脂肪重置联合上睑提肌缩短修复宽重睑的手术效果

Application of fat redistribution combined with shortening of upper eyelid levator muscle in repair of wide double-eyelid

目的针对重睑术后皱襞过宽用上睑局部脂肪重置联合上睑提肌缩短进行矫正手术,观察效果。方法2015年1月至2016年12月,湖南省郴州市第一人民医院整形美容科选择重睑术后皱襞过宽畸形女性患者20例,年龄20~50岁。病程6个月至12年。重新设计美学重睑线,切除原有重睑线与新重睑线之间皮肤或原有切口瘢痕,充分松解各组织间瘢痕粘连,利用眶隔内脂肪或眶深脂肪、眶隔前脂肪联合Roof重置,阻断粘连,并结合上睑提肌缩短进行修复。结果20例均随访1~12个月,宽重睑变窄,上睑下垂及凹陷明显改善,重睑形态自然,睁眼有力。17例经1次手术矫正,术后重睑形态满意,2例术后因双侧眼裂高度不一、经再次修整后效果满意,1例效果欠佳。结论利用脂肪重置联合上睑提肌缩短不仅可修复重睑术后皱襞过宽合并上睑下垂、上睑凹陷等畸形,还可提高角膜暴露率,增加术后眼睛明亮度,符合美学要求。

Objective To evaluate the clinical efficacy of topical fat redistribution in combination with shortening of upper eyelid levator muscle in patients with excessively wide palpebral fissure after double-eyelid operation.Methods Twenty patients with excessively wide palpebral fissure after undergoing double-eyelid operation were selected.The double-eyelid line was aesthetically re-designed,the skin or incisional scar between the original and new double-eyelid lines was excised,and the scarring adhesion among different tissues was fully isolated.The fat tissues within the orbital septum,deep orbit and anterior orbital septum combined with ROOF reconstruction were performed to block the adhesion tissues,shortening of levator muscle of the upper eyelid was equally conducted to enhance the cosmetic effect.Results Seventeen patients were satisfied with the cosmetic appearance following once double-eyelid operation.Two cases underwent twice operations due to different height between bilateral papebral fissures.One patient was unsatisfied with the cosmetic appearance.Conclusions Fat redistribution in combination with shortening of levator muscle of the upper eyelid can not only repair excessively wide palpebral fissure complicated with ptosis and upper eyelid depression,but also enhance the exposure rate of the cornea and increase the cosmetic appearance,which is consistent with contemporary aesthetic perception.