眼轮匝肌后脂肪层注射自体脂肪颗粒矫正上睑凹陷的临床效果

Autologous fat graft injection in the layer of retro-orbicularis oculi fat （ROOF） to correct the sunken upper eyelid

目的探索自体脂肪颗粒注射移植矫正上睑凹陷的适应证、更合理的方法及更稳定的疗效。方法选取上睑凹陷患者124例，其中生理性上睑凹陷95例，均为双侧上睑凹陷；重睑术后形成的上睑凹陷29例。在下腹部吸取皮下脂肪，经过微粒化处理后，在没有局部麻醉的状态下填充于上睑凹陷处的眶上缘后方，注射层次为眼轮匝肌深层、眶隔的浅层眼轮匝肌后脂肪（ROOF）层。结果所有患者随访3～22个月，平均7．8个月。104例经过1次注射后，上睑凹陷明显改善，重睑过宽的患者重睑均得到矫正，伴有上睑下垂的患者9例得到矫正，3例上睑下垂无改善。20例上睑凹陷矫正不足，其中15例经二次自体脂肪颗粒注射移植后获得满意效果。另外5例不接受第2次注射。所有患者均未出现感染、硬结等并发症，有16例出现局部瘀斑，7～10d自行消退。结论自体脂肪颗粒注射移植于上睑ROOF层可有效矫正无明显瘢痕粘连的、无明显皮肤松弛的上睑凹陷外形，并可同时矫正伴随的过宽重睑及假性上睑下垂症状。自体脂肪颗粒注射移植是一种高效、安全的矫正上睑凹陷的微创手术方法。

Objective To study the precise indication, reasonable procedure, and stable effect of autologous fat graft injection in the correction of the sunken upper eyelid. Methods There were 124 cases in our study. Ninety-five cases were physiological and bilateral in origin. Twenty-nine cases were resulted from double eyelid surgery. The fat graft was sucked from the lower abdomen, fine particle processed, and then injected within the supraorbital rim, between the orbicularis and orbital septum （ROOF） without anesthetics. Results All patients were followed up for 3-22 months, with average 7. 8 months. Satisfactory correction was attained in 104 cases. In cases of double eyelid over-correction were partly rectified. Nine of ptosis were corrected, although three were not improved. 20 cases had had undercorrection, and 15 obtained satisfactory outcome after second procedure. Except 16 patients had ecchymoses which subsided within 7-10 days, there were no major complications. Conclusions Lipofilling in ROOF of sunken upper eyelid has no obvious scar adhesion or loose skin effectively. It can also correct over-corrected double eyelid and pseudoptosis at the same time. Autologous fat graft injection is an effective, safe and minimally invasive operation for the sunken upper eyelid correction.