摘要
背景：眼袋形成的原因很多,年轻患者多为遗传因素所致眶隔脂肪肥大、增生。随着年龄增长,下睑皮肤弹性降低,眼轮匝肌退行性改变,眶隔膜张力减弱,眶内脂肪经眶隔的薄弱区向前推移形成突出的眼袋。此外,眶下部浅层软组织受重力影响而向颊部下垂而使该部位软组织变薄,形成眶下缘凹陷沟槽。传统眼袋整形术一般采用经结膜入路及经皮肤切口入路两种术式,以去除眶隔脂肪改善外凸畸形为主。多数年轻患者属于下睑脂肪突出型眼袋、皮肤弹性良好、眶睑沟浅而窄,采用结膜入路术式去除疝出脂肪；中老年人除眼袋明显外,常伴有皮肤松弛、眶睑沟深而宽,从侧面观察呈现双凸型,仅切除眶隔脂肪将使下睑不平整,局部凹陷明显,眶睑沟更加显露,故目前多采用Hamra设计的经皮肤切口入路术式,保留并释放眶隔脂肪、提紧眼轮匝肌、切除松弛皮肤。
目的：针对眶睑沟严重而下睑皮肤松弛不明显的眼袋类型,设计适用性较强的手术方法。
方法：术前应先评估患者情况,了解患者对手术效果的期望,进而选择合适的经结膜入路术式,释放并保留眶隔脂肪的手术方法。
结果：12例眶睑沟严重而下睑皮肤松弛不明显的眼袋患者以经结膜入路释放并保留眶隔脂肪术式,改善眼袋。术后经3-6个月以上随访,表明眼袋及眶、睑沟改善明显,无并发症出现。
结论：针对眶睑沟严重而下睑皮肤松弛不明显的眼袋类型,采用经结膜入路术式,释放并保留眶隔脂肪的手术方法可以达到良好的效果。
Background:Lower eyelid occur in young patients for many reasons, mostly due to genetic factors, orbital fat hypertrophy, hyperplasia. As patients age, the elasticity of the lower eyelid is reduced, regression of the orbicularis oculi muscle causes the tension of the orbital membrane to weaken, leading to the formation of dermatochalasis of orbital fat moving forward to the thinner area of the orbital septum. Further, gravity affect the infraorbital superficial soft tissues to prolapse towards the cheek, causing a thinning of the soft tissue and forming the infraorbital depression groove. Conventional surgery for dermatochalasis usually uses either transconjunctival or skin incision, to improve the protrusion by removing orbital fat. Most young patients have fat protrusion of the lower eyelids, good skin elasticity, and shallow and narrow orbitopalpebral sulcus; the transconjunctival route is taken to remove the herniated fat. Other than a prominent depression, older patients present loose skin, with deep and broad orbitopalpebral sulcus; the deformity appeares to have a double convex from the side. Removal of orbital fat may cause an unevenness of the lower eyelids with more prominent partial depression and orbitopalpebral sulcus. Therefore, the skin incision route designed by Hamra was generally used to preserve and release orbital fat, lift the orbicularis oculi muscle, and remove loosened skin.
Purpose:Using the appropriate surgical method to augment cosmetic defects focused on the orbitopalpebral sulcus, for patients without significant loosening of the skin and non-apparent wrinkles in the lower eyelids.
Method:Before operation, we should assess the patient's condition, understand what they expect the results of operation, and then select the appropriate surgical method: blepharoplasty of orbital fat release and preservation through transconjunctival route.
Result:12 subjects received treatment using the blepharoplasty of orbital fat release and preservation through transconjunctival route; both the surgery and recovery process went smooth. The depression of the orbitopalpebral sulcus was corrected or greatly improved during the 3-6 months follow-up; dermatochalasis was improved.
Conclusion:This approach should be used for patients with cosmetic defect focused on the orbitopalpebral sulcus with non-significant loosening and wrinkling of the skin in the lower eyelid for reconstruction.
引文
[1]Camirand A, Doucet J, Harris J. Anatomy,pathophysiology,and prevention of senile enophthalmia and associated herniated lower eyelid fat pads [J]. Plast Reconstr Surg,1997,100(6):1535-1546.
[2]Tessier P. The conjunctiveal approach to the orbital floor and maxilla in congenital malformation and trauma. J Maxillofac Surg,1973,1:3-8.
[3]Hamra ST. Repositioning the orbicularis oculi muscle in the compsite rhytidectomy. Plast Reconstr Surg,1992.90:14.
[4]Schwarz F, Randall P, Conjunctival incision for herniated orbital fat. Ophthalmic Surg,1980,11(4):276.
[5]Hamra ST. Frequent face lift sequelae:hollow eyes and the lateral sweep:cause and repair. Plast Reconstr Surg,1998,102:1658-1666.
[6]Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation[J]. Plast Reconst Surg,1995,96(2):354-362.
[7]杨晓慧,田永成,刘宁,等.美容整形外科手术学[M].长春：吉林大学出版社,2005：442.
[8]De La Plaza R, et al. A new technique for the treatment of palpebral bags. Plast Reconstr Surg,1988,81:677.
[9]杨晓慧,田永成,刘宁,等.美容整形外科手术学[M].长春：吉林大学出版社,2005：442.
[10]高景恒.美容外科学[M].北京：北京科学技术出版社,2003：226-230.
[11]Doxanas M. t Clinical orbital anatomy. Baltimore:Williams and Wilkins.1984.
[12]Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty: technique andcomplications[J]. Ophthalmology,1989,96(7):1027-1032.
[1]Fumas D. W. Festoons, mounds, and bags of the eyelids and cheek. Clin Plast Surg,1993,20(2):367.
[2]Little JW.Three-dimensional rejuvenation of the midface:vo-lumetric resculpture by malar imbrication [J]. Plast Reconstr Surg,2000,105(1):267.
[3]Little JW. Volumetric perceptions in midfacial aging with altered priorities for rejuvenation [J]. Plast Reconstr Surg,2000,105(1):252-266.
[4]Castanares,s:Blepharoplasty for herniated intraorbital fat. Anatomical basis for a new approach. Plast Reconstr Surg;,1951,8:46.
[5]Doxanas M. t Clinical orbital anatomy. Baltimore:Williams and Wilkins.1984.
[6]Camirand A, Doucet J, Harris J. Anatomy,pathophysiology,and prevention of senile enophthalmia and associated herniated lower eyelid fat pads [J]. Plast Reconstr Surg,1997,100(6):1535-1546.
[7]Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation[J]. Plast Reconst Surg,1995,96(2):354-362.
[8]Hester TR Jr, Codner MA, McCord CD, et al. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience [J]. Plast Reconstr Surg,2000,105(1):393-406.
[9]Rocca RD,(李冬梅译)眼整形外科：手术设计与技术.北京：人民卫生出版社,2003,5：80.
[10]王炜,等.眶肌筋膜韧带提紧一眼袋整形的新思路.中华医学美容杂志,2002,6(6)：284.
[11]Furnas DW. Festoons of orbicularis muscle as a cause of baggy eyelids[J]. Plast Reconstr Surg,1978,61(4):540.
[12]Bernardi C, Dura S, Amata PI. Treatment of orbicularis oculi muscle hypertrophy in lower lid blepharoplasty. Aesthetic Plast Surg,1998,22(5):349.
[13]王佳琦,王原路,罗家麟,等.眼轮匝肌悬吊法下睑袋切除术中华整形烧伤 外科杂志,1995,11：66—67.
[14]Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg,1995,96(2):354.
[15]Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty: technique andcomplications[J]. Ophthalmology,1989,96(7):1027-1032.
[16]Tessier P. The conjunctiveal approach to the orbital floor and maxilla in congenital malformation and trauma. J Maxillofac Surg,1973,1:3-8.
[17]Fumas DW. Festoons of orbicularis muscle as a cause of baggy eyelids. Plast Reconstr Surg,1978,61:540.
[18]Mladick RA.The muscle-suspension lower blepharoplasty. Plast Reconstr Surg,1979,64:171-175.
[19]Sachs ME, Bosniak SL. Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty. Aesthetic Plast Surg,1986,10:111-114.
[20]De La Plaza R, et al. A new technique for the treatment of palpebral bags. Plast Reconstr Surg,1988,81:677.
[21]Huang T. Reduction of lower palpebral bulge by plicating attenuated orbital septa: a technical modification in cosmetic blepharoplasty, Plast Reconstr Sgurg,2000, 105:2552-2558.
[22]Hamra ST. Frequent face lift sequelae:hollow eyes and the lateral sweep:cause and repair. Plast Reconstr Surg,1998,102:1658-1666.
[23]Zarem HA, Resnick J. I Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg,1999,103:1041-1043.
[24]濮哲铭,等.内外联合切口睑袋整复术19例报告.中华医学美容杂志2000,6(1)：5.
[25]张余光,张涤生,等.衰老皮肤结构重塑术的实验研究和临床应用.中华整形烧伤外科杂志,1997,5：338.
[26]张选奋,郭树忠.睑裂周围老化的防治进展[J].中国实用美容整形外科杂志,2004,15(4)：206.208.
