BACKGROUND: Tear trough deformities (TTD) refer to a set of conditions leading to different shapes in the junction between the lower eyelid and the cheek. Tear trough deformity is a major aesthetic concern for a lot of individuals seeking periorbital rejuvenation and is one of the most discussed landmarks in facial aesthetic surgery. OBJECTIVE: To describe a new morphologically related classification system, providing an objective means to evaluating the deformity. METHODS: The article proposes a new classification system exhibiting 5 different forms of a TTD based on the author's clinical experience and review of medical literature. CONCLUSION: Five forms of a TTD include a "hill" due to the superficial infraorbital fat pad herniation; a "valley" caused by fat reduction and skin changes; a "hill-valley" resulting from the weakening of the orbital portion of the orbicularis oculi muscle and its retaining ligaments, followed by fat reduction and skin changes; a "hill-valley-hill-valley" formed by a series of changes in portions of the orbicularis oculi muscle and its retaining ligaments; and a "mixed" form depicting a range of any of the 4 deformities. Classification of TTD is of great value to aid the treating physician in choosing the appropriate treating options.
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