摘要
目的：随着年龄的增长,面部衰老最早表现为上睑老化征象：皮肤松弛,出现皱褶,外眦下垂,严重者影响视野；额肌松弛,眉下垂；部分由于眶隔筋膜松弛,眶脂脱出,上睑呈现臃肿,部分眶脂萎缩,上睑凹陷；部分出现不同程度上睑下垂。通过对中老年上睑老化表现和解剖学变化的整体研究,探讨一种针对中老年上睑老化的较简单、损伤小且一次性改善上睑周围老化状态的手术方法。
方法：门诊手术病例84例,均为女性,年龄40-80岁,上睑均存在不同程度老化外观。针对眉形好且原有重睑线者采用眉缘切口,根据眉与睑缘间距采用眉上、下缘不同切口；针对眉形不佳者采用眉部切口,切除部分眉毛；针对患者单睑有重睑要求者行重睑切口；针对上睑松弛严重者行睑缘切口；对眉下垂且有重睑要求者行提切眉联合重睑切口；术中针对不同情况切除多余的皮肤、脂肪和松弛的眼轮匝肌等。针对老年性上睑凹陷,采用眉缘切口额肌筋膜瓣折叠转移的方法,填充凹陷。针对老年性上睑下垂,采用眉缘切口额肌筋膜-上睑提肌腱膜复合瓣折叠悬吊的方法。
结果：门诊84例病人均实施了上睑年轻化手术,从而矫正了眉下垂、上睑松弛、上睑凹陷及老年性上睑下垂等多个上睑老化表现。术后重睑及眉形自然,瘢痕不明显,上睑老化现象得以纠正。
结论：对于上睑老化者,采用多元切口及额肌筋膜瓣、额肌筋膜-上睑提肌腱膜复合瓣整复的手术方法可最大限度地改善上睑松弛,纠正老年性上睑凹陷及老年性上睑下垂。此方法操作简单,对组织损伤小,使功能得到改善并达到持久的眼睑美化、年轻化。患者易于接受,效果好。
Objective:Gradually increase with aging, facial aging is first expres-sed as the aging eyelid:skin slackening, fold appeared, outer canthal droop, severe impact of vision; frontals muscle slackening, eyebrow ptosis; some due to septum orbitale slackening, orbital fat prolapse, showed swollen upper eyelid, part of orbital fat atrophy, invagination of upper eyelid; Some showed different degrees of ptosis upper eyelid. By studying the clinical manifestations and anatomical changes of aging in elderly upper eyelid. study a surgical method which is simpler, less damage and one-time improve upper eyelid aging.
Methods:84 cases out-patient surgery, all are women, aged 40-80 years, there were varying degrees of aging upper eyelid appearance. Eyebrow edge incision is used for patients whose eyebrow lines were good and the original double eyelid, in a different incision, the distance between the eyebrow and lower eyelid is different; for the poor eyebrow use eyebrow incision, removed some eyebrows; double eyelid incision is used for patients with single eyelid who require double eyelid blepharoplast, for serious relaxation of upper eyelid underwent palpebral incision; for brow ptosis and single eyelid who require double eyelid blepharoplast use raised eyebrow or cut eyebrow surgery and double eyelid blepharoplast. Have an operation for removal of excess skin, fat and slack orbicularis muscle and so on in different circumstances. Eyebrow edge incision frontalis muscle flap fold and shifted is used for aged patients who have invagination of upper eyelid; Eyebrow edge incision frontalis muscle and levator muscle flap are used for The elderly ptosis upper eyelid patients,they are fold and suspension.
Results:all the 84 cases of out-patient with upper eyelid rejuvenation were implemented to correct a drooping brow, upper eyelid relaxation, invagination of upper eyelid and senile upper eyelid ptosis and other aging eyelid performance. Both the double eyelid line and eyebrow shape are natural after surgery, scar is not obvious, aging eyelid will be corrected.
Conclusion:For the upper eyelid in aging, using multiple incisions and the frontalis muscle flap frontalis muscle and levator muscle flap to treat the upper eyelid relaxation for maximum. Both the invagination of upper eyelid and senile upper eyelid ptosis are corrected. This method is simple, smallest in the tissue injury, function is improved and achieve a lasting improvement in eyelid beautification, rejuvenation. Easily accepted by patients and effective.
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