综合提紧法睑袋矫治成形术

Comprehensive study on the blepharoplasty with tightening and removing of lower eyelid bag

目的为提高睑袋成形术的效果，延长有效时间，从理论与实际观察探讨下睑袋的形成原因及病理改变，采取相应手术矫正；尝试综合提紧睑袋切除成形。方法在局麻下，沿下睑缘作切口并在外眦部向外下方延长约５ｍｍ，切口与外眦夹角约１３５°，皮下潜行剥离至骨性眶缘，形成皮瓣；在眶隔膜表面分离形成与皮瓣形态一致的眼轮匝肌瓣；如疝出的眶隔脂肪量较多，可适量切除，一般尽量将疝出的眶隔脂肪还纳复位，横纵向折叠缝合眶隔以增加张力；向外上方提紧眼轮匝肌瓣，据情适量楔形切除一块眼轮匝肌缝合以加强下睑的支撑力；最后嘱受术者睁眼向上看并大张嘴，在下睑张力最大的情况下切除多余的皮肤。结果本组共４５例，男性１０例，女性３５例，年龄３５～６７岁，随访２２例３个月至２年，除１例因眼轮匝肌切除过多而产生轻度下睑退缩外，其余均效果满意持久。结论综合提紧法睑袋矫治术，是针对下睑衰老机理及表现而进行的一种手术设计。

Objective To observe and probe the causes and pathological changes of lower eyelid bag, and try to apply comprehensive blepharoplasty for a long term satisfactory effect.Method After local anesthesia, curve incision 1～2mm below to eyelash, extending 5mm to inferior lateral direction at lateral canthus, the angle was approximately 135 degrees. Reseparating in subcutaneous layer to projection point of infraorbital margin skin flap was formed. Muscle flaps were formed on orbital septum with sharp and blunt dissection. Under common conditions, orbital fat was reposited to orbital septum. If there was excessive fat, it had to be cut off. Orbital septum was folded and sutured in transverse and longitudinal direction. Wedge shaped excision of orbicular muscle flap was tightened and fixed to superior lateral direction. Skin flaps were tightened superiorly, redundant skin were excised (opening the mouth and staring to superior) and sutured.Result Of the 45 patients with this operation, 10 were males and 35 were females, aged 35～67. 22 cases were carried out follow up visits from 3 months to 2 years. The short term and long term results were satisfactory for 21 cases. One case showed mild retraction of lower lid.Conclusion This technique of correcting lower lid aging and eyelid baggy can achieve both short term and long term satisfactoryresults.