重睑成形术后不对称的原因及修复前后比较

Reasons of asymmetry after blepharoplasty and comparison around repair

目的探讨重睑成形术后重睑不对称的发生原因、修复策略及修复后的效果。方法2013年7月至2018年6月,四川大学华西医院整形外科/烧伤科收集各类重睑术后出现双侧重睑不对称患者73例,男14例,女59例,年龄18~42岁,中位年龄27岁。术前重新设计重睑线,术中彻底松解上睑皮下组织纤维粘连、修整下唇眼轮匝肌、调整提上睑肌腱膜固定位置反复比对。让患者及医师在手术修复前后对重睑外形评分,用t检验比较两组评分差异。结果73例重睑不对称患者术后均获矫正,切口均Ⅰ期愈合。随访8~12个月,患者重睑外形满意、双侧重睑线条流畅自然、双侧重睑对称性改善且高度一致,3例(4.1%)术后存在重睑线欠流畅,小切口重新缝合固定后随访未出现并发症。手术后患者及医师评分均高于术前,差异有统计学意义。结论分析重睑成形术后外形不对称产生的原因并实施修复,能再次形成重睑并达到较好的美学修复效果。

Objective To probe into the causes,reconstructive strategies,and repair outcomes of asymmetric eyelid configuration after blepharoplasty.Methods All 73 patients(14 males and 59 females)with asymmetric double eyelid after blepharoplasty were recruited between July 2013 and June 2018 from Department of Plastic and Burns Surgery,West China Hospital,Sichuan University.The patients aged from 18 years to 42 years with the median age of 27 years.The new double eyelid line was designed pre-operation.Releasing subcutaneous adhesion of upper eyelid entirely,trimming inferior orbicularis oculi,adjusting and comparing the attachment position of bilateral levator aponeurosis were performed during surgery.Patients and surgeons marked the appearance of double eyelid both before and after repair operation,results of which were analyzed by t-test.Results All 73 patients obtained improved double eyelid with primary healing.During follow-up from 8 to 12 months,repaired double eyelid showed satisfactory configuration with smooth natural double eyelid line and symmetric bilateral double eyelid.Of the 73 patients,3(4.1%)complaint rough double eyelid line,for whom re-fixation through small incision were adopted and no complication was observed during follow-up time.Scores by patients and surgeons were both significantly better after surgery.Conclusions Analyzing the causes of asymmetric eyelid after double-eyelid blepharoplasty and repairing it contribute to aesthetic pleasing reconstructed double eyelid.