Recurrence of Lower Eyelid Fat Pads (Herniated Fat) after Blepharoplasty: An Analysis of Different Operative Techniques

Background: Aging changes to the lower eyelids and midface include all but not only these changes: pseudoherniated orbital fat, tear trough deformity, lid laxity, and dermatochalasis. Surgical repair often aims at treating redundant skin or orbital fat malposition with a lower eyelid blepharoplasty. In manipulating the inferior orbital fat pads, a surgeon has many options including excision, repositioning, or augmentation with synthetic dermal filler, autologous fat grafts, or acellular dermal allografts [1]. The aim of this study is to find the best approach in preventing fat herniation reccurnce in lower lid blepharoplasty. Methods: The patients in study were classified into three groups depending on the used surgical technique, to test the most effective technique associated with minimal rate of lower fat pad recurrence after surgery. Two of these techniques include a muscular flap suspension from the orbicularis oculae muscle. Results: The two surgical techniques that include orbicularis oculi muscle suspension are associated with no recurrence of lower herniated fat pads after blepharoplasty. Conclusions: The suspension of orbicularis oculi muscle has an important role in enhancing the lower orbital septum and prevents the recurrence of the lower herniated fat pads.

Progress of laser and light treatments for lower eyelid rejuvenation

Laser and light treatments have recently become popular owing to its efficacy in treating laxity,rhytids,hyperpigmentation of the lower eyelids,and drooping of septum fat.For several decades,our department has explored the application of laser and light treatment for eye rejuvenation.This paper summarizes common treatment methods and analyzes the published literature on the indications and outcomes of multiple laser and light treatments for lower eyelid rejuvenation.An extensive survey of peer-reviewed literature was performed using PubMed,with the search terms“noninvasive treatment”,“infraorbital”,“palpebral bags”,“lower eyelid”,“radiofrequency(RF)”,“laser”,“nonsurgical skin tightening”,and“noninvasive fat reduction”.The results showed that the use of lasers,intense pulsed light(IPL),monopolar RF,bipolar RF,AdipoLASER rejuvenation(ALJ),and fractional RF microneedling are safe and effective treatments for palpebral bags.We conclude that using Qswitched lasers,IPL,RF,ALJ,and fractional RF microneedling is safe and effective for lower eyelid rejuvenation,with minimal complications and quick recovery.Further research and development of optoelectronic therapy may encourage breakthroughs in lower eyelid treatment,such as simplified complex surgery and noninvasive methods.

Total lower lid reconstruction: clinical outcomes of utilizing three-layer flap and graft in one session

AIM:To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.METHODS:Seventeen patients with total or near total lower eyelid defect were included.The defects were reconstructed in three layers.Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim.Mobilization of residual orbicularis muscle provided a rich blood supply;and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.RESULTS:The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them.No intraoperative and postoperative complication occurred.Patients were followed from 10 to 15mo postoperatively.Cosmetic results were favorable in all patients and we had acceptable functional results.Thickness of the reconstructed tissue was a concern in early postoperative period.CONCLUSION:Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.

Modified lower eyelid blepharoplasty improves aesthetic outcomes in patients with hypoplastic malar prominences

Aim: Aging affects the appearance of the eyelids and the surrounding malar region. Blepharoplasty improves the aesthetic appearance of this region, and multiple variants of the procedure have been reported. We here report our technique for modified lower lid blepharoplasty and cheek lift for patients with hypoplastic malar regions, which was introduced after observing prominent lower orbital rims in patients with flat malar prominences after blepharoplasty. Methods: This technique combines standard canthopexy and cheek-lift for rejuvenation of the mid-face with redraping of orbital fat and concurrent sub orbicularis oculi fat pad (SOOF) lift to 'double-breast' the lower orbital margin. Data on 33 patients who had undergone this modified lower lid blepharoplasty was collected retrospectively. Results: Thirty-three patients underwent the modified lower lid blepharoplasty resulting in smooth and youthful appearance of the malar region that was consistent and sustained. No recurrence of V-deformity was observed on a median follow-up of 14 months. twenty-two (66.6%) and 11 (33.3%) patients were pleased and satisfied with postoperative outcomes respectively. Three (9.1%) patients experienced minor postoperative complications and no major complication was observed. Conclusion: The proposed modified lower lid blepharoplasty is a safe and effective alternative to the existing technique with improved aesthetic outcomes and therefore is recommended in patients with flat malar prominences.

眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果观察

目的:观察眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛的美学效果。方法:回顾性分析2020年10月-2022年10月在笔者医院治疗的62例上睑皮肤松弛患者临床资料,根据治疗方法不同分为联合治疗组(n=32)和眉下切口组(n=30),联合治疗组行眉下缘切口提升术联合重睑术,眉下切口组行眉下缘切口提升术,术后对患者进行随访,比较两组术后矫治效果,上睑缘至眉距离(The distance between the upper eyelid margin and the eyebrow,DEE)、睑裂宽度(The height of the palpebral fissure,HPF)、瞳孔中点睑缘与重睑距离(Middle pupil margin-fold distance,MPMFD)、角膜内侧睑缘与重睑距离(Medial corneal margin-fold distance,MCMFD)以及外眦处睑缘与重睑距离(Lateral canthus margin-fold distance,LCMFD)、上睑皱纹改善效果(Lemperle评分)、术后外观满意度、术后并发症发生率。结果:治疗后,联合治疗组DEE、HPF、MPMFD、MCMFD、LCMFD均高于对照组(P<0.05);治疗后,两组患者Lemperle评分均有所降低,但联合治疗组低于眉下切口组(P<0.05);治疗后,联合治疗组术后外观满意度96.88%高于眉下切口组76.67%(P<0.05);治疗后,联合治疗组与眉下切口组并发症发生率比较,差异无统计学意义(P>0.05)。结论:眉下缘切口提升术联合重睑成形治疗中重度上睑皮肤松弛,能够有效改善上睑松弛情况,减少上睑皱纹,且患者外观满意度较高。

改良下睑整复术联合调Q1064 nm激光治疗黑眼圈的疗效及安全性分析

目的观察改良下睑整复术联合调Q1064 nm激光治疗混合型黑眼圈疗效和安全性。方法选择2019年8月-2022年7月笔者医院收治的中年男女混合型黑眼圈患者60例,均行皮肤切口改良下睑整复术并联合调Q1064 nm激光治疗,疗程4个月,记录求美者疗效、并发症情况,统计满意度、术前、治疗后2~4个月黑素指数和红斑指数变化。结果治愈32例(53.3%),显效14例(23.3%),好转10例(16.6%),无效(6.7%)总有效率93.3%;随访4个月,术后未见切口感染、血肿、睑外翻和退缩等明显并发症;2例出现轻度睑球分离,7-10天自然消失;3例激光治疗后红斑,冰敷后消退。治疗2个月和4月后患者眼周黑素指数分别为(112.53±18.12)和(97.30±10.17),红斑指数为(1.81±0.67)和(1.16±0.33),明显低于治疗前眼周黑素指数(149.37±18.12)和红斑指数(3.05±0.75),差异有统计学意义(P<0.05);治疗后求美者满意42例(70%),基本满意14例(23.3%),不满意4例(6.7%)总满意率93、3%。结论改良下睑整复术联合调Q1064nm激光治疗中年男女混合型黑眼圈,疗效确切,可有效缩短治疗周期,求美者满意度高。

分层策略性手术矫正下睑下至术后下睑退缩的疗效观察

目的探索下睑下至术后下睑退缩的手术矫治方法及疗效。方法对27例下睑下至术后下睑退缩的病例(54侧)追溯原手术入路方式,结膜入路,共9例,占33.33%;皮肤入路共9例,占33.33%;双入路,同时行结膜入路与皮肤入路者,共9例,占33.33%。根据入路方式及临床表现,初步判断下睑前层、中层、后层退缩情况。手术均采用皮肤入路,拆除中层及后层固定缝线,采用Hamra释放弓状缘和保留眶脂肪的下睑成形术,松解眶隔及眶脂肪层的瘢痕挛缩,采用横切纵缝法恢复中层及后层弹性及解剖位置。对于前层的缺损和不足,采用悬吊眼轮匝肌及提升中面部皮肤加以补充。结果27例术后随访2~36个月,平均13.1个月。所有患者的下睑退缩均得到明显矫正,满意率达93.5%。结论下睑下至导致的轻中度下睑退缩,拆除缝线,松解瘢痕粘连后复位良好,结合Hamra下睑成形术及眼轮匝肌悬吊术,可实现良好的矫治效果。

单极射频联合超脉冲CO_(2)激光经结膜入路下睑袋整形术在眼周年轻化治疗中的应用

目的:探究单极射频联合超脉冲CO_(2)激光经结膜入路下睑袋整形术在轻中度眼周皮肤松弛及皱纹治疗中的应用效果。方法:选取2017年6月-2022年6月在笔者医院就诊的轻中度眼周皮肤松弛及皱纹就医者182例,随机分为观察组(n=92)和对照组(n=90),对照组给予超脉冲CO_(2)激光经结膜入路下睑袋整形术治疗,观察组在此基础上联合单极射频治疗,对比两组治疗后美学效果、不良反应,以及手术前后症状积分、Fitzpatrick评分及医患治疗满意度。结果:术后1个月,观察组睑袋减轻、眼周皱纹改善、皮肤色泽增强有效率分别为78.26%、81.52%、85.87%,高于对照组的64.44%、67.78%、73.33%(P<0.05);术后6个月,观察组睑袋减轻、眼周皱纹改善、皮肤色泽增强有效率分别为95.65%、96.74%、94.57%,高于对照组的76.67%、81.11%、83.33%(P<0.05);术后6个月,观察组肤色晦暗、色素沉着、眼睑凹陷及皮肤质地各项症状积分均小于对照组(P<0.05);术后1个月及术后6个月观察组Fitzpatrick评分均低于对照组(P<0.05);医生及就医者满意度分别为97.83%、98.91%均高于对照组的88.89%、92.22%(P<0.05);两组并发症对比差异无统计学意义(P>0.05)。结论:单极射频联合超脉冲CO_(2)激光经结膜入路下睑袋整形术可有效改善就医者眼周皮肤松弛与皱纹,促进眼周年轻化。

眼轮匝肌楔形切除联合眶隔释放法在中老年睑袋整形中的应用

目的探讨眼轮匝肌楔形切除联合眶隔释放法在中老年睑袋整形手术中的临床效果。方法选择2020年10月至2021年10月贵阳市第二人民医院收治的下睑皮肤及眼轮匝肌松弛、眶隔脂肪疝出的中老年睑袋病人20例,经皮肤切口入路,分离出皮肤与眼轮匝肌间隙以及眼轮匝肌与眶隔膜间隙,行眶隔脂肪释放并将脂肪团用丝线反折固定缝合于下睑凹陷部位,楔形切除部分外侧眼轮匝肌并精细缝合断端,将眼轮匝肌提紧固定在外侧眶骨膜上,并去除多余皮肤。结果20例睑袋病人,术后随访3~12个月,眶下区皮肤松弛、眼轮匝肌松弛、脂肪突出得到改善,无感染、血肿、下睑外翻、睑球分离等并发症发生,未出现睑袋复发,术后效果满意。结论采用眼轮匝肌楔形切除联合眶隔释放法进行睑袋整形手术,在不改变原有眶下区解剖结构的基础上,从横纵两个方向加强眶前壁的力量,使下睑形态更加自然,达到去除睑袋的目的,对下睑支持结构松弛的中老年病人具有良好的效果。

结膜入路整形术治疗下眼袋的临床疗效分析

目的探讨结膜入路整形术治疗下眼袋的临床效果。方法55例行下眼袋整形术患者,随机分为观察组(30例)和对照组(25例)。观察组患者行结膜入路整形术,对照组患者行皮肤入路整形术。比较两组患者的手术效果、术后切口愈合良好率及下眼袋复发率、术后并发症发生情况、对手术治疗的满意度评分。结果观察组患者手术总有效率为100.0%,高于对照组的84.0%,差异具有统计学意义(P<0.05)。观察组患者术后切口愈合良好率93.3%高于对照组的68.0%,下眼袋复发率0低于对照组的24.0%,差异具有统计学意义(P<0.05)。观察组患者术后眼睑外翻、流泪、水肿、异物感、皮肤瘢痕、感染、色素沉着发生率分别为0、6.7%、3.3%、6.7%、0、3.3%、0,均低于对照组的20.0%、28.0%、24.0%、28.0%、24.0%、20.0%、24.0%,差异具有统计学意义(P<0.05);观察组患者术后框下凹陷、血肿发生率低于对照组,但差异无统计学意义(P>0.05)。观察组患者对手术过程、术后恢复过程、术后恢复效果及总体评价满意度评分分别为(97.29±1.43)、(98.55±1.06)、(97.92±1.33)、(98.51±1.27)分,均高于对照组的(94.71±3.25)、(95.48±2.13)、(93.72±2.17)、(94.52±2.13)分,差异具有统计学意义(P<0.05)。结论对于手术去除下眼袋治疗,结膜入路整形术的临床效果显著,手术切口愈合良好,二次复发率低,同时术后并发症少,患者对于手术治疗的满意度较高,值得临床推广应用。

改良的下睑缘切口在眼袋整复术及中面部年轻化中的应用

目的:探讨改良的下睑缘切口在眼袋整复术及中面部除皱术中的应用。方法:经下睑缘切口完成眼袋整复术,并行眼轮匝肌、中面部SMAS筋膜的悬吊以达到面部年轻化的效果。结果:50例患者术后经过3～18个月术后随访,眼袋去除,面中部松弛得以改善,鼻唇沟纹变浅,部分鱼尾纹消除,面部年轻化效果明显。结论:下睑缘切口设计隐蔽而合理,术中创伤小,手术效果好,适用于眼袋明显及面中部轻、中度松弛患者。

眼袋术后睑外翻的早期非手术治疗策略

目的:探讨一种早期矫正眼袋术后睑外翻的非手术治疗方法。方法:对眼袋术后轻中度睑外翻行早期积极干预:早期仅采用弹力胶布牵引固定,如术后14 d还未完全矫正则采用曲安奈德局部注射联合弹力胶布牵引固定治疗。结果:对15例(20侧)眼袋术后睑外翻患者早期积极处理后,所有病例睑外翻均获完全矫正。结论:早期应用弹力胶布牵引固定联合曲安奈德治疗对眼袋术后的睑外翻有良好的治疗效果,是一种简单、安全、有效的方法。

眶区年轻化策略——王韧带松解及提紧的睑袋整形术(待续)

目的研究眶区老化改变的动态解剖,下睑眶区筋膜韧带功能和睑袋手术方法的改进.方法通过尸体解剖和数千例睑袋手术的临床实践,阐明眶肌筋膜韧带(王韧带)的解剖,及其在睑袋手术中的应用;结合文献复习,对下睑眶区韧带的作用进行了比较性研究,并进行了下睑老化的分类和睑袋手术方法的改进.结果在眶区老化中,皮肤、皮下组织、肌肉的松弛较韧带的松弛明显.采用眶肌筋膜韧带(王韧带) 的松解、提紧是眶区年轻化的有效手段.眶肌筋膜韧带位于眼外眦韧带内下方,眼轮匝肌外侧1/3的深面.起于眼轮匝肌外1/3的深面,和下睑板外侧1/3下缘,止于上颌骨眶下缘的外下1/4骨膜,长约12～15 mm,宽约10～12 mm.眶肌筋膜韧带松解、提紧睑袋整形术,较其他手术方法更能提紧下睑松弛皮肤3～5 mm.不仅提紧了下睑皮肤,而且可提紧颧眶区松弛的组织.结论王韧带松解、提紧睑袋整形术,其方法创伤小,能够有效地矫正下睑松弛,使眶区达到年轻化的效果.

保留下睑缘轮廓的睑袋整复术

目的:探讨一种保留下睑缘轮廓线的睑袋整形术。方法:在下睑睫毛下2～3mm处作切口,经轮匝肌下入路去除膨出眶脂和松弛皮肤,缩短眼轮匝肌悬吊于外眦,收紧眶隔,上移眼轮匝肌重叠缝合,重建下睑缘轮廓线。结果:350例患者均获良好效果,下睑缘轮廓自然。5例早期出现睑外翻,术后1月随访时外翻情况已消失,情况满意。结论:保留下睑缘轮廓的睑袋整形术能获得更好的术后效果。

应用改良肌皮瓣法下睑袋整复术180例临床体会

目的:探讨提高下睑袋整复术的手术效果。方法:对180例下睑袋整复求术者,术中根据设计先去除多余的皮肤,用电刀切开眼轮匝肌、眶隔,将膨出的三团脂肪予以去除,伸展眼轮匝肌,再去除多余皮肤,将切口上、下缘眼轮匝肌重叠缝合,依次缝合皮肤。结果:术后恢复迅速,下睑皮肤平整,无睑退缩且睑缘有适度"眼轮匝肌门槛"形成,远期瘢痕不明显。出现暂时性睑外翻1例,随访效果满意。结论:通过对下睑袋整复术式的改良,有效地加快恢复、减轻了术后的并发症,改善下睑外形,达到微创年轻化矫治目的。

眶隔缩紧在改善睑袋整复效果中的作用

目的 评价缩紧眶隔在提高睑袋整复效果中的作用。方法 ①采用经皮肤入路下睑成形术切口 ,在眼轮匝肌与眶隔之间剥离至眼轮匝肌下缘 ,形成皮肤 -肌肉瓣。②向下牵拉皮肤 -肌肉瓣 ,显露眶隔与眶下缘。③沿眶下缘剪开眶隔 ,释放眶内脂肪 ,如眶内脂肪过多 ,可做部分切除。④将眶隔下缘连带眶脂肪下缘缝合固定于眶下缘下方 3～ 5mm处的骨膜上 ,以缩紧眶隔和填充眶下缘前方的凹陷区。⑤切除多余的皮肤与肌肉 ,缝合切口。结果 自 1999年以来 ,共施术 5 2例 ,其中 2 7例患者随访 3～ 12个月 ,除 1例术后因发生下睑退缩做第 2次手术矫正外 ,其余均获得满意的美容效果。结论 眶隔紧缩对提高睑袋整复的美容效果具有重要作用和意义 。

个性化下睑袋整形术2057例临床经验总结

目的:回顾2 057例下睑袋整形术的临床经验,总结针对不同患者的个性化下睑袋整形手术方案。方法:根据下睑皮肤和眼轮匝肌松弛度、睑板前眼轮匝肌肥厚度、眶隔脂肪膨出程度、泪沟凹陷程度不同,有针对性地采用不同的手术技术,改善患者的下睑袋。2001～2010年临床应用2057例。结果:本组患者随访2～84个月,下睑袋改善效果明显,无并发症,满意率达99.76%。结论:针对不同类型下睑袋采用个性化的技术方法十分必要。

眼袋术后下睑退缩的整复

目的探讨眼袋术后下睑退缩的形成机制,退缩程度的分型及根据不同类型的不同手术方法修复的临床效果。方法2000～2007年,采用经外眦下睑提升固定术;眼睑囊筋膜,下睑缩肌松解术修复22例,29只眼。结果随访17例,20只眼,随访3个月～5年。除2只眼复位欠佳外其余完全复位且形态良好。结论针对不同类型的眼袋术后下睑退缩采取经外眦下睑提升固定;眼睑囊筋膜,下睑缩肌松解予以修复,手术操作简便,准确,效果良好。

中老年人眼睑整形美容术75例临床分析

目的探讨中老年人眼睑整形术的临床特点及其整形手术经验。方法回顾性总结分析中老年人眼睑整形美容手术75例,其中包括上睑皮肤松弛57例,下睑袋18例。对上睑松垂者采取松弛皮肤切除及重睑成型术,合并倒睫者需一并矫正;下睑袋者采取外切口方法切除下睑松驰皮肤及膨隆的眶脂肪,如果合并下睑张力降低者需同时予以下睑轮匝肌加强术以恢复下睑的张力。结果 75例中老年眼睑整形美容手术均获得满意效果。结论中老年的眼睑整形美容术要注意与年龄相关的眼睑局部病变或退化性改变,同时予以矫正方能收到满意的效果。

多技术综合应用下睑成形术矫正下睑泪槽畸形

目的:探讨多项技术综合应用下睑成形术矫正下睑泪槽畸形的可行性,总结手术操作技巧及经验。方法:经皮肤肌皮瓣手术入路,采用弓状缘眶隔脂肪释放、眶内脂肪保留、眶隔紧缩重置技术及眶肌筋膜韧带提紧悬吊相结合的综合手术方法。结果:本组56例患者,术后无明显出血、瘀斑,无睑球分离、下睑外翻等并发症出现。随访2～30个月,下睑部皮肤平整,泪槽畸形明显改善,患者自感外观效果满意。结论:多项技术综合应用下睑成形术矫正下睑泪槽畸形是获得面中部年轻化的行之有效的手术方法。