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Preaponeurotic fat hinders location of septum-levator aponeurosis junction in Asians
Ophthalmology. 2009;116(10):2031-2035.
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Fat volume in the preaponeurotic area sometimes affects eyelid appearance and increases the difficulty of accurately locating the conjunction of the septum and aponeurosis, a study showed.
Findings also showed that anatomic relationships between the preaponeurotic fat pad, orbital septum and distal end of the anterior layer of the levator aponeurosis (DEALLA) in relation to the superior tarsal plate border are similar in Asian and Caucasian eyes.
"It is generally stated that historically, the differences in the clinical appearance of the eyelid crease in Asian and white eyelids have been attributed to an anatomic difference in the relationship between the orbital septum and levator aponeurosis," the study authors said. "However, the basic structures are very similar."
The prospective clinical case series and experimental anatomic study included 22 upper eyelids of 11 Asian patients (mean age, 76.5 years) studied in vivo and 10 eyelid specimens from seven Asian cadavers (mean age, 81 years).
In vivo measurements were performed in patients undergoing blepharoplasty.
"Orbital septum attachment on the levator aponeurosis in Asians seems to be situated above the superior tarsal plate border in vivo, but the preaponeurotic fat extends beyond the DEALLA, sometimes reaching the tarsal plate. In some cadavers, the confluent part was found to be situated on the tarsus laterally," the authors said. "Judging the confluent site of the orbital septum and the levator aponeurosis in Asians, based on the inferior end of the preaponeurotic fat pad, probably is not accurate and probably should not be evaluated based on the DEALLA."