摘要
目的:既往传统睑袋去除眶脂肪术较为简单,对下睑袋臃肿形态进行简单处理,而对面中部过渡区域的泪槽畸形等老化形态却没有改善。本文通过对眶脂肪眶隔弓缘释放下睑袋整复术和传统术式两种方法进行对比,来研究和探讨睑袋整复术中应用眶脂肪眶隔弓缘释放术修复下睑袋方法在临床应用上的优势及其对面中部年轻化的临床效果。
方法:选用需要进行美容手术患者36例。将这些患者进行随机分组,分为两组,每组18例,一组用传统睑袋修复术即去除眶脂肪法,一组用眶脂肪眶隔弓缘释放法睑袋整复术,即在睑袋整形术基础上,将眶隔筋膜打开,原有的眶脂肪去除变为保留,眶脂释放并固定于眶下缘的骨膜或软组织上,以填充眶下缘凹陷区,使下睑较为丰满。两组根据患者皮肤松弛程度、年龄大小、接受度等情况采用经结膜入路或经皮肤入路。在睑袋下缘凹陷区任意定点,测量它与鼻尖所在且与面部平行的垂直平面的距离,术前与术后分别测量,比较和观察前后距离变化,并进行统计学分析。术后一年内进行随访。
结果:本组共36例,于2009年6月至2010年6月期间,随访三个月至一年,术后1名患者略有肿胀,肿胀消退较慢。发现用传统睑袋修复方法的患者对手术较满意,下睑臃肿形态得到明显改善,但是泪槽凹陷等状况改善不明显;有些患者面中部骷髅状老化形态会逐渐显现。应用眶脂肪眶隔弓缘释放术的患者均对手术效果满意,下眼睑袋状外观均消失或改善,下睑眶缘沟、鼻颊沟、眶颊沟等凹陷畸形得到缓解和解决,明显得到矫正,恢复自然、圆润、丰满的下睑轮廓。外眼角、下眼睑及内眦处无明显变化,无眼睑外翻、溢泪、内外眦变形、术后复发、下睑凹陷等并发症。术前与术后通过测量数据发现应用传统睑袋方法测量的距离在术后变化不明显,说明去除眶脂肪后,只是改变其下睑松弛和臃肿形态;而应用眶脂肪眶隔弓缘释放法术后的距离较术前减小,说明下睑凹陷区域被眶隔脂肪下移填平,凹陷区域得以改善,使面中部过渡区得以显现年轻化。
结论:保留眶脂肪的眶脂肪眶隔弓缘释放睑袋整复术是应用弓缘释放法和眶区脂肪转移,这种手术方法是非常有效的方法,同时能使面部年轻化。结合被释放并下移的眶脂肪组织,充填于睑袋凹陷处,与单纯睑袋修复术相比,恢复自然形态。对于鼻颊沟、下眶缘沟及眶颊沟等沟槽畸形患者,较为适合这种手术。从解剖学角度解释成因,从面部衰老征象产生机制矫正睑袋畸形,使其更合理、自然,能够达到眶区面中部年轻化的效果。
Objective:Previous traditional blepharoplasty with removing orbital fat was simple, which handled the fat and clumsy baggy eyelid,but tear trough deformity in the midfacial transition zone was not improved.This article ,by comparing arcus margialis release and fat preservation with traditional method, investigate and explore the advantages arcus marginalis release and orbital fat preservation in lower eyelid blepharoplasty in clinical application, and its clinical effect in midface rejuvenation.
Methods: Select 36 cases,the patients need the blepharoplasty. Devided in two groups at random,for one group, we have the operation of the traditional blepharoplasty ,that is,to remove the orbital fat. For the other group,we have the operation of lower blepharoplasty using arcus marginalis release and orbital fat preservation,that is,on the basis of traditional blepharoplasty, instead of resection of obital septum fat ,orbital fat was exposed by dissection of orbital septum,the exposed orbital fat was moved by sitching it to periosteum or soft tissue of the orbital rim to fill the introcession in the inferior orbital rim, so a more natural looking plumpish eyelid was obtained.They use the methods through the transconjunctival approach or transcutaneous approach according skin relaxation,age and acceptance,etc. The point was fixed in any introcession of the lower eyelid.The distance of the point to the vertical plane which is passed by nasal tip and parallelled with face was measured before or after surgery. Changes of distances were observed and compared, which were conducted by statistial analysis. The patients were followed up for three months to one year.
Results:36 patients were followed up for three months to one year in June 2009 to June 2010.One patient showed slow swelling. The patients of using traditional methods are satisfied with the surgery. baggy deformity is improved,but an improvement of introcession is not obvious.Some patiens will appear skeleton-like aging gradually.Using arcus margialis release methods make patients satisfied, and baggy deformity, herniation of the orbital fat, eyelid orbital margin groove, nasojugal groove and palpebromalar groove have been alleviated and resolved, obviously been corrected.Restore the natural, mellow and full lower eyelid contour. External canthus of the eye, lower eyelid and the inner canthus are not significant changes, no ectropion, epiphora, internal and external canthal distortion, recurrence, complications such as lower eyelid introcession. We found the changes unobviously for traditional method which only changed the loosen skin and baggy deformity under resection of the orbital septum fat through measuring the data before or after surgery,and The latter,changes of distances become greater,the introcessions are filled by orbital fat,midfacial rejuvenation can be achieved in transition zone.
Conclusion:The lower blepharoplasty combined with orbital fat preservation is using the arcus marginalis release and fat preservation over the orbital rim.The technique is an effective method that can be performed concomitantly with facial rejuvenative procedures. Orbital septum fat which was released and moved down was filled in the introcession of lower eyelid.It restore the natural appearance. Anatomically, this article explain the causes,and correct baggy eyelid deformity according to signs of facial aging mechanism of to make it more reasonable and natural, can be achieved in the effect of orbital midfacial rejuvenation.
引文
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