Anatomy curriculum expands—
surgeons identify new body part
Anatomy textbooks are now incomplete!A previously unrecognized fascial (fibrous tissue) structure, an impenetrable membrane located beneath the muscle and fat under the eye, has been identified by Joel E. Pessa, MD, assistant professor and director of plastic surgery’s section of cleft and craniofacial surgery; and Jaime R. Garza, MD, DDS, assistant professor and division head of plastic and reconstructive surgery, at the Health Science Center.
The two surgeons named this mound, most easily seen on aging persons, the malar septum. Malar, from the Latin mala or malae, refers to the jaw or cheekbone and denotes the origin of the anatomical structure; septum describes the partitioning nature of the membrane, which acts as a barrier to fluid and pigment.
To find the cause of the swelling, the surgeons did three studies using cadavers. They found the malar septum, which was identified and documented.
To remove unsightly bags from under the eyes, plastic surgeons have historically excised the skin and used liposuction to remove fat from this area, then repositioned the ocular muscles. Despite common use of this surgical technique, knowledge of the anatomy of malar mounds has been incomplete.
Drs. Pessa and Garza noticed swelling and edema under patients’ eyes after facial surgery or when a black eye occurs. Since both conditions produce the same sharply defined lower border as malar mounds, some type of barrier was indicated (see top photo and illustration on the next page).
"It was like a mystery, a puzzle," Dr. Pessa said, "and we were detectives. In research, you never know when a discovery will be made or if it will be of use, and to whom.
"The nice thing is, we were just searching, looking, and now this blepharoplasty (surgery to correct eye defects) helps other plastic surgeons understand why swelling occurs, and this, in turn, will help many, many patients," Dr. Pessa added. "Here we are in the ’90s and so much still remains, just waiting to be discovered."
"This work underscores the importance of research and academic institutions in the field of aesthetic surgery," Dr. Garza said. "Dr. Pessa’s lab at the Health Science Center has several ongoing projects related to other areas of the aging face. We look forward to continuing to understand the aging process and to reporting our findings to our colleagues."
Dr. Pessa received the American Society for Aesthetic Plastic Surgery’s Tiffany Award for the best scientific paper after presenting this discovery at the Aesthetic Society’s meeting in Dallas in 1994.
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