the major orbicularis oculi reserved ligament.
The following are a series of factors that may form lacrimal groove malformation, but none of them have anything to do with pouch:
(1) The descent of cheek at the joint of cheek and eyelid skin appears at a lower point than usual;
(2) Muscle defect between orbicularis oculi muscle and the tip of labial muscle;
(3) hypoplasia of suborbital buccal mixed area (unilateral exophthalmos);
(4) Facial fat gradually loses with age.
In addition, there are three theoretical deformities that can cause nasobuccal sulcus, including:
(1) suborbital septum fixation;
(2) There is a triangular groove formed by one lateral canthus muscle and the other orbicularis oculi muscle;
(3) In the infrasulcus region, the orbicularis oculi muscle lacks adipose tissue.
In order to deal with these conditions, free fat transplantation, sliding fat with middle fat pad and buccal fat aspiration can be used.
Regarding the viewpoint that the decrease of the orbital-buccal junction causes the lacrimal groove, in fact, the orbital-buccal junction is stable all its life, and the percentage of decrease is related to age, not actual exercise. If it is obvious, it is mostly due to the swelling of periorbital fat with the weakening of orbital diaphragm and orbicularis oculi muscle. These shadows aggravate the lacrimal groove deformity and orbital buccal groove. Moreover, skin atrophy leads to blackening and aggravation of periorbital skin, eyelid transplantation and facial weakness. Studies have shown that the lacrimal groove deformity has nothing to do with facial descent, arcuate margin, orbital margin or levator ani and orbicularis oculi muscle.
Studies have shown that age-related lacrimal groove malformation has nothing to do with facial decline, arcuate margin, orbital margin or levator ani and orbicularis oculi muscle. Lacrimal groove deformity and eyelid-cheek junction obviously extend along the lower edge of orbit, which is mainly explained by the anatomical characteristics of subcutaneous plane. Especially, these landmarks are located in the joint area between eyelid and orbicularis oculi muscle orbit, which will become more obvious due to the lack of subcutaneous fat, the difference of skin quality and the existence of buccal fat pad whose side boundary suddenly ends in lacrimal groove and eyelid-cheek joint. These two markers are different when attached to the bone surface. Along the lacrimal groove, the muscles are closely connected with the bone surface. Along the eyelid-cheek junction, the orbicularis oculi muscle keeps the ligament connected to the bone through the muscle. The anatomical findings in this study are consistent with the following conclusions.
This information is suitable for the clinical treatment of senile lower eyelid, so that the terms of lacrimal groove and eyelid joint are more consistent and it is easier to discuss the treatment of these problem areas. These anatomical structures are complex, which helps to deal with some key points in this paper in many ways. The similarity between lacrimal groove and buccal eyelid wrinkles is described as follows:
1. Lacrimal groove and eyelid wrinkles share similar anatomical plane in subcutaneous plane: the anatomical dividing line here is the transition from eyelid of orbicularis oculi muscle to periorbital area.
2. Compared with the skin on the outer cheek, the skin of lacrimal groove, eyelid and cheek wrinkles is thinner.
3. Lacrimal groove and orbital and buccal wrinkles lack subcutaneous fat.
4. Lacrimal groove and orbital and buccal wrinkles are located under orbital margin and arcuate margin.
The following are the main differences between lacrimal groove and orbital and buccal wrinkles:
1. The orbicularis oculi muscle is attached to the orbital margin in the lacrimal groove, and it is suspended from the bone through the retention ligament in the eyelid and buccal fold. Therefore, the difference between lacrimal groove and eyelid and cheek wrinkles lies in the muscle plane.
2. The orbicularis oculi muscle keeps the ligament discontinuous because it fuses with the bone at the lacrimal groove.
These views are appropriate both clinically and anatomically. Previous theories believed that lacrimal groove appeared in the space between eyelid, levator rhinoceros and orbicularis oculi muscle. Current research shows that the lacrimal groove is higher than this. Filling between these two muscles does not improve the lacrimal passage. Another point of view is that these grooves do not appear at the orbital margin and orbital septum fixation as pointed out earlier. These methods are different from the release of orbital septum and are necessary to improve these grooves. Before discussing these clinical significance, these anatomical viewpoints have information value alone.
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