title: New Classification System for Tear Trough Deformity.
abstract: BACKGROUND
  Tear trough deformities (TTD) refer to a set of conditions leading to different shapes in the junction between the lower eyelid and the cheek. Tear trough deformity is a major aesthetic concern for a lot of individuals seeking periorbital rejuvenation and is one of the most discussed landmarks in facial aesthetic surgery.
  
  
  OBJECTIVE
  To describe a new morphologically related classification system, providing an objective means to evaluating the deformity.
  
  
  METHODS
  The article proposes a new classification system exhibiting 5 different forms of a TTD based on the author's clinical experience and review of medical literature.
  
  
  CONCLUSIONS
  Five forms of a TTD include a "hill" due to the superficial infraorbital fat pad herniation; a "valley" caused by fat reduction and skin changes; a "hill-valley" resulting from the weakening of the orbital portion of the orbicularis oculi muscle and its retaining ligaments, followed by fat reduction and skin changes; a "hill-valley-hill-valley" formed by a series of changes in portions of the orbicularis oculi muscle and its retaining ligaments; and a "mixed" form depicting a range of any of the 4 deformities. Classification of TTD is of great value to aid the treating physician in choosing the appropriate treating options.
authors.affiliation: Department of Dermatology, Derma Clinic, Riyadh, Saudi Arabia.
authors.forename: Mohammed G
authors.initials: MG
authors.lastname: Turkmani
mesh_terms: D002610:Cheek / Q000002:abnormalities*; D000013:Congenital Abnormalities / Q000145:classification; D005143:Eyelids / Q000002:abnormalities*; D006801:Humans