#2-3. Anatomic Study of Skin Surface II

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Local anatomy of the face

1. Eyelid (upper and lower eyelids)

In youthful and beautiful eyes, the palpebral fissure rises in an almond like slope from medial to lateral. The lower eyelid is not drooping and maintains a proper degree of tension. At 8~12mm into the vertical length of the lower eyelid, the border with the cheek should be invisible and smooth. But with aging, the lower eyelid’s vertical length increases, the palpebral fissure gets rounded, the transverse diameter of the palpebral fissure is shortened, infraorbital rim becomes more pronounced, lower eyelid skin changes and cheek atrophy occurs (Figure 4).

<Figure 4>

The skin of the eyelid is less than 1mm of thick, the thinnest in the body. It also lacks the subcutaneous fat layer. Such fat defect is the main cause behind fine wrinkles of the eye with aging. This area of the skin tends to stretch thin from excessive tension during rubbing of the eyes or surgery.

The surface wrinkles of the upper eyelid (Figure 5) typically locate on the superior end of the tarsal plate and are called supratarsal skin creases. The fascia of levator palpebrae muscle originates from pretarsal extension and passes orbicularis oculi muscle to insert into pretarsal dermis. It elevates the eyelash as high as supratarsal skin creases. The intermuscular septum above this crease is not inserted allowing easy movement of the eyelid. These relatively loose skin creases lie over the supra tarsal fold and form tarsal creases. The suprapalpebral tarsal plate creases are indistinct and lie low in Asians. This is because levator aponeurosis inserts close to the eyelash.

<Figure 5>

The fiber bands of capsulopapebral fascia in the lower eyelid passes orbicularis oculi muscle, form infratarsal creases and inserts into the dermis. This stretches diagonally from the palpebral edge 5mm medially and 7mm laterally. Unlike tarsal plate creases, they are not noticeable even with progressed aging.