自体乳糜脂肪注射在辅助修复重睑过宽中的应用

Clinical application of autologous chyle fat injection in the auxiliary repair of over-wide double eyelids

目的探讨上睑内侧皮肤瘢痕组织内注射自体乳糜脂肪辅助修复重睑过宽的临床效果。方法回顾自2015年1月至2018年10月,治疗上睑内侧高于内眦赘皮切口的重睑过宽患者138例(260眼),其中30例(60眼)患者常规行高位瘢痕粘连松解(A组),释放眶隔脂肪阻隔异位粘连后,再低位重新固定形成新的重睑;108例(200眼)患者在A组术式的基础上,对上睑内侧皮肤瘢痕组织采用27 G锐针按多点、多层、少量、多次的原则直接注射自体乳糜脂肪,并对眉下组织较薄者采用1.0钝针于眼轮匝肌下层注射乳糜脂肪(B组),以增加上睑饱满度。随访3～30个月,观察其临床效果。结果 A组:30例60眼,30眼(50%)一次获得成功,30眼(50%)在重新松解高位粘连同时注射自体乳糜脂肪,效果较满意。B组:108例200眼,180眼(90%)一次获得成功,20眼(10%)同法再次补充注射自体乳糜脂肪后,获得较满意的效果。术后保留的上睑内侧皮肤瘢痕组织变软,弹性及重新形成的重睑弧度良好,形态自然,外观较满意。结论对上睑内侧皮肤瘢痕组织内注射自体乳糜脂肪,对预防瘢痕增生,改善皮肤弹性,增加上睑容量及辅助重睑过宽的修复,效果较确切。

Objective To explore the clinical efficacy of autologous chyle fat injection in the auxiliary repair of skin scar tissue in the medial upper eyelid. Methods From January 2015 to October 2018, 138 patients(260 affected eyes) with over-wide double eyelids were divided into two groups. For the 30 patients(60 affected eyes) in group A, conventional loosening was performed for high-position scar adhesion. After releasing the orbital septum fat to separate the ectopic adhesion, a new narrow upper eyelid fold was formed by low-position refixation. There were 108 patients(200 affected eyes) in group B. Based on the treatment method of Group A, the skin scar tissue in the medial upper eyelid was directly injected with a 27 G sharp needle. According to injection guidelines,multipoint and multilayer injections of autologous chyle fat was directly administered in small amounts. In order to increase the fullness of the upper eyelid, a 1.0 blunt needle was used to inject autologous chyle fat in patients with thinner under-eyebrow tissue. The follow-up period was 3 to 30 months, and the clinical effect was observed. Results In group A, 30 eyes(50%) were successful after the first injection. High-position adhesions were re-released and autologous chyle fat was injected at the same time in the other 30 eyes(50%). In group B, 180 eyes(90%) were successful after the first injection. Re-injection of autologous chyle fat to the other 20 eyes(10%) achieved satisfactory results. After the operation, the scar tissue in the medial upper eyelid was softened, the elasticity and reformed radian of the double eyelid was good. The shape was natural and the appearance was satisfactory. Conclusion Autologous chyle fat injection to the skin scar tissue in the medial upper eyelid was effective in preventing scar hyperplasia. It can improve the elasticity of skin, increase the volume of the upper eyelid, and achieve auxiliary repair of over-wide double eyelids. The results were accurate.