Release of the tear trough ligament for correction of tear trough deformity: A technique based on a recent anatomical understanding.

Abstract

Tear trough deformity (TTD) is a common esthetic concern characterized by a concave infraorbital groove. Recent anatomical studies have identified the tear trough ligament and its lateral continuation, the orbicularis retaining ligament, as key contributors. To evaluate the esthetic outcomes of surgical release of the tear trough ligament in patients with varying grades of TTD. This prospective case series included patients with clinically evident TTD treated via a sub-ciliary approach. The procedure involved release of the tear trough ligament, with additional release of the orbicularis retaining ligament when indicated, allowing spontaneous repositioning of the sub-orbicularis oculi fat and conservative lower eyelid skin excision. Outcomes were assessed using standardized photographs evaluated by independent surgeons according to Barton's grading system. Patient satisfaction was measured using patient-reported outcome measures (PROMs). Statistical analysis was performed using chi-square testing. Seventy-three patients were included with a mean follow-up of 10 months. Excellent outcomes were achieved in 19/21 Grade I, 29/33 Grade II, and 14/19 Grade III cases; no poor outcomes were observed. PROMs demonstrated high satisfaction across all grades, with a trend toward lower satisfaction in more severe deformities. No major complications, including ectropion or lower eyelid malposition, occurred. Differences between the grades were not statistically significant (p > 0.05). Tear trough ligament release provides consistent esthetic improvement across all deformity grades by addressing the underlying anatomical tethering. This technique may represent a simplified alternative to volume augmentation or septal manipulation. Further controlled studies are warranted. Level IV, therapeutic study.