联合眉部和下睑缘切口矫正上睑区及中面部老化

Combining eyebrow and inferior palpebral margin incision for the facial rejuvenation in the upper eyelid and midface region

目的探讨一种简易、微创、效果好的矫正上睑区域及中面部老化的手术方法。方法采用屑部切口行上睑成形术，同时将眼轮匝肌瓣悬吊于眉深面骨膜上；采用下睑缘下切口，眼轮匝肌下分离，充分分离颧前间隙，通过释放眶脂肪并重置、加固眶隔，以眼轮匝肌瓣转位矫正睑袋及沟槽畸形，通过颧脂肪垫及眼轮匝肌瓣双重悬吊来矫正鼻唇沟加深、面颊部松垂。于术后1周、3和6个月及1、2和3年进行随访、拍照，评估术后效果和恢复时间，并注意观察并发症等。结果2010年2月至2014年10月临床治疗190例，术后均获随访，其中随访6个月13例，1年96例，2年66例，3年15例。8例下睑外眦切口末端有少许猫耳，3～6个月消失；1例一侧悬吊线松脱导致下睑明显外翻，再次手术悬吊矫正；10例术后早期诉眼部有干涩感，双眼上视时有轻微睑球分离，3个月后消失；其余患者效果满意，眉、上睑区域及中面部老化得到良好矫正，无严重并发症出现。结论通过联合眉部和下睑缘切口，对颧脂肪垫及眼轮匝肌进行悬吊，可有效提高上睑区域及中面部年轻化手术效果，方法简单、创伤小、效果可靠。

Objective To investigate a simple, minimally invasive and effective operative method for the facial rejuvenation in the upper eyelid and midface region. Methods Blepharoplasty was combined with suspending orbieularis oculi muscle flap and fixing it on the periosteum underneath the eyebrow through eyebrow incision. Meanwhile, for midface rejuvenation, inferior palpebral margin incision was performed and prezygomatic interspace was separated completely under the orbicularis oculi muscle. The under - eye puffiness and tear trough deformity were corrected through releasing orbital fat, reposition and fastening orbital septum, and transposition of orbicularis oculi muscle flap. And the deep sulci nasolabialis and cheek anetoderma were relieved by dual lifting of malar fat pad and orbicularis oculi muscle flap. Follow- up was taken at the 1 week, 3 months, 6 months, 1 year, 2years and 3 years after operation. Each case was evaluated with postoperative effect, reprocessing time and postoperative complications and underwent photography. Results From Feb. 2010 to Oct. 2014, 190 patients （9 male, 181 female, an average age of 49.03 ±5.67 years） underwent this operation. Obvious improvement on the upper eyelid and midface region was achieved in all the patients after operation without serious or irreversible complication. Conclusions Combining eyebrow and inferior palpebral margin incision, through suspending the malar fat pad and orbicularis oculi muscle flap at the same time, as a simple, minimally invasive and reliable method, can strengthen tile effect of the facial rejuvenation in the upper eyelid and midface region markedly.