整体内固定联合上睑提肌腱膜悬挂治疗臃肿上睑重睑术的效果

Efficacy of integrated internal fixation combined with levator aponeurosis suspension on swollen eyelid blepharoplasty

目的探讨整体内固定联合上睑提肌腱膜悬挂治疗臃肿上睑重睑术的临床效果。方法回顾性纳入2019年1月至2023年11月菏泽市立医院整形美容科收治双侧单睑或隐双伴上睑臃肿患者102例, 男6例、女96例, 年龄18~32岁, 平均25岁。92例为首次重睑术, 11例为埋线术后重睑术, 同期行内眦赘皮矫正术38例。手术用重睑切口下唇软组织整体内固定联合上睑提肌腱膜悬挂重睑术, 术中保留切口下唇各层软组织完整性, 并做睑板前筋膜-眼轮匝肌-真皮深层组织整体性内翻缝合固定。在相应固定点行上睑肌腱膜-眶隔复合瓣悬挂。术后随访观察动、静态下重睑的效果、并发症发生情况及患者满意度。结果 102例患者术后伤口均一期愈合, 未出现明显并发症, 术后瘀血、水肿、瘢痕等症状较轻, 恢复较快。术后随访6~12个月, 平均9个月, 除2例因上睑过于臃肿, 忽视了眼轮匝肌后脂肪去除范围出现术后重睑线变浅外, 100例患者术后形态改善明显, 患者满意度高, 其中非常满意92例(90%), 满意8例(8%), 不满意2例(2%)经修复后达到满意。结论臃肿上睑重睑术中用整体内固定联合上睑提肌腱膜悬挂术后效果好, 重睑动、静态均接近天然重睑, 上睑臃肿外观改善明显, 不易出现重睑不对称及重睑线变浅;患者总体满意度高。

Objective To investigate the clinical effects of integrated internal fixation combined with levator aponeurosis suspension in the swollen eyelid blepharoplasty.Methods A retrospective analysis was conducted from January 2019 to November 2023,involving clinical data of patients with upper eyelid swelling simultaneously possessing bilateral monolid or hooded double eyelid from the Department of Plastic and Cosmetic Surgery at Heze Municipal Hospital.Integrated internal fixation of soft tissue combined with levator aponeurosis suspension for patients with upper eyelids swelling was performed,preserving the integrity of the lower lip soft tissues.The pre-tarsal fascia,orbicularis oculi muscle,and deep dermis were internally flipped and sutured holistically,followed by suspension of the levator aponeurosis-orbital septum composite flap at appropriate fixation points.Postoperative follow-up was conducted to observe the effects of dynamic and static double eyelid,occurrence of complications,and patients'satisfaction.Results A total of 102 patients were enrolled,including 6 males and 96 females,with an age range of 18 to 32 years and a mean age of 25 years.After 6 to 12 months of follow-up with an average of 9 months,all 102 patients experienced primary wound healing with no significant complications,and experienced mild symptoms of congestion,edema and scarring with rapid recovery postoperatively.Except for 2 cases with excessive swollen eyelid preoperatively showed shallow upper eyelid creases after surgery due to inadequate removal of retro-orbicular oculi fat(ROOF),the remaining patients showed significant improvement in eyelid morphology,and high patient satisfaction was achieved,with 92 patients being very satisfied(90%),8 satisfied(8%),and 2 dissatisfied(2%),which were improved after repair to achieve satisfaction.Conclusions The application of integrated internal fixation combined with levator aponeurosis suspension in the swollen eyelid blepharoplasty results in good postoperative outcomes,close-to-natural dynamic and static upper eyelid.Significant improvement in the appearance of upper eyelid swelling,low proportion of asymmetrical upper eyelids and shallow upper eyelid creases is observed.Overall,the patient satisfaction rateis high.