下眼袋整形术常见并发症及防治

The prevention and treatment of the common complications in lower eyelid blepharoplasty

下眼袋整形术并发下睑外翻的主要原因是去除皮肤过多或切除眼轮匝肌过多所致。预防要点在于术中掌握好去除皮肤及眼轮匝肌的尺度，应恰到好处。严重外翻者需再次手术修复纠正。下睑凹陷主要是由于去除眶隔脂肪过多所致，故应掌握好去脂的量，术中如发现脂肪去除过多，可将去除的脂肪部分回植，若术后发生凹陷，可行脂肪充填术予以弥补。眼袋部分存留主要是对多余皮肤和脂肪去除的量过于保守所致。两侧不对称，是因术前两侧眼袋大小不一，而去除的皮肤及脂肪量却相同，或是因术前两侧眼袋大小相同，而去除的量不一致所造成，故术中要仔细观察，进行对照，如发现不对称则予调整纠正。血肿系止血不彻底而引起，球后血肿虽然少见但却是严重的并发症，应予以高度重视。去除眶隔脂肪时止血必须彻底，一旦发生球后血肿应及时再次手术止血。此外，作者还对切口线靠下、睫毛脱落、复视、外眦眼裂变小、感染等并发症的发生原因作了分析，提出防治方法。

The lower eyelid blepharoplasty is a common technique in aesthetic plastic surgery-however, the unskillful use of it often leads to some complications, some of them are even severe.Ectropion is mainly due to the excessive dissection of skin or orbicularis oculi muscle. the key point ofpreventing ectropion is to excise the appropriate amount of the skin and the muscle, Reoperation is nec-essary to correct secondary deformity for severe ectropion. The depression of the lower eyelid region isdue to the excessive removal of the fat from septum orbitale, which can be corrected by fat tissue graftfrom the dissected fat during operation or from other parts of the body in reoperation patients. Tooconservative excision of the excess skin and fat leads to residual eyelid bags. Asymmetry can be causedeither by bilaterally identical dissection amount of skin and fat in preoperatively asymrnetrical eye bagsor by bilaterally different dissection aniount in symil1etrical eye bags, reguiring the surgeon's careful ob-servation and comparison between the two eye during operation, Incomplete haemostasis causeshaematoma, yet retrobulbar haematoma,a severe complication reguiring much attention seldom oc-curs, Accurate haemostasis in dissection of fat tissue from septum orbitale is quite essential. wheneverretrobulbar haematoma occurs, reoperation should be performed immediately. Other complicationssuch as a lower incision, peeling of eyelash, diplopia and infection and their prevention and manage-ment are also introduced in the paper.