下睑成形术的术式选择

The choice of lower eyelid blepharoplasty surgery

下睑老化的实质是组织的萎缩和松弛，临床上常将下睑老化表现分成四型：（１）下睑皮肤松弛；（２）眼轮匝肌肥厚；（３）眶内脂肪过多而致的脂肪膨出，或眶膈松弛致使脂肪疝出；（４）混合型。下睑成形术的术式较多，本文就下睑老化四个类型应采取的不同术式作了较详细的分析，提出皮肤松弛型可仅切除多余的皮肤。眼轮匝肌肥厚型可切除部分眼轮匝肌，并同时做眼轮匝肌内外眦悬吊术，以减轻下睑低张。而对眶内脂肪疝出或膨出的患者，大多不切除脂肪，只有当眶膈缩紧术仍无法改变下睑袋外观时，才采取切除疝出的眶膈脂肪的术式。同时还强调了颞部除皱术和眼轮匝肌下脂肪垫在下睑成形中所起的辅助作用。

The essence of lower eyelid aging is relaxation and atrophy.The aging lower eyelid is divided into four types clinically:(1)skin relaxation, (2)hypertrophy of musculus orbicularis oculi, (3)bulging of excessive orbital fat and herniation of orbital fat owing to orbital septum relaxation, (4)mixed type. There are many types of surgery of lower lid blepharoplasty. An analysis is present in detail according to the four types mentioned. In the first type the excessive skin should be removed and in second type partial musculus orbicularis oculi should be removed. At the same time, muscular canthopexy must be done to correct the lower lid hypotonicity. In majority of last type septum fat should not be removed. Bulging fat shouldn't be removed unless septum tightening can't correct the protrusion of the lid. The role of temporal rhytidectomy and suborbicularis oculi fat pads in blepharoplasty are also emphasized, and seventy-eight cases of lower lid blepharoplasty were reported.