Skin-muscle flap lower lid blepharoplasty

Lateral to medial dissection in the "potential space" between the orbicularis oculi muscle and the septum orbitale simplifies the skin-muscle flap lower lid blepharoplasty. The procedure is safe, rapid, and atraumatic.     

Management of the lower lid in male blepharoplasty

Rejuvenation of the lower eyelid blepharoplasty in men requires consideration of different esthetic norms than those considered in women. Although both require a thorough understanding of anatomy, and the process of aging in each includes descent of the globe, pseudoherniation of the orbital fat, and skeletonization of the inferior bony rim, the goals for male blepharoplasty differ. The authors review the primary surgical approaches in lower lid blepharoplasty (transconjunctival skin-muscle flap) and the currently described techniques used to address displaced orbital fat, with special consideration of the male patient.     

睑袋成形术并发泪囊功能不全

目的 探讨睑袋成形术导致泪囊功能不全的原因和治疗方法。方法 对睑袋成形术后无睑外翻出现溢泪的患者，进行泪道功能检查，功能不全者行下睑睑部眼轮匝肌缩短或断端吻合，下睑眶部眼轮匝肌上移手术。结果 28例患者因睑袋成形术后并发泪囊功能不全，再次手术时均发现有过量切除或未能缩紧（或缩紧不足）睑部眼轮匝肌。经手术加强睑部眼轮匝肌张力后，泪囊“泵”功能恢复，溢泪消失。结论睑袋成形术中，对多余及松弛组织去除量的控制不当，或术中未能有效地恢复下睑各层结构张力的平衡，尤其是下睑睑部眼轮匝肌张力明显减弱时，其泪囊的“泵”作用消失，出现功能性溢泪。通过手术恢复下睑轮匝肌张力的“泪泵”功能，有效地治疗了因睑袋成形术所并发的泪囊功能不全。     

睑袋成形术并发泪囊功能不全

目的探讨睑袋成形术导致泪囊功能不全的原因和治疗方法。方法对睑袋成形术后无睑外翻出现溢泪的患者,进行泪道功能检查,功能不全者行下睑睑部眼轮匝肌缩短或断端吻合,下睑眶部眼轮匝肌上移手术。结果28例患者因睑袋成形术后并发泪囊功能不全,再次手术时均发现有过量切除或未能缩紧(或缩紧不足)睑部眼轮匝肌。经手术加强睑部眼轮匝肌张力后,泪囊“泵”功能恢复,溢泪消失。结论睑袋成形术中,对多余及松弛组织去除量的控制不当,或术中未能有效地恢复下睑各层结构张力的平衡,尤其是下睑睑部眼轮匝肌张力明显减弱时,其泪囊的“泵”作用消失,出现功能性溢泪。通过手术恢复下睑轮匝肌张力的“泪泵”功能,有效地治疗了因睑袋成形术所并发的泪囊功能不全。     

激光在二次睑袋整复中的应用

目的　观察利用超短脉冲CO2 激光对睑袋整复术后 ,眶脂肪消除不理想的患者进行二次睑袋整复术的效果。方法　采用Ultrapulse超脉冲CO2 激光 ,选用连续波输出功率 8W ,激光输出手具 0 .2mm ,于下睑结膜面切口进入眶隔去除脂肪。结果　 2 3例患者全部取得满意效果。结论　采用激光进行二次睑袋整复具有手术时间短 ,术后恢复快 ,无并发症及后遗症出现 ,患者容易接受等优点 ,能达到医患双方均满意的效果     

激光在二次睑袋整复中的应用

目的观察利用超短脉冲CO2激光对睑袋整复术后,眶脂肪消除不理想的患者进行二次睑袋整复术的效果.方法采用Ultrapulse超脉冲CO2激光,选用连续波输出功率8W,激光输出手具0.2mm,于下睑结膜面切口进入眶隔去除脂肪.结果 23例患者全部取得满意效果.结论采用激光进行二次睑袋整复具有手术时间短,术后恢复快,无并发症及后遗症出现,患者容易接受等优点,能达到医患双方均满意的效果.     

Upper lid blepharoplasty

Upper lid blepharoplasty is the most common cosmetic procedure performed in men and women. The eyes are the most important aesthetic facial unit and also a sensitive projector of facial aging changes. Patients will complain about tired eyes, sad eyes, or extra tissue around the eyes. Dermatochalasis, fat herniation or protrusion, brow ptosis, and eyelid ptosis secondary to disinsertion or dehiscence of the levator aponeurosis all contribute to a patient's perceptions of the need for upper lid blepharoplasty. In this article we discuss aging changes in the periocular region in Asian and Caucasian type eyelids and in male and female patients. Traditional upper lid blepharoplasty techniques, indications for surgery, psychological considerations in candidates for cosmetic surgery, and frequently encountered complications are also covered.     

Upper lid blepharoplasty

Upper lid blepharoplasty is the most commonly performed operation in patients seeking facial rejuvenation. When evaluating the patient, attention should be focused on the possibility of concomitant eyelid or eyebrow ptosis. Meticulous planning and technique are required to achieve high levels of patient satisfaction.     

Prevention of ectropion by horizontal shortening of the lower lid during blepharoplasty

Vertical wedge excision of the lower lid is advocated in selected patients undergoing blepharoplasty to prevent postoperative ectropion. Candidates for "V" excision include patients with a predisposition for senile ectropion. Diagnosis and surgical technique are described.     

Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.     

国人下睑眼袋分类及对应术式

为提高下睑袋手术效果，避免并发症出现。对国人下睑袋进行了分类并制订相应手术方案。６８例下睑袋分类及手术获得满意效果。对下睑袋形成机制的正确认识、合理分型，有利于提高手术效果，防止并发症出现。特别强调对轮匝肌松弛合并眶脂膨出型应采用保留眶脂肪术式，不可盲目切除     

Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.     

Advanced upper lid blepharoplasty.

Advanced blepharoplasty invaginates the upper lid tissues. It requires an intimate familiarity with the anatomy of the upper lid. The two keys to success are (1) approaching the deep fascia network via strip resection of the pretarsal fascia and (2) forming a free edge of the levator aponeurosis. The result is an attractive and permanent upper lid fold.     

Lower lid blepharoplasty and canthal surgery

Lower lid blepharoplasty is an effective procedure to address aging changes of the eyes and periorbital regions. Success requires a thorough understanding of the relevant anatomy, proper patient selection, and meticulous surgical technique. When performed skillfully, the transcutaneous and transconjunctival approaches can offer the patient excellent results with a low risk of complications.     

应用阶梯瓣法行下睑袋整形术

目的：探讨及完善应用皮瓣加肌皮瓣进行下睑袋整形的手术方式，并观察应用这种方法整形下睑袋后的效果。方法：在进行下睑袋整形的组织瓣分离过程中，在睑板前，仅在眼轮匝肌表面分离形成皮瓣。分离到睑板下缘时，在眼轮匝肌深面分离形成肌皮瓣，使分离后的组织瓣像一阶梯形状而冠以阶梯瓣这一名称。结果：自2000年3月～2005年底5年时间，共应用这种方进行120例睑袋整形手术，手术中出血少，手术后肿胀轻，术后恢复快。所做的这120例手术中没有出现一例并发症。结论：由于这种方法同时具有皮瓣法和肌皮瓣法整形睑袋的优点，而又可以避免这两者的缺点，所以手术效果较好，是一种简单、有效的手术方法。     

Lower lid “tarsal fixation” blepharoplasty: A personal technique

The majority of patients seeking lower-lid blepharoplasty find that a muscle roll under their lowerlid ciliary margin is a desired postoperative feature. Very few prefer a flat postoperative lower lid. In addition to the cosmetic advantage obtained by more closely simulating a youthful lower eyelid, preservation of the pretarsal portion of the orbicularis oculi muscle also has a physiologic value in maintaining lower eyelid tone and support. A method to create this fold, which included placement of tarsal fixation sutures, has been previously described [1]. It was accompanied by prolonged postoperative swelling. In hands other than masterful surgeons, it often resulted in irregular shape and asymmetry. Perhaps this is why the technique never became very popular. The technique described here consists of overlapping two layers of orbicularis oculi muscle over the lower lid tarsal plate. The method is simple, quick, requires no additional sutures, and does not complicate or prolong the postoperative course. The result is that of a soft, even, and naturalappearing lower eyelid roll and lower eyelid.     

Evolution of lower lid support following lower lid/midface rejuvenation: the pretarsal orbicularis lateral canthopexy.

An 18-month experience with an endoscopically assisted "closed" technique of modified transblepharoplasty lower lid and midface rejuvenation is presented. In the modified approach, preseptal dissection in the body of the lower lid is eliminated to decrease the incidence of septal scarring and lower lid retraction. The technique also leaves intact the connection between the orbicularis and septum, resulting in tightening of the septum and better support of lid with redraping of the muscle. By providing more secure support of the lower lid and lateral canthus, the need for direct canthal manipulation has been reduced significantly. This experience confirms, however, that an occasional patient with significant exophthalmus occasionally might need additional lower lid support (spacer graft or more direct lateral tendon fixation) to obtain ideal lower lid position. Conversely, an occasional older patient with relative enophthalmus and horizontal lower lid laxity will be best served by canthoplasty with correction of excess laxity. So far, the quality of aesthetic results compared with the "open" approach has not been compromised, and morbidity seems to have been decreased.