Tear Trough and Lid/Cheek Junction

DISCUSSION: continuation.... Loeb described three theoretical malformations that cause what he termed the nasojugal groove. These include (1) fixation of the orbital septum at the level of the inferomedial portion of the arcus marginalis; (2) the existence of a triangular gap limited by the lateral portion of the angular muscle on one side and the medial portion of the orbiculares oculi muscle on the other; and (3) the absence of fat tissue from the central and medial fat pads subjacent to the orbicularis oculi muscle in the area below the groove . Loeb also noted that this natural sulcus may be inconspicuous until neighboring fat pads grow and exaggerate the defect. To manage these spatial derangements, Loeb described a number of treatment options, including (1) transplant of free fat grafts; (2) sliding fat from the medial and central hypertrophic fat pads; and (3) liposuction of excess fat on the cheek region.