[The submalar hiatus]

Abstract

The submalar hiatus is a furrow located below the lower orbital arch; it is oblique downwards and outwards; it divides the cheek in two in some patients; it has been well individualized by artists since Antiquity, notably sculptors; some anatomists have called it the midjugal groove; its anatomical structure is very precise, however its origin is debated; some authors attribute to it the melting of the fat located between the external malar fat compartment and the fatty rim parallel to the nasolabial fold; other authors including myself rather invoke localized fat loss associated with a rotation of the nasolabial fat pad downwards and inwards. In fact, there is a center of rotation at the level of each nostril which has a fixed vascular hilum at depth. The submalar hiatus does not in itself constitute a marked ugliness but it can become a concern for certain patients, both women and men. The surgical correction of the submalar hiatus involves the repositioning of the fatty rim by a facelift, the technique of which can vary between a biplane skin+Smas facelift, with re-tensioning of the Smas upwards and outwards; another solution is the medio-facial lifting described by Le Louarn; finally, there is a non-operative solution thanks to aesthetic medicine using a specific injection technique that we describe.

Keywords: Acide hyaluronique; Anatomie visage; Biplane facelift; Face lipofilling; Facial anatomy; Facial ptosis; Hiatus sous-malaire; Hyaluronic acid; Lifting biplan; Lipofilling face; Medio-jugal sulcus; Ptose faciale; SMAS; Sillon medio-jugal; Submalar hiatus; Valley of tears; Vallée des larmes.