title: The anatomy of midfacial ptosis.
abstract: OBJECTIVE
  To investigate the anatomic and histologic changes present in midfacial ptosis.
  
  
  METHODS
  Experimental study applying gross anatomic and histologic techniques to formalin-preserved and fresh-frozen cadaver heads with and without midfacial ptosis. High-resolution surface coil magnetic resonance imaging (MRI) was performed to obtain radiologic correlations.
  
  
  RESULTS
  The orbitomalar ligament was further characterized by identification of a well-developed lateral component in the sub-superficial musculoaponeurotic plane; abnormalities of this important supporting structure were present in the subcutaneous plane in 8 of 10 specimens with midfacial ptosis. The zygomatic and masseteric cutaneous ligaments also were further characterized on a gross anatomic level, and histologic evidence of these two structures was produced. The subcutaneous components of the zygomatic and masseteric cutaneous ligaments were attenuated or not identifiable in 40% and 30% of specimens with midfacial ptosis, respectively. High-resolution surface coil MRI provided exquisite correlations of midfacial anatomy.
  
  
  CONCLUSIONS
  The lateral component of the orbitomalar ligament provides major osteocutaneous midfacial support. Subcutaneous attenuation of the orbitomalar, masseteric cutaneous, and zygomatic ligaments was associated with midfacial ptosis.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Seoul National University College of Medicine, Korea.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lucarelli
authors.forename: S I
authors.initials: SI
authors.lastname: Khwarg
authors.forename: B N
authors.initials: BN
authors.lastname: Lemke
authors.forename: J S
authors.initials: JS
authors.lastname: Kozel
authors.forename: R K
authors.initials: RK
authors.lastname: Dortzbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000473:pathology*; D002102:Cadaver; D005145:Face / Q000473:pathology*; D005152:Facial Muscles / Q000473:pathology*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000473:pathology*