Davis Jared M, Choo Joshua, Brooks Ronald, Gossman Douglas
Aesthet Surg J Open Forum. 2025 Jun 3;7:ojaf050. doi: 10.1093/asjof/ojaf050. eCollection 2025.
The anatomic basis of lower eyelid bulging remains enigmatic, and the concept of compartmentalization is often used to describe bulge location but does not completely explain the cause of periorbital aging.
The authors of this study aim to explore lower septal structure, including the concept of adipose tissue compartmentalization, and assess relevance to aesthetic presentation and operative rejuvenation.
The inferior orbital septa of 10 cadavers (20 lids) were dissected with magnification, with special attention to contiguous tissues, such as orbital fat, orbicularis oculi muscle, tarsus, and inferior oblique muscle. The cadaveric specimens were 71 to 83 years old (mean = 75). Subsequent comparative observations were made in 63 consecutive patients undergoing lower lid blepharoplasty for eyelid distention. The age range was 35 to 82 years (mean = 63).
Both cadavers and patients demonstrated a loose anterior membrane deep to the postorbicular fascia and discrete, transverse ligamentous elements deep to the anterior membrane. In surgical patients, evaluation of the posterior adipose tissue space disclosed a posterior septal membrane that joined the anterior septal membrane at the superior transverse ligament, creating a discrete compartment isolating the adipose tissue from the eyelid protractors and retractors. Variation in the gross fibrous characteristics of septal constituents was observed in both cadavers and operative patients, and this accounted for observed patterns of clinical presentation.
Lower lid topography is predictive of the fibrous character of the underlying septal components, and topography is useful for surgical planning.
下眼睑膨出的解剖学基础仍不明确，间隔化概念常被用于描述膨出位置，但并不能完全解释眶周衰老的原因。
本研究作者旨在探究下睑隔结构，包括脂肪组织间隔化概念，并评估其与美学表现及手术年轻化的相关性。
对10具尸体（20只眼睑）的眶下隔进行放大解剖，特别关注相邻组织，如眶脂肪、眼轮匝肌、睑板和下斜肌。尸体标本年龄在71至83岁之间（平均75岁）。随后对63例因眼睑膨隆而接受下睑成形术的连续患者进行了对比观察。年龄范围为35至82岁（平均63岁）。
尸体和患者均显示在眼轮匝肌后筋膜深层有一层疏松的前膜，在前膜深层有离散的横向韧带成分。在手术患者中，对后脂肪组织间隙的评估发现一层后隔膜，它在上横韧带处与前隔膜相连，形成一个将脂肪组织与眼睑牵开器和收缩器隔离开的离散腔隙。在尸体和手术患者中均观察到隔成分的大体纤维特征存在差异，这解释了观察到的临床表现模式。
下睑形态可预测其下方隔成分的纤维特征，该形态对手术规划有用。
