Overview
The deep attachments of the facial fascia had been mapped as retaining ligaments in the forehead, temple and cheek, but not in the lower lid and outer eye corner. The authors dissected 6 fresh cadavers with tissue slides and matched the findings to what they saw in surgery.
Findings
- 6 fresh cadavers dissected, with histology; correlated with surgical observations.
- The deep fascia of the orbicularis muscle is attached to the bone of the orbital rim by the orbicularis retaining ligament.
- This attachment is weakest in the center and tightest over the lower outer orbital rim.
- Beyond the outer eye corner, the ligament joins a wider fibrous attachment, the lateral orbital thickening, which runs over the outer orbital rim onto the deep temporal fascia.
- With age, these supports weaken, letting the lower border of the lid move down and adding to typical aging in the area.
- In the outer eye region, the superficial fascia is continuous, linking the temporoparietal fascia and orbicularis fascia to the lateral canthal tendon through the tarsal plate.
- Releasing the lateral orbital thickening and orbicularis retaining ligament matters in some canthopexy and rejuvenation procedures.
- Release allows the lower lid orbicularis and the tissue over the upper cheek to be moved up and redraped.
What it means for a patient
- The lower eyelid and upper cheek are held to bone by ligaments that loosen with age, letting the lid-cheek border drop.
- Lifting the lower lid and upper cheek well requires releasing these ligaments.
- Ask your surgeon whether your facelift or eyelid surgery includes this area.
- This is a 6-cadaver anatomy study. It does not report surgical results.
Why this paper matters
It defined the retaining ligaments of the lower lid and outer eye corner and linked their weakening to lower lid aging. Cited 191 times (NIH iCite, 2026-09-25).
Terms
- Orbicularis retaining ligament: a band holding the eye's ring muscle to the bony rim of the eye socket.
- Lateral orbital thickening: a dense fibrous area at the outer edge of the eye socket.
- Lateral canthus: the outer corner of the eye.
- Canthopexy: surgery to tighten or support the outer eye corner.
- Tarsal plate: the firm plate that gives the eyelid its shape.
- Premalar: over the upper cheekbone.