眶脂肪重置矫正上睑凹陷

Autogenous orbital septum fat redistrbution in correction of sunken upper eyelid

目的 探讨上睑眶隔脂肪重置及眶脂肪包膜内脂肪颗粒填充矫正上睑凹陷的手术方法及疗效。方法对48例上睑凹陷者，采用切开法重睑成形术常规切口，水甲切开眼轮匝肌，剪开眶隔膜，显露眶脂肪，松解眶脂肪包膜与眶隔膜间的疏松连接，将移位的脏脂肪牵引、复化到凹陷区，并做定位缝合。对眶脂肪容量不足的患者，在凹陷区的眶脂肪包膜内注入适量脂肪颗粒．并向后上方部分推移。达眶上缘空虚的区域，复位眶隔膜以补不足，常规缝合切口。结果 48例（96只眼）中32例（61只眼）获6-42个月随访，平均随访11个月，上睑凹陷消失，重睑线流畅、两侧对称，跟部外观接近美学标准，无并发症。结论对上睑凹陷患者，施行眶脂肪重新分配和（或）眶脂肪包膜内脂肪颗粒移植，使眶脂肪的位置和容量达到解剖结构上的恢复，有利于眼外形的美化．可取得良好的手术效果。

Objective To study the effect and methods of orbital septum fat redistribution or autogenous orbital septum granular fat transplantation methods on upper eyelid depression. Methods Blepharoplasty incision was used to cut open musculus orbicularis oculi and septum orhitale horizontal ly, exposuring orbital fat, the conjunction was relieved between orbit fat envelope and septum orbit- ale, displaced orbital fat was extended and replaced to the depression region of upper eyelid, and the wound was routinely sutured. For orbital septum fat volume depletion, appropriate amount of granular fat was injected into depression region and put fat backward upto supraorbital margin. Then, rescuing orbital septum and closing incision were conducted with suture technique of blepharoplasty. Results Of 48 cases （96 eyes）, 32 cases was followed-up for 6 to 42 months with mean of 11 months. All ca- ses got ideal outcomes, with smooth and symmetry lid folds, depression of upper eyelid were fixed and no complication occurred. Conclusions Orbital septum fat redistribution or autogenous orbital septum granular fat transplantation can anatomically reduce the fat distribution of upper eyelid. This method is easy and effective to improve the appearance of eyelid.