改良皮肤入路间断埋线重睑成形术

目的:探讨间断埋线重睑探讨成形术的手术方法和术后效果。方法:通过改进皮肤入路间断埋线法的结膜出针点,使缝针穿透睑板和结膜,确保上睑皮肤与睑板牢固联结。结果:本组50例受术者(95侧重睑),经1～24个月随访,重睑线流畅自然,无线结外露或松脱现象。结论:该法术后重睑线牢固不易消失,操作简便可行,手术损伤小,术后恢复快。     

双层次定位设计缝合法在重睑成形术中的应用

目的：探討在重睑成形术中,如何将重睑切口线与挂缝睑板层定位弧线精确对应,从而形成优美传神的重睑。方法：从皮肤、睑板二个层面综合设计重睑切口线、皮肤及对应睑板的缝合点,将其进行皮下、皮面双层与睑板缝合形成稳妥粘连,使皮面的重睑弧线与对应睑板缝合点相对应。结果：采用该方法行重睑术的患者,无一例出现双侧重睑宽度不一、重睑皱襞中断或消失,多重睑及皮下结节等并发症,随访的所有病例,均对手术效果满意。结论：应用双层次定位设计缝合法行重睑术,并发症少,重睑线形态自然流畅,患者满意度高,值得临床推广应用。     

眶隔释放前置重睑术的临床应用

目的：探讨一种具有上睑提升作用且不改变上睑提肌解剖形态的重睑成形方法。方法：采用重睑切口设计,去除切口下唇适量眼轮匝肌,离断眶隔与提上睑肌腱膜的融合,眶隔释放,离断眶隔脂肪与提上睑肌腱膜间束带连接,去除疝出的眶脂,眶隔膜断端下缘折叠、前置缝合于提上睑肌腱膜在睑板融合处,勾带提上睑肌腱膜缝合皮缘切口。结果：采用该法在形成自然重睑弧的同时,获得不同程度的上睑提升效果。结论：该方法未改变提上睑肌解剖形态,解除了眶隔膜与提上睑肌腱膜的融合、眶脂与提上睑肌腱膜间束带连接并将眶隔膜前置缝合,从而减轻了提上睑肌腱膜的上提阻力,加固和增强了提上睑肌腱膜-睑板的上提联动,获得了上睑提升的效果,增加了角膜暴露率,从而加强了重睑的效果。     

小切口联合埋线重睑术的临床应用

目的:探讨埋线重睑术的手术方法.方法:患者取站立位或坐位设计重睑宽度,一般6～8mm,设计内、中、外三点.外侧点位于外眦内侧约5mm,以外侧点为中心设计长约5mm,位于重睑线上的切口线.切开皮肤,去除眼轮匝肌,打开眶隔,去除眶隔脂肪,彻底止血后,按切开重睑的方法,用6-0美容线带提上睑肌腱膜将伤口缝合,内中二点行埋线重睑.结果:本组56例,术中取出适量眶隔脂肪,组织量类似切开重睑.上睑臃肿明显减轻,外侧小切口瘢痕不明显,效果满意.结论:上睑不松弛,但臃肿者,小切口埋线重睑是一较好的选择.     

上睑皮肤松弛患者的睑缘切口重睑术

目的：探讨经上睑缘切口的重睑成形术,同期矫治上睑皮肤松弛的可行性及其设计要点方法：在术前估测拟祛除松弛皮肤的量及重睑线的位置,沿上睑缘上方1-1．5mm刀刃平行睫毛方向斜上切开上睑皮肤,向上分离至睑板上方,切除多余皮肤,在原设计基础上微调重睑线,并适量切除重睑线下方的眼轮匝肌,将提上睑肌腱膜或睑板与真皮层固定缝合3-5点,形成重睑褶皱,最后缝合切口。结果：自2009年1月至2011年6月间,用此术式共行上睑皮肤松弛患者的重睑成形术57例,术后上睑皮肤松弛均得以矫正,重睑形态关观,瘢痕隐蔽,求美者满意率高。结论：睑缘切口的重睑成形术,对上睑皮肤松弛的求美者能有较好的矫正效果,且具有切口痕迹隐蔽的优点。     

双针同步多点打结埋线法重睑成形术

目的探讨埋线法重睑成形术的一种新术式。方法双针同步、深浅交替、多点打结,行埋线法重睑成形术96例(186侧),观察重睑效果。结果随访观察6～48个月,重睑线流畅,并发症少,效果持久、恒定。结论本方法兼具了间断埋线法与连续埋线法的优点,方法简便,效果肯定。     

A New Technique for Levator Lengthening to Treat Upper Eyelid Retraction: The Orbital Septal Flap

Correction of upper eyelid retraction can be achieved by numerous techniques. We have developed a new flap, the orbital septal flap, to interpose between the recessed levator complex and the tarsus to correct the retracted upper eyelid of a young girl. The orbital septum is a facial structure; it is readily available and easy to dissect. The flap acts like a vascularited spacer without the problem of resorption; normal anatomical continuity of the levator mechanism can be functionally restored. We believe the orbital septal flap is a promising technique for correcting upper eyelid retraction; however, more case studies are needed.     

颞部悬吊加强外眦韧带张力的睑袋矫正术

目的　不破坏前壁切除眶脂 ,加强眶前支撑结构 ,达到矫正睑袋膨出 ,去除眼睑周围皱纹。方法　睑结膜入路切除眶脂 ,颞部小切口入路 ,加强眼轮匝肌外眦韧带张力。结果　在随访 1～ 4年不同方法 3组患者当中 ,颞部切口悬吊外眦韧带加睑结膜入路组疗效显著。结论　本方法对中年以上睑袋患者疗效确切 ,可以推广。     

A simple and durable way to create a supratarsal fold (double eyelid) in Asian patients

Background: Although non-incisional surgery to create a supratarsal fold (double eyelid) is preferred by Japanese patients, current procedures are either technically complex or do not produce lasting results. Objective: We describe a new, non-incisional technique that makes use of double-armed sutures and twists to create double eyelids in Asian patients. Methods: After everting the upper eyelid, a double-armed suture needle is passed from the conjunctival surface through the tarsal plate and then to the skin surface. The other end of the suture is advanced about 3 to 5 mm and also brought out through the tarsal plate. A second suture is used to create another U-stitch adjacent to the first suture. The upper eyelid is returned to its original position, and the sutures from the central hole are twisted around each other 4 or 5 times. They are then passed under the skin, one medially and one laterally, and the lateral and medial sutures are tied. Results: The authors have performed 1108 procedures during the past 10 years with no loss of double-eyelid line in a mean follow-up time of 32 months. Conclusions: The double suture and twist technique for creating double eyelids in Asian patients is simple, reproducible, durable, and safe. (Aesthetic Surg J 2001;21:227-232.)     

Nonincisional Blepharoplasty Using the Debulking Method

As more women work outside home, a growing number of women who want to have a natural-looking double eyelid choose the method with a short healing time and less pain. Thus blepharoplasty by the nonincisional method is performed frequently. This technique uses 7-0 nylon for simple triple ring–shaped or center doubled triple ring–shaped suture, with removal of subcutaneous fat, pretarsal muscle, and orbital septum through small incisions. This prevents the possibility that the folds will be loosened. By creation of a scar adhesion between the wider portion of the dermis and the tarsal plate after debulking of the soft tissue, the nonincisional method can be applied to a very thin eyelid without any difficulty.A retrospective review of the data for 327 patients who underwent nonincisional blepharoplasty using the debulking method from November 24, 2000 through March 9, 2003 is presented. Except for four cases, the procedures were successful. Two complications of conjunctivitis occurred, requiring removal of the buried suture, and two patients reported a mild scar.     

小切口微创重睑术的临床应用

目的：探索一种手术创伤小,术后肿胀轻、恢复快,效果稳定持久的重睑成形术。方法：在设计好的重睑线近内、外眦及瞳孔正上方三点作长约5mm小切口,掏剪睑板前眼轮匝肌及部分睑板前筋膜并去除臃肿的眶隔脂肪。三点小切口分别与睑板前筋膜缝合固定。结果：对146例患者施行三点小切口微创重睑术,术后7天拆线,随访半年至一年重睑稳定无消退,重睑外形自然逼真,无严重并发症。结论：本术式创伤小,恢复快,重睑效果稳定持久,是一种值得推广的手术方式。     

Benefits from Lifting of the Lower Eyelid

Lifting the lower eyelid includes removing skin excess of the lid and, most of the time, improves the fat herniation without any removal of the fat because of the tension of the orbicularis muscle obtained with this maneuver. The ``lifting' also corrects the arcus marginalis as well as malar bags when they exist. Most of the crow's-feet lines are eliminated by this procedure, and the superior aspect of the nasolabial fold is often considerably smoothed.     

New adjustable suture technique for managing eyelid ptosis.

The challenge of accurately predicting eyelid height after levator surgery for ptosis is a well-known problem even in competent hands. It is always better to correct an unfavorable postoperative result without surgical intervention, and thus spare the patient another involved procedure. The author describes a new adjustable suture technique that ensures a secure connection between the levator muscle and the tarsus, and allows easy postoperative adjustment of lid height. The suture design consists of an inner and an outer loop in a configuration that resembles a paper clip. When the suture is tightened, the inner loop approximates the distal part of the levator muscle to the tarsal plate, bringing the tissues into secure contact. When tightened further, the outer loop is activated and it approximates the more proximal part of the levator muscle to the tarsus as much as desired to achieve the proper eyelid height. When the sutures are tightened, the levator muscle shortens by folding on itself like the pleats of an accordion. Using this method, muscle slack is reduced as the tissue is folded on itself several times.     

Scanning Electron Microscopic Study on Double and Single Eyelids in Orientals

The conventional theory is that Occidentals have a terminal insertion of the levator aponeurosis at the anterior portion, resulting in a double eyelid, whereas in Orientals this fiber is not present, and therefore results in a single eyelid have been anatomically demonstrated. However, there have been more than a few reports indicating that the anatomical difference between a single eyelid and double eyelid in Orientals cannot be explained by this theory. Therefore, in order to verify the direction of the levator aponeurosis in the eyelids of Orientals, we observed Japanese eyelids using a scanning electron microscope (SEM). As a result of three-dimensional, cross-sectional observations using SEM, we were able to confirm the existence of a branch of the levator aponeurosis that runs through the layer of the orbicularis oculi muscle and connects with the levator aponeurosis in the double eyelid, as in the occidental eyelid. This was not seen in the single eyelid. It is thought that this new anatomical finding will become an important fundamental for double eyelid operations in Orientals.     

小切口去脂联合连续埋线法重睑术

目的:探讨小切口去脂联合连续埋线重睑的适应证。方法:设计重睑线,在重睑线上外侧1/3做3～5mm小切口,去除部分眼轮匝肌及上睑外侧眶隔脂肪内,埋线起点位于小切口内,连续埋线后打结,提起板前筋膜进行缝挂,再次打结于小切口内。结果:76例患者术后重睑线流畅,外观自然,上睑臃肿情况得到良好改善,2例变浅,所有患者均未出现因打结引起的线结反应。结论:本术式结合埋线法与切开法的优点,操作简单,稳定性及可调性高,易于被患者接受。     

An upper eyelid cyst from migration of a hard corneal contact lens

A migrated polymethylmethacrylate contact lens in the upper eyelid presented as a mass of unknown etiology. The lens had been unknowingly retained in the eyelid for seven years, after it had migrated through the conjunctiva of the superior fornix, and then moved in front of the levator aponeurosis and upper tarsal plate, where it lay encysted by conjunctiva. We believe that having sequestered conjunctival epithelium around the lens explains the minimal nature of the inflammatory and secretory responses necessary to allow such a protracted period of retention.     

颞侧眼睑分裂痣Ⅰ期手术临床治疗

目的探讨颞侧眼睑分裂痣Ⅰ期手术的临床疗效。方法术中先完全切除患侧浸及皮肤、睑缘及睑板的痣组织,并制作共蒂双斧状皮瓣。根据病变切除范围的大小及皮瓣转位后的张力,做相应睑缘缩短。通过睑板下移做睑缘重建。根据睑板切除的高度计算上睑提肌-Muller肌的延长量。皮瓣转位覆盖缺损的眼睑皮肤,在低张力下缝合。结果8例8只眼均为单侧,术后经22个月至3年的随访,患眼睑缘位置正常,皮肤无明显色差,瘢痕不明显,患眼睑裂大小及上下睑活动良好,未见痣复发。结论针对较大的颞侧眼睑分裂痣,治疗中除需考虑皮瓣修复的设计外,睑板缩短、睑缘重建和上睑提肌力量的均衡也同样不可忽视。     

小切口去脂联合连续埋线重睑78例体会

目的:探讨小切口去脂联合连续埋线重睑的适应证。方法:设计重睑线,在重睑线上外侧1/3做3～5mm小切口,去除部分眼轮匝肌及外侧眶隔脂肪,起点位于外侧小切口内,连续埋线后打结后提起睑板前筋膜进行缝挂,再次打结于小切口内。结果:76例患者术后重睑线流畅,外观自然,上睑臃肿情况得到良好改善,2例变浅,所有患者均未出现因打结引起的线结反应。结论:本术式结合埋线法与切开法的优点,操作简单,稳定性及可调性高,易于被患者接受。     

睑缘上切口重睑成形术的探讨

目的 探讨切开法重睑成形术之切痕隐蔽,以提高手术效果.方法 50例采用在睑缘上近睫毛根部的睑缘切口,剪除睑板前大部分疏松组织,做5针切口上唇真皮与睑板的内固定缝合.适当剪除切口上唇宽1～3 mm的皮肤.另50例为对照组,采用常规切口在距睑缘上6～8 mm处切开,剪除睑板前大部分疏松组织,做5针切口下唇皮肤与睑板的固定缝合.结果 5 d拆线时,睑缘切口者肿胀均较常规切口者轻,切痕隐蔽,重睑外形均颇满意,睫毛无损伤.常规切口者则切痕明显可见.结论 对比两种切口的重睑成形术,睑缘上切口者优势在于切痕隐蔽、手术创伤小、肿胀轻.但手术操作难点在于,缝合固定真皮与睑板使两侧重睑线圆滑弧度对称良好.     

经上睑缘入路保留单睑形态的上睑松弛矫正术

目的:探讨一种新的可以保持患者原有单睑形态的上睑松弛矫正方法。方法:回顾2015年7月-2016年10月经门诊行上睑松弛矫正术的32例患者,均行经上睑缘切口去除松弛皮肤、眼轮匝肌、眶隔脂肪等组织,并将切缘皮肤连续缝合。结果:术后随访1~12个月,32例患者上睑形态良好,角膜暴露率较稳定,均获得满意外观。结论:采用经上睑缘入路的上睑松弛矫正术可有效改善上睑松弛外观,且手术操作简单,疗效可靠。