Discussion: The Tear Trough Ligament: Anatomical Basis for the Tear Trough Deformity

In their cadaveric study of 36 hemifaces, the authors describe a ligamentous structure that arises from medial orbital rim periosteum and inserts into dermis. The authors suggest that this is an osteocutaneous ligament that defines the anatomical area referred to as the tear trough or medial nasojugal crease. The conclusion of the article is that the tear trough ligament is the primary etiologic factor in the development of the tear trough deformity; effective treatment requires submuscular preperiosteal release to effect a marked correction. This study defines a tear trough ligament that originates from the maxilla near the medial canthal tendon inferior to the lacrimal crest. It travels to the medial pupillary line, where it becomes continuous with the bilaminar orbicularis retaining ligament. The dissections are meticulous; the anatomy is precise; and the work is clinically relevant in that it explains why release of the orbicularis origin helps to diminish the tear trough deformity.Thisclassicarticleadvancessomeofthe authors’ previous work and ideas concerning