Overview
Earlier descriptions of midcheek anatomy did not explain midcheek aging or malar mounds, nor guide safe surgery there. The authors studied the area in cadavers, supported by many dissections during surgery. They describe a space over the cheekbone they call the prezygomatic space.
Findings
- A glide plane space lies over the body of the zygoma (cheekbone).
- It lets the orbicularis oculi move where it covers the zygoma and the origins of the upper lip elevator muscles.
- The space is a cleft between the sub-orbicularis oculi fat (SOOF) and the preperiosteal fat, lined by a fine membrane.
- Retaining ligaments define its triangular boundaries.
- No direct attachments join the orbicularis in the roof to the floor.
- The lower boundary, formed by the zygomatic ligaments, is more rigid.
- The upper boundary, the orbicularis retaining ligament, is more mobile and separates the space from the preseptal space of the lower lid.
- These features determine aging changes in the region and explain much about malar mounds.
- The space can be reached from the temple, lower lid and cheek.
- Zygomatic branches of the facial nerve do not cross the space; they run in its walls and in the SOOF in its roof.
What it means for a patient
- Puffy mounds on the upper cheek, called malar mounds, relate to how this space and its ligaments age.
- The facial nerve branches to the eye muscle run in the walls and roof of this space, not across it. Ask your surgeon how they protect them.
- This is an anatomy study. It does not report results of surgery in patients.
Why this paper matters
It described the prezygomatic space and its ligament boundaries as an explanation for midcheek aging and malar mounds. It also mapped where the facial nerve branches run relative to the space. Cited 235 times (NIH iCite, 2026-09-25).
Terms
- Prezygomatic space: a gliding space over the cheekbone, under the orbicularis oculi muscle.
- Malar mound: a puffy swelling on the upper cheek below the lower eyelid.
- Zygoma: the cheekbone.
- Orbicularis oculi: the ring-shaped muscle around the eye.
- SOOF (sub-orbicularis oculi fat): a fat layer under the orbicularis muscle over the cheekbone.
- Retaining ligament: a fibrous band holding soft tissue to bone.
- Preperiosteal fat: a thin fat layer lying on the bone's outer covering.