眼轮匝肌后脂肪定向片切矫治上睑臃肿

Directional laminar resection of retro-orbicularis oculus fat: a method for upper eyelid heavinesscorrection

目的探讨应用眼轮匝肌后脂肪定向片切的方法矫治上睑臃肿的有效性。方法2017年6月至2018年5月,南京中医药大学附属医院整形外科应用眼轮匝肌后脂肪定向片切的方法矫治上睑臃肿87例,术前按眶外上区、眶睑沟区、眶睑沟下区3个区域标记上睑臃肿部位,指导眼轮匝肌后脂肪切除和眶脂的处理。采用眶隔瓣内固法完成重睑成形术,倒L法完成内眦赘皮矫正术,切口放置引流片,术后加压包扎。结果术后2例出现右眼血肿,原切口清除血肿,愈合良好。2例左上睑内侧凹陷,1个月后改善。术后随访6~12个月,所有患者上睑臃肿得以改善,手术效果满意。结论眼轮匝肌后脂肪定向片切结合眶脂处理可有效改善上睑臃肿,术中解剖定位眼轮匝肌后脂肪切除范围、眶隔完整保留及眶脂平铺应用是预防并发症的关键。

Objective To apply an operative method of directional laminar resection of retroorbicularisoculus fat( ROOF) for correction of upper eyelid heaviness. Methods From June 2017 to May2018 , 87 cases with preoperative diagnosis of puffy eyes were operated on the technique. In order to guidethe resection of ROOF and orbital septum fat( OF) , the upper eyelid was marked by three areas before theoperation: lateral superior orbital region, orbital blepharoculi, and inferior orbital blepharoculi.Blepharoplasty was performed by septoaponeurosis junctional thickening technique. The epicanthoplasty wascompleted by inverted L-type technique. Drainage skin plate was placed in the incision and postoperativecompression bandage was applied. Results Two patients developed postoperative hematoma in the righteye. The incisions healed well after debridement. Two cases of which developed superior sulcus in the lefteye was improved after one months. The patients was followed 6 months to 12 months after surgery. All thepatients were satisfied with the effect. Conclusions The technique was effective in reducing the heavinessof upper eyelid. In the operation , anatomical positioning of ROOF resection , complete retention of orbitalseptum and the release and anchorage of OF were the key steps to prevent complications.