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A Quantitative Three-Dimensional Tear Trough Deformity Assessment and Its Application in Orbital Septum Fat Transposition

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  • Oculoplastic
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Abstract

Background

Existing evaluation tools of tear trough deformity are based on subjective impression of clinicians. More accurate quantitative assessment methods are needed. This study aimed to propose a quantitative three-dimensional assessment method for the tear trough deformity in comparison with the Barton’s grading system and apply it to the efficacy evaluation of orbital septum fat transposition.

Methods

117 healthy Chinese adults (234 eyes) were enrolled and divided into four groups according to the Barton’s grading system. Three-dimensional facial images were captured using Vectra H1 handheld camera. 6 anthropometric landmarks were identified on each eye and 8 linear measurements were generated accordingly. Intra-observer reliability was determined and measurements were compared between groups. Pre- and post-operative three-dimensional measurements were compared in 19 patients who received lower blepharoplasty with orbital septum fat transposition.

Results

The severity of tear trough was positively correlated with age (P < 0.001) but not BMI (P = 0.145) or gender (P = 0.280). Intra-rater reliability of the 8 linear measurements was excellent except for the vertical distance between the palpebrale inferioris margin and the tear trough below the pupillary center. Intergroup comparison showed that the horizontal distance between the lateral end of tear trough (P < 0.001) and medial canthus and the sagittal vector from tear trough point toward eyelid bag point (P = 0.009) increased with grade, while the vertical distance from mid-pupil to palpebrale inferioris margin decreased gradually (P = 0.001). Orbital septum fat transposition significantly improved the tear trough deformity as assessed by these three-dimensional measurements.

Conclusions

We demonstrated a novel quantitative evaluation method of the tear trough deformity using three-dimensional stereophotogrammetry and proved it to be valid and reliable. It showed good value of clinical application and might help with periorbital rejuvenation planning and outcome assessment.

Level of Evidence IV

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Funding

The work was supported by National High Level Hospital Clinical Research Funding, grant No. 2022-PUMCH-B-041

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Author notes

  1. Yuyan Yang, Zenan Xia and Yue Shi have contributed equally to this article.

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing, People’s Republic of China

    Yuyan Yang, Zenan Xia, Yuanbo Kang, Yuming Chong, Wenchao Zhang & Lin Zhu

  2. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing, People’s Republic of China

    Yue Shi

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  1. Yuyan Yang
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  2. Zenan Xia
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Correspondence to Lin Zhu.

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The authors have no financial interest to declare in relation to the content of this article.

Ethical approval

This study was approved by the Institutional Review Board of the Peking Union Medical College Hospital (No. JS-2807) and conducted in accordance with the Declaration of Helsinki.

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All participants provided written consent for the use of their 2D and 3D facial images.

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Yang, Y., Xia, Z., Shi, Y. et al. A Quantitative Three-Dimensional Tear Trough Deformity Assessment and Its Application in Orbital Septum Fat Transposition. Aesth Plast Surg 47, 2453–2460 (2023). https://doi.org/10.1007/s00266-023-03474-0

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