四层次重置联合眶周定点悬吊重建下睑亚单位美学结构

Four-layer reposition combined with periorbital fixed-point suspension to reconstruct the aesthetic structure of lower eyelid subunits

目的探讨下睑缘入路行皮瓣、肌皮瓣、眶隔膜瓣、眶隔脂肪瓣四层次重置联合眶周定点悬吊面中部复合软组织,重建下睑亚单位美学结构的临床效果。方法回顾性分析2019年6月至2021年8月浙江省荣军医院美容整形外科收治的经下睑缘切口行中面部年轻化手术患者的临床资料。手术采用下睑缘入路,行眶隔前间隙、上颌前间隙、颧前间隙松解形成肌皮瓣,释放固定眶隔脂肪瓣,解剖眶隔膜瓣行眶周横纵排列的渔网状交叉缝合固定;坐位上推面部软组织确定中、外侧悬吊点及悬吊组织,进行悬吊点标记、固定,提升并修剪肌皮瓣与下睑缘皮肤重叠部分形成皮瓣等手术操作。术后进行随访,通过患者自评(十分满意、满意、不满意、十分不满意),以及1位未参与手术的整形外科主治医师采用观察者总体美容改善评分法(IGAIS)(-1~3分,分数越高表明改善效果越显著),对下睑亚单位美学结构(笑丘、下睑皱襞、下睑板下沟、睑颊交界区)的重建效果进行评价。结果共纳入96例患者,其中男7例,女89例,年龄38~83岁,平均53岁。所有患者术后1周眼部肿胀基本消退,无血肿、下睑退缩、睑球分离、下睑外翻等并发症出现,无颧骨外侧软组织堆积及悬吊点凹陷畸形;术后随访6~12个月,所有患者笑丘、下睑皱襞、下睑板下沟重建效果好,其中2例睑颊交界区稍明显,呈现轻度脂肪膨出眼袋,3例睑颊沟轻微显现,其余患者睑颊交界区的弧面连续性好。患者自评情况:非常满意76例,满意16例,不满意4例;医生IGAIS评分结果:96例患者评分为(2.43±0.35)分,其中76例3分,16例2分,4例1分。结论经下睑缘入路行皮瓣、肌皮瓣、眶隔膜瓣、眶隔脂肪瓣四层次重置联合眶周定点悬吊面中部复合软组织,能够有效地重建笑丘、下睑皱襞、下睑板下沟、睑颊交界区亚单位美学结构,可获得较好的美学效果。

Objective To investigate the clinical effect of four-layer reposition of skin flap,musculocutaneous flap,orbital septum flap,and orbitum septum fat flap via lower eyelid margin approach,combined with periorbital fixed-point suspension of the midfacial soft tissue,to reconstruct the aesthetic structure of lower eyelid subunits.Methods The clinical data of patients admitted to the Department of Beauty and Plastic Surgery of Zhejiang Rongjun Hospital for midface rejuvenation via lower eyelid margin approach surgery from June 2019 to August 2021 were retrospectively analyzed.The layer above the orbital septal,maxillary space,and zygomatic space were dissected to form a musculocutaneous flap.The septal fat flap was released and fixed,then the orbital septum flap was dissected and to make a net-like fixation in horizontal and vertical arrangement around the orbit.The mid and lateral suspension points and suspension tissues were determined and marked by pushing up the facial soft tissues in the sitting position,followed by fixation.Then,the abondant part of the musculocutaneous flap and the lower eyelid margin skin were trimmed to form a flap.Post-operative follow-up was performed by patient self-assessment(very satisfied,satisfied,dissatisfied,very dissatisfied).One attending plastic surgeon who was not involved in the surgery evaluated the results of the reconstruction of the aesthetic structures of the lower lid subunits,including laughing hill,lower eyelid fold,inferior sulcus of the lower tarsal plate,and eyelid-cheek junction based on global aesthetic improvement scale(IGAIS)(-1 to 3,the higher the score the more significant the improvement).Results A total of 96 patients were included,including 7 males and 89 females,aged 38-83 years,with an average age of 53 years.In all patients,the swelling subsided 1 week after surgery,with no complication such as hematoma,lower eyelid retraction,blepharon separation,lower eyelid ectropion,etc.There was no malar lateral soft tissue accumulation and suspension point sunken deformity.6-12 months postoperative follow-up showed that all patients had expected benefit outcomes in the reconstruction of laughing hill,lower eyelid fold,and inferior sulcus of lower tarsal plate.Yet,fat bulgings at the eyelid-cheek junction were moderately visible in 2 cases,and it is slightly visible in 3 cases.The rest of the patients had good curvilinear continuity in the eyelid-cheek junction area.Patient self-assessment showed that 76 were very satisfied,16 were satisfied,and 4 were dissatisfied.IGAIS score showed 96 patients scored 2.43±0.35,with 76 scored 3,16 scored 2 and 4 scored 1.Conclusion Four-layer reposition of skin flap,musculocutaneous flap,orbital septum flap,and orbital septum fat flap via lower eyelid margin approach,combined with periorbital fixed-point suspension of the midfacial soft tissue can effectively reconstruct the aesthetic structure of the lower eyelid subunits,including the laughing hill,lower eyelid fold,inferior sulcus of inferior tarsal plate and eyelid-cheek junction.