睑袋整形术同时行眶隔脂肪释放与填充剂矫正泪槽畸形的疗效对比

The contrast of effect of arcus marginalis release and orbital fat preservation and filler in treating tear trough deformity in eyelid bags of plastic surgery

目的:对中面部老化在睑袋整形术的同时矫正泪槽畸形采用眶隔脂肪释放与填充剂矫正的疗效进行对比。方法:46例睑袋整形术,其中33例采用睑袋整形术切口,皮下锐性分离皮瓣约1cm,于皮肤切口缘下方4mm切开眼轮匝肌,眼轮匝肌与眶隔之间钝、锐性游离达眶缘,松解眶肌筋膜韧带(王韧带),于眶缘处分离支持韧带,在骨膜上分离眼轮匝肌达眶缘下1～2cm,弓状缘释放眶隔脂肪并重置,6-0可吸收线将眶隔脂肪固定于眶缘下骨膜上。如果脂肪较多者适当去除部分脂肪,以局部平整为度。去除多余的眼轮匝肌和皮肤后缝合切口;另外13例采用睑袋整形术方法同上,只是不行眶隔脂肪释放,于术后2个月后采用填充剂治疗泪槽畸形。结果:本组46例中33例眶隔脂肪释放重置者,泪槽畸形均矫正,回访3～12个月效果良好。13例填充剂治疗泪槽畸形矫正者,回访3～12个月,其中5例填充爱贝芙者泪槽畸形改善较好,8例填充玻尿酸者,泪槽畸形仍较明显。结论:睑袋整形术时采用眶隔脂肪释放重置矫正中面部老化泪槽畸形是一种很好的方法。虽然填充剂也能解决泪槽畸形,但毕竟有时效性,加之填充剂本身也有一定的并发症,故在睑袋整形术时不要轻易将眶隔脂肪去除。

Objective To contrast the curative effect of arcus marginalis release and orbital fat preservation and filler in treating tear trough deformity on the aging of facial plastic surgery of the eyelid bags. Methods 46 cases of lower eyelid bags were operated, including 33 cases of eyelid bags plastic surgery incision, dissected the skin flap about lcm area ,designed orbicularis oculi incision beyond the skin incision 4mm and cut it, separated orbicularis muscle from orbital septum to the orbital rim, released the orbital fascia ligament （Wang ligament） ,separated supporting ligaments of lower eyelid from the orbital rim, and separated the orbicularis muscle from the orbital rim about 1-2cm area on periosteum, taken arcus marginalis release and orbital fat preservation. If the orbital fat is more enough and some the fat was removed to local area smooth. Removed excess orbicularis oculi muscle and local skin. skin incision was sutured. The other 13 cases of eyelid bags of plastic surgery were, just not released of orbital fat, as above and the filler treated the tear trough deformity after operation 2 months. Results In 46 cases of eyelid bags plastic surgery, 33 cases of arcus marginalis release and orbital fat preservation were perfect effect by-following 3-12 months. The other 13 cases of filler innlude 5 cases of Artecoll and 8 cases of hvaluronic acid. The Artecoll arouD, the tear trouah deformitv was correctedand the hyaluronic acid group,the tear trough deformity was still evident by-following 3 ~12m. Conclusion Arcus marginalis release and orbital fat preservation is a good process for the eyelid bags with tear trough deformity.Fillers can solve the tear trough deformity, but fillers have timeliness and some complications,so the plastic surgery of the eyelid bags do not remove easily the orbital fat.