睑缘切口多点多层次悬吊固定在面中部提升中的应用

Application of multi-point and multi-level suspension and fixation through palpebral margin incision in midface lift

目的探讨经睑缘切口,利用面中部软组织间隙,多点多层次悬吊固定技术提升面中部的临床效果.方法65例病例均为自2017年10月至2019年2月在福建医科大学附属第一医院就诊的面中部衰老患者.其中,初次睑袋整形同时行面中部提升47例;睑袋术后二次面中部提升18例,包含处理睑袋术后并发下睑退缩或睑外翻的患者5例.采用睑缘切口,在眼轮匝肌下分离眶隔前间隙.离断眼轮匝肌限制韧带和泪槽韧带,行骨膜前分离,将眶隔前间隙与上颌前间隙和颧前间隙联通.选择眶下缘内、中、外3点,将颧脂肪垫和浅筋膜垂直向上悬吊固定于眶缘骨膜上.将眼轮匝肌向外上悬吊固定在眶外侧壁骨膜处,从而实现多点多层次悬吊固定提升面中部.结果本组65例,切口均一期愈合.1例术后1个月出现睑球分离,予以行外侧睑板条法外眦成形术,术后得到矫正;1例术后早期出现下睑外侧局部隆起,通过热敷按摩,3个月后好转;其余均无并发症发生.术后随访1~8个月,手术效果满意.结论睑缘切口多点多层次悬吊固定提升面中部,方法简单易行,利用面中部软组织间隙,具有损伤小,出血少,并发症少,临床效果好等特点,是面中部年轻化手术的一种较好选择,尤其适用于睑袋术后再次进行面中部年轻化或并发下睑退缩、睑外翻者.

Objective To explore the clinical effect of the multi-point, multi-level suspension as well as fixation using midfacial soft-tissue spaces for midface lifting. Methods A total of 65 patients with aging midface were admitted at the First Affiliated Hospital of Fujian Medical University from October 2017 to February 2019. Among them, 47 patients underwent primary blepharoplasty and midface lifting. Eighteen patients, including 5 patients with lower eyelid retraction or ectropion after blepharoplasty, underwent secondary midface lifting after blepharoplasty. The preseptal space was separated under orbicularis oculi muscle by palpebral margin incision. The orbicularis retaining ligament and the tear trough ligament were severed through preperiosteal plane. The preseptal space was connected with premaxillary space and prezygomatic space. The malar fat pad and superficial fascia were vertically suspended and fixed on the periosteum of infraorbital ridge by selected medial, middle and lateral points. The orbicularis oculi muscle was suspended and superolaterally fixed at lateral orbital periosteum. Therefore, the midface could be lifted by multi-point, multi-level suspension and fixation. Results All incision healed in the first stage. Eyelid separation occurred to 1 patient, around 1 month after the operation. Tarsal strip lateral canthoplasty was performed for repair. Local protuberance of lateral lower eyelid occurred to another patient shortly after the operation, but improved after 3 months by lid massaging. No other complication was observed in the rest of the cases. All patients were followed up for 1 to 8 months and the results were satisfactory. Conclusions It is simple and practicable to utilize midfacial soft-tissue spaces. This method could benefit patient of less trauma, bleeding, and complications, and good clinical effect. It is a good choice for rejuvenation of the midface, especially for secondary midface rejuvenation after blepharoplasty, or complicated with lower eyelid retraction and ectropion.