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Anatomic Relationship of SOOF and ROOF in Eyelid Rejuvenation
The Clinical Problem: Prominent Bulging Suborbicularis Oculi Fat Pad and Retro-Orbicularis Oculi Fat Pad ( Fig. 9.1 )
The aging lower eyelid can be a complex and difficult problem to improve aesthetically. There is considerable risk of over-resection of both fat and skin, with consequent pull-down ectropion and permanent hollowness. An anatomic understanding of the superficial and deep face fat compartments is crucial when attempting to relocate, reduce, or augment the suborbicularis oculi fat pad (SOOF) or retro-orbicularis oculi fat pad (ROOF) during periorbital rejuvenation.
Anatomy
Upper and Lower Eyelids
These are composed of an anterior lamella and posterior lamella separated by the orbital septum. The anterior lamella is formed by the skin and underlying orbicularis oculi muscle. The orbital septum, originating from a band of thickened periosteum at the orbital rim (the arcus marginalis), separates both lamellae and is often referred to as the middle lamella.
The posterior lamella is composed of the tarsal plate, eyelid retractors, and conjunctiva. Fibers from the capsulopalpebral fascia attach to the anterior lamella a few millimeters below the tarsus to form the lower eyelid crease. The forces imposed by the lower eyelid retractors and the canthal ligaments determine the position of the lower eyelid margin.
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