The beauty of eye has always been the center of cosmetic and aesthetic procedures. The patient in the clinic often ask: "Why am I looked so tired? The dark circles and the eye bags (眼袋) made me looked so old. My friends even called me a drug addict!” The problem they mentioned in the clinic is actually not completely related to the dark circle or eye bags. The most important reason of their concern is the tear trough (淚溝) and the related anatomical structures. With the aging of the skin, the skin around the eyes will gradually drop, causing the formation of fine lines and bags under the eyes.

 

During aging, the junction between lower eyelids and cheeks (the lid-cheek junction) will also gradually move downward. Because eye bags and tear trough are adjacent anatomical structures, the junction between lower eyelid and cheek can significantly affect the position of the eyes and the signs of aging. Only treatments to both of the deformities simultaneously can get the best results. In this article, we will describe the tear trough and the tear trough ligament. A popular novel minimal invasive procedure to treat the tear trough in Taiwan will also be briefly discussed.

 

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Tear Trough and Eye Bags

Ancient Chinese beauties were always said to have puffiness of the lower eyelids, which was called a silkworm underneath the eyes or lying silkworm (臥蠶). It is a width of 4 to 7mm uplift at the edge adjacent to the eyelashes, like a recumbent silkworm over lower eyelid edge. It is usually more obvious when smiling or squinting. In fact, this is not the eye but local orbicularis oculi muscle hypertrophy. It is different from the eye bags, which are the sagging of the lower eyelids with protrusion. On the other hand, the eye bags and the tear trough are always confused in the clinical settings. People often come to the clinic and ask for improvement of eye bags, but actually presenting with prominent tear trough.

 

Lower eyelid fat pads can be divided into three areas, including nasal, central, and the lateral ones. Eye bags are the protrusion or herniation of these fatty tissues under the eyelids. In contrast, the tear trough is actually the groove between the lower eyelids and the cheek, normally called lid-cheek junction. The tear trough is not exclusively a feature of aging, as it can be seen in some young people. However, it does become more pronounced with age.

 

In the past, many hypotheses described the reasons of tear tough formation. Some said the prominence of orbital rim, drooping of the fat pad, or the loss of the orbital septum result in this deformity. Others blamed the orbicularis oculi muscle or other levator muscles like levator labii superioris alaeque nasi, and the levator labii superioris. 

 

-To be continued