Zygomatico-buccal groove
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The bucco-zygomatic groove is a linear or arcuate depression visible in the midface, usually running obliquely from the medial part of the cheek toward the zygomatic region. In English-language literature, it most often corresponds to the terms midcheek groove, malar groove, or mediojugal groove. It forms at the boundary of structures differing in mobility, thickness, and volume: the skin, retaining ligaments, orbicularis oculi muscle, as well as the superficial and deep fat compartments of the cheek. Its visibility is not merely an epidermal issue or a single wrinkle. It constitutes a three-dimensional manifestation of anatomical structure or midface aging; therefore, proper correction requires an assessment of the cheeks, the infraorbital region, the zygomatic bones, skin quality, and potential malar edema.
Cheek-zygomatic groove - what is it
The palpebromalar groove is an anatomical depression at the border of the lower eyelid and the cheek, the course of which depends on the arrangement of retaining ligaments, fat tissue distribution, and the projection of the zygomatic bone and the maxilla. It should not be equated with a wrinkle resulting from epidermal creasing. It is an alteration of the facial contour, visible primarily through the contrast of light and shadow.
Factors contributing to the formation of the groove include:
- the zygomaticocutaneous ligament, which stabilizes the skin over the zygomatic eminence;
- the lateral part of the orbicularis retaining ligament;
- connective tissue septa separating the fat compartments of the cheek;
- superficial and deep fat compartments of the midface;
- the orbicularis oculi muscle and the underlying SOOF (sub-orbicularis oculi fat);
- the bony support of the maxilla, the inferior orbital rim, and the zygomatic bone.
The groove can be present even in young individuals, particularly in cases of reduced midface projection, thin subcutaneous tissue, or prominent ligamentous attachments. With age, it typically becomes more visible. It frequently coexists with cheek flattening, tear troughs, orbital fat pseudoherniation/bulging, malar bags, or festoons, although these are distinct features requiring separate assessment. Evaluation is performed both at rest and while smiling, under frontal and oblique lighting.
Zygomatic-malar groove - how does it differ from the tear trough
The terms “tear trough” and “palpebromalar groove” are sometimes used interchangeably, but they do not refer to the exact same structure. The distinction is important because each of these deformities may require a different location, depth, and treatment approach.
Feature | Palpebromalar groove | |
Typical location | Medial infraorbital area, from the inner canthus of the eye to the pupillary line area | Medial and lateral part of the cheek, usually below or lateral to the tear trough |
Key anatomical basis | Tear trough ligament and attachments in the maxillary area | Zygomatic ligaments, cheek septa, and fat compartment boundaries |
Clinical presentation | Shadow and hollow under the medial part of the lower eyelid | Oblique line or crease crossing the cheek |
Main aggravating factors | Infraorbital volume deficiency, orbital fat bulging, thin skin | Loss of cheek volume, tissue descent, strong ligament attachment |
Therapeutic approach | Cautious infraorbital correction, sometimes following prior cheek support | Midface restoration, selective groove filling, or tissue lifting |
The tear trough usually ends near the pupillary line, whereas the palpebromalar groove can be its lateral or oblique extension. In some individuals, both depressions merge, creating a continuous boundary between the lower eyelid and the cheek. Before treatment, it is also necessary to rule out malar edema, malar bags, and festoons. Administering a volumizing product in an area with impaired lymphatic drainage can exacerbate swelling instead of improving the contour.
Cheek-zygomatic groove - why does it deepen
The deepening of the groove is the result of overlapping bone, ligamentous, fat, and skin changes. Facial aging does not solely consist of gravitational „skin sagging”. Individual layers change at different rates, and adjacent fat compartments do not lose volume evenly.
The key mechanisms include:
- congenital predispositions: low projection of the zygomatic bone or maxilla, negative vector of the infraorbital region, thin subcutaneous tissue, and strong ligamentous attachments;
- craniofacial bone remodeling: age-related changes of the inferior orbital rim, maxilla, and zygomatic complex reduce support for soft tissues;
- atrophy of deep fat compartments, including the tissue beneath the orbicularis oculi muscle and deep cheek fat;
- displacement of superficial fat compartments, which increases the contrast between the cheek convexity and the fixed ligamentous line;
- loss of collagen, elastin, and glycosaminoglycans, leading to thinning, reduced elasticity, and poorer skin adherence;
- photoaging, smoking, chronic oxidative stress, and significant body weight fluctuations;
- natural asymmetry of bones, muscles, and fat compartments.
Rapid weight loss can reveal or deepen the groove by reducing cheek volume. In turn, swelling located above the groove increases contour contrast and may seemingly intensify its depth. Therefore, prior to treatment, it is necessary to determine whether volume deficit, laxity, ligamentous attachment, edema, excess skin, or several mechanisms simultaneously predominate.
Malar groove - how to reduce it
The choice of method should be based on an anatomical examination, not solely on the depth of the visible line. Cosmetics can improve skin hydration and the skin surface, but they will not rebuild deep structural support or alter ligamentous attachments.
The Ambasada Urody offer includes the following procedures, which may be included in an individual treatment plan:
- cheek and facial contouring with cross-linked hyaluronic acid: restores cheek projection and midface support; direct filling of the groove itself is not always necessary;
- biostimulatory fillers, including products containing poly-L-lactic acid with hyaluronic acid and calcium hydroxyapatite: serve to gradually rebuild the structure and volume of appropriately qualified areas;
- tissue stimulators, polynucleotides, amino acid and collagen preparations, mesotherapy with non-cross-linked or partially stabilized hyaluronic acid: improve skin quality, hydration, and density, but on their own do not compensate for significant volume loss;
- HIFU SonoQueen, 3D microneedle radiofrequency, classic radiofrequency, Zaffiro, and Palomar Deep IR: can improve tension and collagen remodeling in cases of tissue laxity;
- fractional lasers, Microplasma Pixel RF, chemical peels, and needle mesotherapy: primarily improve skin quality and minor irregularities;
- lifting threads and Needle Shaping autologous threads: may be considered in cases of tissue descent or insufficient support;
- Icoone, facial endermologie, cryoplasty, iontophoresis, and firming massages: serve a supportive role, primarily for skin quality and microcirculation.
In the case of festoons, significant excess skin, or orbital fat herniation, a surgical consultation may be more appropriate. Injections in the infraorbital and zygomatic regions require a physician who knows vascular anatomy. Possible complications of fillers include swelling, lumps, product show-through, asymmetry, compression of lymphatic drainage, and rare but serious vascular occlusion.
