提眉术联合下睑缘切口中面部提升术治疗上下睑松弛临床观察
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摘要
目的:探讨一种实用有效的治疗上下眼睑松弛老化的手术方法。方法:选取2012年1月-2017年12月于笔者医院行提眉联合下睑缘切口中面部提升术治疗上下睑松弛的患者32例。手术在局麻下进行,于眉下作内窄外宽的刀形切口,全层切除上睑松弛皮肤,折叠缝合收紧肌层后缝合上下切缘。随后,于下睑缘距睫毛平行2mm处切开皮肤,向下分离皮瓣,保留5mm睑板前眼轮匝肌,切开皮肤及眼轮匝肌,广泛分离眶膈前间隙、颧骨前间隙、颌骨前间隙,行眶膈脂肪重置、中面部提升、眼轮匝肌瓣锚着固定。对患者术后眼周形态及面部年轻化程度进行观察。结果:所有患者对手术效果均满意,其中29例表示满意,满意率达90.6%,3例表示基本满意。术后上下眼睑松弛老化消失,面中部提升明显,在面部年轻化显现的同时上眼睑无闭合不全,下眼睑无外翻,未出现增生性瘢痕。结论:提眉联合下睑缘切口中面部提升术联合行眶膈脂肪重置,在治疗上下睑松弛的基础上,可以有效提升面中部,是一项综合多项技术整体性恢复面部年轻化的手术方式,值得临床推广应用。
Objective To seek an effective surgical method for upper and lower eyelid laxity and aging. Methods From January 2012 to December 2017, 32 patients with upper and lower eyelid laxity treated by eyebrow lifting combined with middle facial lift in the incision of lower eyelid margin in the author's hospital were selected. The operation was underwent in local anesthesia. The flabby skin of the upper eyelid was completely removed through an inner wide and outer narrow incision under the eyebrow. The upper and lower cut edges were sutured after folding and suturing to tighten the muscle.Then,incise the skin with 2mm distance from lower eyelid edge, the incision is parallel with the eyelash. Keep separating downward the flap,incise the skin and orbicularis oculi muscle after 5mm anterior tarsal plate orbicularis oculi muscle are reserved. The following procedures including the wide separation of the preseptal,premaxillary and prezygomatic spaces,the septal fat reset,the midcheek lift and orbicularis oculi flap anchored.The postoperative appearance of eyelid and facial rejuvenation were observed.Results Among the 32 patients, 29 patients were satisfied with the operation, the satisfaction rate was up to 90.6%. 3 patients were basically satisfied and all of them were sufficed by the operation. After the procedure,the upper and lower eyelids of the patient were rejuvenated, the visible midcheek lift effect were obvious as well. While the facial rejuvenation was shown, there was no incomplete upper eyelid closure, no valgus of the lower eyelid, and no hyperplastic scar. Conclusion The procedure of eyebrow lifting combined with midcheek lift through lower eyelid margin incision with the septal fat reset, not only lead to an obvious effect on upper and lower eyelid laxity but also can effectively lift the mid-cheek of the face. This is a comprehensive surgical method to restore facial rejuvenation and deserves to be generalization and application.
Objective To seek an effective surgical method for upper and lower eyelid laxity and aging. Methods From January 2012 to December 2017, 32 patients with upper and lower eyelid laxity treated by eyebrow lifting combined with middle facial lift in the incision of lower eyelid margin in the author's hospital were selected. The operation was underwent in local anesthesia. The flabby skin of the upper eyelid was completely removed through an inner wide and outer narrow incision under the eyebrow. The upper and lower cut edges were sutured after folding and suturing to tighten the muscle.Then,incise the skin with 2mm distance from lower eyelid edge, the incision is parallel with the eyelash. Keep separating downward the flap,incise the skin and orbicularis oculi muscle after 5mm anterior tarsal plate orbicularis oculi muscle are reserved. The following procedures including the wide separation of the preseptal,premaxillary and prezygomatic spaces,the septal fat reset,the midcheek lift and orbicularis oculi flap anchored.The postoperative appearance of eyelid and facial rejuvenation were observed.Results Among the 32 patients, 29 patients were satisfied with the operation, the satisfaction rate was up to 90.6%. 3 patients were basically satisfied and all of them were sufficed by the operation. After the procedure,the upper and lower eyelids of the patient were rejuvenated, the visible midcheek lift effect were obvious as well. While the facial rejuvenation was shown, there was no incomplete upper eyelid closure, no valgus of the lower eyelid, and no hyperplastic scar. Conclusion The procedure of eyebrow lifting combined with midcheek lift through lower eyelid margin incision with the septal fat reset, not only lead to an obvious effect on upper and lower eyelid laxity but also can effectively lift the mid-cheek of the face. This is a comprehensive surgical method to restore facial rejuvenation and deserves to be generalization and application.
引文
[1]樊芙蓉,刘毅,刘阳,等.改良上睑整形术治疗老年性上睑皮肤松弛[J].中国美容医学,2017,26(11):1-3.
[2]Mendelson BC,Hartley W,Scott M,et al.Age-related changes of the orbit and midcheek and the implications for facial rejuvenation[J].Aesthetic Plast Surg,2007,31(5):419-423.
[3]吴文渊,孔豫苏,鲁加祥,等.不同术式治疗中老年女性上睑区松弛的临床效果[J].中华医学美学美容杂志,2017,23(1):39-42.
[4]李长江,李攀,王青宾.眉下切口上睑提升术的临床应用分析[J].中国美容整形外科杂志,2011,22(4):240-242.
[5]邵仁玲.分析面中部提升术结合睑袋整形术对眶周皮肤皱纹的疗效与美容影响[J].当代医学,2018,24(9):75-77.
[6]Turkmani MG.New classification system for tear trough deformity[J].Dermatol Surg,2017,43(6):836-840.
[7]Wong C,Hsieh MK,Mendelson B.The tear trough ligament:anatomical basis for the tear trough deformity[J].Plast Reconstr Surg,2012,129(6):1392-1402.
[8]Wong CH,Mendelson B.Midcheek lift using facial soft-tissue spaces of the midcheek[J].Plast Reconstr Surg,2015,136(6):1155-1165.
[2]Mendelson BC,Hartley W,Scott M,et al.Age-related changes of the orbit and midcheek and the implications for facial rejuvenation[J].Aesthetic Plast Surg,2007,31(5):419-423.
[3]吴文渊,孔豫苏,鲁加祥,等.不同术式治疗中老年女性上睑区松弛的临床效果[J].中华医学美学美容杂志,2017,23(1):39-42.
[4]李长江,李攀,王青宾.眉下切口上睑提升术的临床应用分析[J].中国美容整形外科杂志,2011,22(4):240-242.
[5]邵仁玲.分析面中部提升术结合睑袋整形术对眶周皮肤皱纹的疗效与美容影响[J].当代医学,2018,24(9):75-77.
[6]Turkmani MG.New classification system for tear trough deformity[J].Dermatol Surg,2017,43(6):836-840.
[7]Wong C,Hsieh MK,Mendelson B.The tear trough ligament:anatomical basis for the tear trough deformity[J].Plast Reconstr Surg,2012,129(6):1392-1402.
[8]Wong CH,Mendelson B.Midcheek lift using facial soft-tissue spaces of the midcheek[J].Plast Reconstr Surg,2015,136(6):1155-1165.