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。     

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。     

小切口去脂埋线重睑成形术

目的 探索一种小切口去除眶隔脂肪埋线重睑成形术的方法.方法 在重睑线中外点衔接处,切开皮肤3～4 mm,去除中、外组部分眶隔脂肪,然后采用埋线法重睑成形术,可较好地解决上睑轻度臃肿行单纯埋线法重睑效果不佳的问题.结果 731例患者,术后均随访半年以上,重睑线过浅18例(单侧或双侧),双侧轻度不对称25例,针眼排舁感染2例,其余效果满意.结论 小切口去脂埋线重睑成形术,其方法简单易行,损伤小,恢复快,效果可靠,值得临床推广应用.     

“半开放”法重睑术在臃肿型单重睑中的应用

目的:探讨对于上睑臃肿的单眼皮患者采用"半开放"法重睑术的手术方法及临床效果。方法:沿重睑线由正中点向外侧切开皮肤约10mm。处理切缘上下皮下眼轮匝肌、眶隔及脂肪,充分显露睑板前筋膜,按连续埋线法行重睑术,后按切开重睑术缝合法缝合两针,关闭切口。结果:采用该术式行重睑术63例,术区均无明显瘢痕,重睑保持稳定,效果满意。结论:"半开放"法重睑术可适用于上睑皮肤臃肿而不愿接受切开法重睑术的单眼皮患者,该术式创伤小,出血少,肿胀轻,恢复快,重睑效果自然、流畅,值得推广。     

改良连续埋线法重睑术临床应用探讨

目的:探讨小切口去轮匝肌联合连续埋线法的手术要点及临床效果。方法:在局部麻醉下,于重睑设计线中段作一约5mm的小切口,掏剪睑板前轮匝肌,暴露睑板后再按连续埋线法作重睑术。结果:本组56例就医者,术后随访均形成良好的重睑线,弧度自然,两侧对称,效果满意。结论:小切口去轮匝肌适用于上睑皮肤弹性较好,上睑脂肪少或上睑稍臃肿的就医者,术后重睑线稳定持久并保留原来的眶隔脂肪,使上睑饱满年轻。     

上睑中段切口切开法重睑术效果分析

目的:探讨中段切口切开法重睑术的临床效果。方法:根据受术者眼睑外形和脸形设计重睑线,局部麻醉下在上睑中部1/3做长15mm的中段切口,去除切口内部分眼轮匝肌、眶隔脂肪及睑板前结缔组织,将上睑皮肤与睑板固定3针,形成重睑。结果:采用该术式完成重睑成形术123例,82例进行了上睑眶隔脂肪部分切除,术后肿胀轻、恢复快;随访3个月至1年,121例获得满意效果,上睑无明显瘢痕,重睑弧度流畅、形态自然。结论:中段切口切开法重睑术是一种简便有效的方法,创伤小、恢复快,适合于不需要去除上睑皮肤的重睑成形术。     

改良加固埋线法重睑术86例分析

目的探讨一种微创小切口加固埋线重睑术的方法。方法在重睑线中点设计一小切口，经此切口去除少许眼轮匝肌及切口中、外部分眶隔脂肪。可有效地解决单纯埋线法重睑上睑臃肿不佳的问题。然后采用埋线法形成重睑。将两根线头分别在睑板前潜行3—4mm后穿出皮肤，剪断线头，有效避免线结滑脱，然后将切口处加固一针，5天拆线。结果86例患者术后36例随访6个月～2年，均形态自然，切口无明显瘢痕，获得满意效果。结论该手术方法损伤小，恢复快，术后效果好。     

上睑缘切口修复重睑术后并发症

目的:探讨一种修复重睑术后并发症更有效的方法。方法:针对重睑术后常见几类并发症,采用上睑缘切口切除多余松弛皮肤、眶隔脂肪、眼轮匝肌、松解上睑皮下瘢痕粘连、缝合睑缘切口后再联合上睑连续埋线的方式重睑成形。结果:术后随访3个月～2年,修复重睑术后并发症62例,61例术后效果满意,1例因重睑过宽上睑凹陷,组织缺损过多而修复效果不佳。结论:采用上睑缘切口,能有效去除埋线法不能去除的上睑多余松弛皮肤、眶隔脂肪、肥厚眼轮匝肌,又能松解切开法造成的上睑皮下瘢痕异常粘连,具有切口痕迹不明显、操作灵活、恢复时间短的特点。     

改良后埋线结扎法重睑术102例分析

目的：探讨改良埋线结扎重睑术的方法。方法：在重睑线中点设计一微小切口,经此切口去除少许眼轮匝肌及切口中、外部分眶隔脂肪。然后采用埋线结扎法形成重睑：在上睑标记进出针点,形成4针结扎线,5天后拆除缝线。结果：102例患者术后58例随访6个月～2年,均形态自然,切口无明显瘢痕,获得满意效果。结论：该术式操作简单,损伤小,恢复快,术后弧线流畅自然、美观。     

下睑眶隔脂肪移植在重睑术后不良形态修复中的应用

目的:利用下睑眶隔脂肪移植对重睑术后重睑过宽、多层重睑、上睑眼窝凹陷等上睑外观形态缺陷失败案例进行整形修复。方法:自2016年7月-2018年10月,对57例重睑失败患者采用下睑眶隔脂肪移植修复术式进行整形修复,术中根据上睑缺陷形态及缺损组织程度新设计重睑线高度约6～7mm,适当去除原重睑线及新重脸线之间的皮肤,于提上睑肌表面向上进行充分剥离,松解局部组织粘连、释放游离残余眶隔脂肪,切取下睑眶隔脂肪均匀平铺于提上睑肌及其腱膜表面并缝合固定,缝合形成新重睑线。结果:术后随访57例患者3～12个月,患者重睑线宽度自然、流畅对称,多层重睑及眼窝凹陷消失,角膜暴露正常,上睑形态饱满自然。其中2例上睑切口轻度增生,处理后恢复。结论:重睑术后重睑过宽、多层重睑、上睑眼窝凹陷不仅影响美观同时上睑生理功能也会出现障碍,其基本病理改变是组织缺损,本次通过下睑眶隔脂肪移植修复上睑正常解剖形态,恢复上睑的正常形态外观和生理功能,效果满意。     

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。     

Partial-incision technique for creation of the double eyelid

Background: Three principal techniques exist with which to create the Asian double eyelid: the suture, partial-incision, and full-incision methods. The partial-incision method is reliable and long-lasting without many of the drawbacks of the full-incision method. Objective: The surgical technique of the partial-incision method is reviewed in a stepwise fashion so that the reader can reproduce this method for double-eyelid creation. Methods: Preoperative lid measurements were made with the patient in an upright sitting position to account for the effects of gravity on the lid. An incision was made through both the skin and orbicularis muscle to expose the underlying orbital septum. The lateral septum was lifted upward and a small wedge of elevated septum removed to permit entry into the preaponeurotic adipose tissue, which was then teased forward through the aperture in the orbital septum. Normally, only half of the exposed fat is removed, leaving a small adipose cuff on the hemostat. The remaining adipose cuff was cauterized and the wound inspected for hemostasis. Suture fixation was accomplished with a 7-0 nylon suture to tack the levator aponeurosis to the inferior skin edge along the incision line. The suture was passed through the epidermis to ensure permanence. Results: We have successfully used the partial-incision method of double-eyelid correction in 1500 cases. The 3 notable complications that can occur are loss of the lid crease, suture extrusion, and asymmetry. All of these complications occur in approximately 2% to 3% of cases but are easily corrected. The apparent elevated appearance of the lid height during the postoperative period is attributed to edema and diminishes by 1 to 2 mm to a more natural position after 3 to 12 months. Conclusions: The partial-incision approach is a simple, safe, and straightforward approach to double-eyelid creation that can be performed even by surgeons with relatively little experience in the technique. (Aesthetic Surg J 2003;23:170-176.)     

Unexpected Bleeding Caused by Arterial Variation Inferolateral to Levater Palpebrae

When incisional or nonincisional double-eyelid operations are in process, unexpected bleeding adjacent to the lateral canthal area is often encountered. The unexpected bleeding may result in intraoperative hematoma and swelling. It may also cause temporary intraoperative ptosis. The intraoperative swelling along the designed double-eyelid line or temporary ptosis may prevent surgeons from taking an accurate measurement of the height of fold. Therefore, surgeons might have difficulties making symmetrical double-eyelid lines. Among the detailed dissections of 230 eyelids along the orbital septum and levator palpebrae during incisional double-eyelid operations, 25 cases of noticeable arterial variation were found adjacent to the inferolateral end of levator palpebrae. The artery is located 4–5 mm medial from the lateral canthus, at the inferior margin of levator palpebrae. During the dissections, the artery was found to be superficial to the orbital septum and it could be traced down into a deeper layer along the inferior end of levator palpebrae. It connects to the lateral canthal artery behind the levator palpebrae. During double-eyelid operations, accidental tearing of this artery, even at the superficial layer of orbital septum, might cause the retraction of the cleaved arterial end down into the levator palpebrae. The bleeding from the retracted arterial end rapidly makes a large hematoma posterior to the levator palpebrae, causing temporary intraoperative ptosis and an asymmetric double fold, and possibly retrobulbar hematoma and blindness. We should bear in mind the possibility of presence of this artery. Once bleeding of this artery begins, clamping this artery and the inferolateral portion of levator palpebrae with a hemostat is effective in preventing massive hematoma posterior to levator palpebrae and ptosis, but electocoagulation is not effective. A cadaver dissection study, with red colored latex injection into the ophthalmic artery, is in progress.     

小切口加埋线重睑术的临床应用

目的:探讨小切口加埋线重睑术的临床应用。方法:首先设计重睑线,局麻成功后,在瞳孔正上方处的重睑线做一长约8mm切口,掏剪重睑线下方的1～2条眼轮匝肌,去除适量眶脂,对切口两侧重睑线进行间断埋线,最后缝合切口。结果:采用该术式进行重睑术128例,124例术区无明显青紫、肿胀,恢复良好,2例各1侧术后出现重睑线皮下异物性结节,经2个月后吸收;2例双侧术区出现肿胀明显,予消炎、止血治疗后肿胀消退。术后随访6个月～1年,手术切口瘢痕不明显,全部重睑稳定,效果满意。结论:小切口加埋线重睑术创伤小,恢复快,重睑效果自然、持久,是一种值得推广的手术方式。     

小切口切开法与埋线法联合重睑成形术的应用

目的探讨小切口切开法与埋线法联合较传统无切口埋线法的重睑成形术的优越性。方法将201例单睑者随机分成A、B两组。A组101例,采用小切口切开法与埋线法联合重睑成形术;B组100例,采用传统无切口埋线法重睑成形术;将其手术效果进行比较。结果随访157例,其中A组81例,含薄睑者45例和较厚睑者36例;B组76例,含薄睑者32例和较厚睑者44例。术后1个月,比较A、B两组薄睑者间的重睑形态满意率,差异无统计学意义（P〉0．05）,较厚险者间比较,差异有统计学意义（P〈O．05）。术后2．5～3．5年。比较A、B两组重睑维持良好率,薄睑者间及较厚睑者间,差异均有统计学意义（P〈0．05）。结论小切口切开法与埋线法联合的重睑成形术术后,形态满意率及远期疗效均优于传统无切口埋线重睑成形术,具有广泛的应用价值。     

重睑成形术后重睑过宽粘连畸形的修复

目的 探索重睑成形术后重睑过宽粘连畸形的修复方法.方法 重新设计重睑线宽度为6～8 mm,去除上睑瘢痕性皮肤1～2 mm,彻底松解局部粘连,利用眶隔脂肪瓣,邻近眼轮匝肌肌瓣、眼轮匝肌下脂肪垫及脂肪颗粒注射,充填上睑凹陷粘连区,重新缝合.结果 共修复16例患者20侧上睑,其中利用上睑眶隔脂肪瓣修复2例2侧,眼轮匝肌肌瓣修复3例4侧.眼轮匝肌下脂肪垫修复8例10侧,脂肪颗粒注射充填3例4侧.术后随访12例,10例14侧医患双方满意,2例2侧患者可以接受.结论 利用眶隔脂肪瓣、眼轮匝肌肌瓣、眼轮匝肌下脂肪垫、脂肪颗粒注射充填修复重睑过宽粘连畸形有效可行.     

上睑眶隔膜缝合固定在重睑成形术中的应用

目的:进一步探讨上睑眶隔膜缝合提升固定,在切开重睑成形术效果的新方法。方法:在重睑成形术中用眶隔膜缝合提升固定完成切开重睑成形术。结果:临床应用200例400支眼获得令人满意的美容效果,满意率100%。结论:一种有良好美容效果,简便可靠,可广泛应用于临床美容外科手术中的缝合技巧及手术方式,可有效减少并杜绝术后并发症及提高重睑成形术后求美者满意度及减少医疗纠纷的新方法。     

Double Eyelid Procedure by Removal of Transconjunctival Orbital Fat and Buried Sutures Combined with Sling Technique to Avoid Wounding the Eyelid

In the typical transconjunctival buried suture procedure for double eyelids, the adhesion between the skin and the pretarsal tissue or conjunctiva through the tarsal plate and the sling with the skin, the levator, and Muller's muscle are obtained by suturing. These are assisted by the stab wound or a needle through the eyelid skin, and the skin wound takes several days to heal. Also these suturing knots are buried under the skin on the tarsal plate, so that these will tend to appear on the skin surface later on. Removing the excess orbital fat that migrates to the area of fixation and jeopardizes the effect of the suturing technique is performed with skin incision and usually leaves a linear scar. The author devised a method that makes a double eyelid with two linear, wide sutures that lie between the levator and Muller's muscle and the immediately adjacent subdermal tissue of the skin by using one thread. It also reduces the excess orbital fat through the conjunctiva without wounding the skin and makes face washing or application of make-up possible immediately after the operation. Only one ligation is left at the lateral subconjunctiva to avoid its appearance on the skin surface to effect easy correction in case necessary. This method has evolved from previous method of transcutaneously burying sutures for the double eyelid, which was made wide by a linear suture by using one thread. Insufficient results were observed in eight of 280 cases.