眶隔复位法重睑成形术的效果观察

Observation of the effect of blepharoplasty using orbital septum reduction method

目的探讨将眶隔及内容物向上复位的切开法重睑成形术的临床效果。方法自2020年3月至2021年3月,重庆美莱整形美容医院整形中心采用眶隔复位法对25例单睑患者行切开法重睑成形术。按照睑板高度设计重睑对应宽度及去皮量;切开皮肤并切除拟去除皮肤,沿切口下唇切开眼轮匝肌至眼轮匝肌后脂肪(retro-orbicularis oculi fat,ROOF)层,分别提起上下唇眼轮匝肌将眶隔游离,在眼轮匝肌后方游离至睑板上缘1~2 mm,在睑板上3~4 mm处切开眶隔去除多余眶隔脂肪及眶隔壁,缝合收紧眶隔,最后分别在内、中内、中间、中外、外侧经下唇皮肤-眼轮匝肌-睑板上缘筋膜-上唇眼轮匝肌-皮肤缝合5针,其余对位缝合即可。结果25例患者获随访3~12个月,术后重睑均未见变浅或消失,睁闭眼舒适、无紧绷、牵扯感。2例右侧早期出现3层重睑,4周后均恢复正常;1例因上睑凹陷,游离脂肪眶隔移植后仍觉不够饱满,其余患者效果均满意。结论眶隔复位法重睑成形术无需内固定,只需将眶隔复位至睑板上缘阻挡眶内脂肪下移,通过下唇组织自身愈合传导动力,同时无缝线残留及束缚,无“肉条感”、紧绷感,效果稳定,患者满意度较高。

Objective To explore the clinical effect of incisional blepharoplasty with upward reposition of orbital septum and contents.Methods From March 2020 to March 2021,we used the method of orbital septum repositioning to perform 25 cases of incisional blepharoplasty on patients with monolids.The corresponding width and amount of skin removal were designed according to the height of the eyelid plate.The skin was incised and the skin to be removed was removed.The orbicularis oculi muscle was incised along the lower lip of the incision to the retro-orbicularis oculi fat(ROOF)layer.The orbital septum was freed by lifting the upper and lower lips of the orbicularis oculi muscle,and freed to the upper edge of the eyelid plate 1 to 2 mm behind the muscle.At 3 to 4 mm above the eyelid plate,the orbital septum was incised to remove excess orbital fat and orbital septum,and the orbital septum was sutured and tightened.Finally,5 sutures were made between the inner,inner middle,middle,outer middle,and outer sutures of the lower lip skin-orbicularis oculi muscle-fascia above the eyelid plate-upper lip orbicularis oculi muscle-skin,and the remaining sutures were made in place.Results Twenty-five patients were followed up for 3 to 12 months.Postoperative double eyelids were not found to have become shallower or disappeared.The eyes were comfortable when opening and closing,without tightness or pulling sensation.Two patients developed three layers of double eyelids on the right side early,and returned to normal after 4 weeks.One patient felt that the fat in the orbital septum was not plump enough after autologous fat transplantation for upper eyelid depression,but the other patients were satisfied with the results.Conclusion Orbital septum repositioning blepharoplasty does not require internal fixation.It simply repositions the orbital septum to block the downward movement of orbital fat and uses the self-healing power of the lower eyelid tissue to transmit the force.There is no residual sutures or bindings,no"meat strip"or tightening sensation,and the effect is stable,resulting in high patient satisfaction.