眶周韧带离断联合眶隔脂肪释放改善中面部老化的研究

Clinical application of orbital ligament disruption combined with orbital septum fat release in improving facial aging

目的探讨离断泪沟韧带和眼轮匝肌韧带复合体,释放眶隔脂肪的手术在中面部年轻化应用的效果。方法2018年6月至2019年6月,重庆橙尚医疗美容门诊部美容外科收治眼袋伴泪沟、睑颊沟凹陷患者39例,男2例、女37例,年龄30~58(39±7)岁。用下睑缘切口完全离断泪沟韧带和眼轮匝肌支持韧带复合体,骨膜上钝性剥离贯通眶前间隙、颌前间隙和颧前间隙,充分舒展内、中、外侧眶隔脂肪团,平整下移至眶骨下缘骨膜上,分内、中、外3点固定,同时行眼轮匝肌外眦骨膜悬吊。结果术后随访12个月,39例患者睑袋膨出、泪沟、睑颊沟凹陷得到改善,中面部下垂组织复位较好且效果持久。3例患者术后自觉外眼角牵拉感,3~4周后症状消失。1例患者因术后血肿出现轻度睑球分离,抗瘢痕治疗后3个月症状消失。结论伴有睑袋膨出、泪沟凹陷、睑颊沟凹陷的中面部组织下垂患者,该术式可安全有效地解决衰老问题,达到中面部年轻化目的,值得临床应用。

Objective To explore the clinical effect of the middle facial rejuvenation by cutting off the tear trough ligament and the orbicularis retaining ligament complex,opening the soft tissue spaces,combined with the lower eyelid muscle flap lateral canthus periosteum suspension and the orbital septum fat release.Methods The clinical data of 39 patients with pouch and lacrimal groove,eyelid buccal groove depression in the Department of Cosmetic Surgery,Chongqing Chengshang Medical Beauty Clinic from June 2018 to June 2019 were retrospectively analyzed,including 2 males and 37 females,aged 30-58(39±7)years.Through the incision of lower eyelid margin,the tear trough ligament and the orbicularis retaining ligament were completely severed.Up on the periosteum blunt,the preseptal,premaxillary and the prezygomatic spaces were dissected,and thus the fat of orbital diaphragmatic was fully expanded,by moving down and fixing on the inside,midside and outside periosteum of the inferior edge of the orbital bone.The lower eyelid muscle flap was suspended on the lateral canthus periosteum at the same time.Results The patients were followed up for 12 months,the pouch,lacrimal groove and eyelid buccal groove depression were solved,the ptosis tissue of middle face was restored well and the effect was lasting.3 patients felt the external eye angle traction after operation,and the symptoms disappeared 3-4 weeks later.1 patient had mild eyelid ball separation due to hematoma organization after operation,and symptoms disappeared 3 months after anti scar treatment.Conclusions For patients with pouch,lacrimal groove depression,eyelid buccal groove depression and midface tissue ptosis,the operation can safely and effectively solve the above problems and achieve the purpose of rejuvenation of the middle face,which is worthy of clinical application.