An Orbicularis Oculi-Related Band as a Potential Modifier of Tear-Trough Visibility: A Hypothesis-Generating Observation of a Layered Boundary in a Patient

Background/Objectives: A surface feature first noticed after aesthetic treatment may be misclassified as treatment-created. This single-patient observation examined a stable medial tear-trough contour noticed after midface volumization. The aims were to map its clinically continuous course across anatomical layers and assess whether a superficial orbicularis oculi (OOc)-related component could modify its visibility. Methods: Clinical examination, palpation-guided surface marking, retrospective photography, cone-beam computed tomography (CBCT), thin-section computed tomography (CT), high-frequency ultrasound, and qualitative color Doppler were correlated using the marked course as a common spatial reference. Results: Diffuse fullness decreased after clinically indicated hyaluronidase treatment, whereas a narrower palpable line persisted; retrospective photographs showed similar earlier topography. CT/CBCT identified a bilateral asymmetric osseous correlate confined to the superior medial segment. Ultrasound identified a superficial band-like structure along the medial and inferior border of OOc with sonographic features compatible with an OOc-related muscular component; it was more superficial on the left and separated from the levator labii superioris alaeque nasi/levator labii superioris (LLSAN/LLS) field by adipose tissue. Qualitative color Doppler localized a deeper angular venous pathway and a superficial tributary passing beneath the band. The clinical course was continuous, but its correlates changed by segment and plane. Conclusions: In this patient, the contour was best understood as a layered boundary rather than a single substrate. Changes in surrounding volume may have increased its visibility, while the OOc-related band may have sharpened the edge adjacent to the tear-trough hollow. Layer-specific classification may be useful before corrective treatment is considered.