下睑眼袋内入路眶隔脂肪团取出处理后回填矫正泪沟及睑颊沟畸形的效果

Effect of backfilling in correction of malformation of lacrimal sulcus and blepharobuccal sulcus after removal and treatment of orbital septum cellulite through intraocular pouch of lower eyelid

目的:探讨下睑眼袋内入路眶隔脂肪取出处理后回填矫正泪沟及睑颊沟畸形的效果。方法:2019年11月至2022年9月,北京黄寺医疗美容门诊部美容外科行下睑眼袋内入路眶隔脂肪团块取出后颗粒化处理,回填矫正泪沟及睑颊沟凹陷畸形患者42例,男13例、女29例;年龄16~47(23.8±6.9)岁。患者均存在不同程度的眶隔脂肪膨出,轻、中、重度泪沟和睑颊沟凹陷畸形,下睑皮肤不松弛。经下睑结膜切口入路,将自然疝出的眶隔脂肪团剪除,颗粒化处理后装入1 ml注射器中,依据术前划线标记的凹陷区,精准填充至泪沟和睑颊沟凹陷的区域。术后随访3个月,观察手术效果及不良反应。结果:42例患者切口均一期愈合,无血肿感染;2例患者出现皮下瘀斑,48 h后局部热敷,1周瘀斑消退。分别在术后1、2、3个月随访,其中35例患者术后效果满意,眼袋膨出及睑颊沟、泪沟凹陷症状消失。7例眼袋伴泪沟及睑颊沟患者,由于眶隔脂肪量不足,还有轻微凹陷,术前已告知可能需要2次脂肪填充,1个月后于腿部取脂肪颗粒填充泪沟、睑颊沟凹陷,效果满意。结论:下睑内路眼袋眶隔脂肪团取出后处理并回填矫正泪沟及睑颊沟畸形的临床操作简单,手术后满意度高,值得临床应用。

Objective To investigate the effect of backfilling on the deformity of lacrimal sulcus and blepharobuccal sulcus after special treatment of the fat from orbital septum of the pouch in the lower intra-palpebral approach.Methods From November 2019 to September 2022,a total of 42 patients(13 males and 29 females)aged 16-47(23.8±6.9)years with orbital septal fat swelling were treated by the surgical department of Beijing Huangsi Medical Cosmetic Clinic after the removal of orbital fat mass by the intraocular pouch approach.With mild,moderate,and severe lacrimal sulci and blepharobuccal depression deformity,the lower eyelid skin was not relaxed.The naturally herniated orbital septal adipose mass was cut off through the lower eyelid conjunctival incision approach,and then granulated into a 1 ml syringe,which was accurately filled into the depressed area of lacrimal sulci and blepharobuccal sulci according to the depressions marked before surgery.Results The incisions of all 42 patients healed in the first stage without hematoma and infection,and the subcutaneous ecchymosis of 2 cases was observed by local hot compress 48 h later and the ecchymosis subsided 1 week.Follow-up was performed at 1 month,2 months and 3 months,respectively.Among them,35 patients underwent the operation of removing the lower eyelid bag and orbital septum cellulite and backfilling to correct the malformation of lacrimal sulci,and the postoperative effect was satisfactory.The symptoms of puffed eye bags,blepharobuccal sulci and lacrimal sulci depression disappeared,and the wound healed in one stage.7 patients with eye bags accompanied by lacrimal sulci and blepharobuccal sulci were told before surgery that they might need two fat fillings due to insufficient fat content in the orbital septa and slight indentations.One month later,granular fat was taken from the legs to fill the lacrimal sulci and blepharobuccal sulci with satisfactory results.Conclusions The treatment after the removal of orbital septum cellulite and the correction of lacrimal sulcus and blepharobuccal sulcus deformity are simple and satisfactory,and worthy of clinical application.