The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty.

Abstract

Sir: We read with great interest the article entitled “The Long-Term Static and Dynamic Effects of Surgical Release of the Tear Trough Ligament and Origins of the Orbicularis Oculi in Lower Eyelid Blepharoplasty” by Wong and Mendelson.1 Tear trough deformity is a critical component of the orbitomalar area, defining an unsightly, unhealthy, aged, and tired appearance. Furthermore, the presence of tear trough deformity maximizes the appearance of the malar fat pad. Representing a strong anchorage between the dermis and the maxilla, its release should be taken into account during both surgical and medical correction. Although tear trough correction should account for the individual needs of each patient, it is not merely a question of volume restoration, but should deliver aesthetically pleasant results without a puffy and unnatural appearance. Although filling the hollow is one of the most common methods used to correct tear trough deformity, the authors maintain that filler injections alone cannot always correct the disorder adequately because of the tear trough ligaments; they firmly connect the dermis to the periosteum, which may cause an irregular puffiness to the malar area. This unnatural appearance could even worsen over time, because of the osmotic activity of the filler itself. Therefore, we completely agree with the authors regarding the etiologic approach to tear trough deformity, but we have some elements to discuss. Recently, we published an article proposing an alternative nonsurgical outpatient procedure to release the tear trough ligament using a blunt cannula introduced directly in the supraperiosteal plane through an intraoral access under infraorbital nerve block injection. [See Video (online), which shows the proposed procedure to release the tear trough ligament using a blunt cannula introduced directly in the supraperiosteal plane trough an intraoral access under aesthetic block of the infraorbital nerve.] Once the deep insertion of the ligament from the maxilla is gently separated by the cannula, the tear trough depression is evenly recontoured, requiring only a small amount of filler to define a regular and smooth profile, avoiding at the same time the risk of the tear trough ligament reattachment2–4 (Fig. 1). {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"This video shows the proposed procedure to release the tear trough ligament using a blunt cannula introduced directly in the supraperiosteal plane trough an intraoral access under aesthetic block of the infraorbital nerve.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_5k961mef"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Fig. 1.: (Left) A 31-year-old man shown before treatment. (Center) Tear trough release, showing natural and satisfactory result. (Right) Hyaluronic acid transcutaneous injection, showing partial correction and Tyndall effect.The aim of this communication is to highlight an alternative nonsurgical procedure to correct the tear trough deformity, using a comfortable, efficient, easy, and reliable outpatient procedure that could be accepted by a larger number of patients. Obviously, in the presence of malar fat pads, the surgical approach is strictly required. PATIENT CONSENT Patients provided written consent for the use of their images. DISCLOSURE The authors have no financial or conflict of interest to declare in relation to the content of this communication.