Surgical treatment of the sunken upper eyelid

The youthful upper eyelid shows no depression because the orbital contents are firm and the eyelids are tightly stretched across the bony socket. With progressive aging, there is skeletonization of the orbit as the periorbital tissues undergo laxity or absorption. With aging, hollowing of the eyes results in a deep upper eyelid sulcus. Most surgical procedures that address the aging appearance of the eyes involve excision of excess skin and removal of fat, with resultant volume disproportion that may lead to further hollowing and older appearance. Few procedures have been introduced that address age-related periorbital volume disproportion. We discuss a newly developed surgical technique for the correction of this major orbital aesthetic problem. In this surgical technique, the orbital rim periosteum, periorbita, and released superior extraconal orbital fat are used to fill the superior periorbital space, improving the patient's appearance.     

Augmentation blepharoplasty

Conventional lower lid blepharoplasty techniques emphasize the removal of excess skin and fatty bulges of the lower eyelid. The appearance is improved at the expense of lateral pretarsal flatness associated with the senile eyelid. Augmentation blepharoplasty is a modified technique for a lower lid blepharoplasty using an overlapping orbicularis oculi muscle repair to increase pretarsal fullness, which is associated with the youthful lower eyelid. The technique was used successfully in 30 consecutive, unselected patients, and this experience is reviewed in detail. The technique, surgical anatomy, and complications are outlined. The results prove this technique to be a safe method of lower lid blepharoplasty that does not interfere with the additional goals of periorbital fat and excess skin removal.     

Recurrent periorbital cellulitis: an unusual clinical entity.

OBJECTIVES: To discuss the cause and management of recurrent periorbital cellulitis (RPOC). STUDY DESIGN: Retrospective case series and review of literature. MATERIALS AND METHODS: In the past 11 years, we have treated 6 patients for recurrent periorbital cellulitis (RPOC). Inclusion criteria were a minimum of 3 episodes of periorbital cellulitis (POC) within a 1-year period, with interval convalescence lasting at least 1 month. All patients were followed for at least 1 year after resolution. RESULTS: The causes of RPOC were as follows: (1) 2 patients developed RPOC attributed to environmental allergies; (2) 1 was diagnosed with underlying recurrent sinusitis resistant to medical management with resolution attained through surgery; (3) 1 patient with vesicular RPOC was diagnosed with herpetic RPOC and treated medically with antiviral therapy; (4) 1 patient had allergic contact dermatitis from cosmetic make-up use; and (5) 1 patient was suspected of malingering via repeat subcutaneous self-injection of an irritant. CONCLUSIONS: Although periorbital cellulitis is a commonly encountered and treatable condition, recurrent periorbital cellulitis is rare and may be challenging to manage. In our experience, the causes of recurrence varied, but resolution was achieved by identifying the underlying cause through continuous clinical reassessment and by appropriate medical or surgical management. EBM rating: C-4.     

Treatment of Facial Skin Using Combinations of CO2, Q-Switched Alexandrite, Flashlamp-Pumped Pulsed Dye, and Er:YAG Lasers in the Same Treatment Session

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.     

研究应用扩张皮 修复睡周软组织缺损时综合护理干预预防脸外翻的方法及效果

的 分析综合护理干预在扩张皮瓣修复眶周软组织缺损中对睑外翻的预防效果。方法 选取遵 义市播州区人民医院2022年2月-2023年2月收治的60例眶周软组织缺损患者作为研究对象，均予以扩张皮 瓣修复治疗，按照睑外翻预防干预方式不同分为对照组和观察组，各30例。对照组应用常规护理措施，观 察组应用围术期综合预防干预，比较两组护理效果、护理满意度和并发症发生情况。结果 两组护理总有 效率比较，差异无统计学意义（P＞0.05）；观察组对美观程度、服务态度、服务方式的满意度评分均高于 对照组，差异有统计学意义（P＜0.05）；观察组并发症发生率为0，低于对照组的16.67%，差异有统计学 意义（P＜0.05）。结论 综合护理干预在行扩张皮瓣修复治疗的眶周软组织缺损患者中具有良好的临床效 果，可减少睑外翻等并发症的发生，提高患者对治疗和护理的满意度。     

Treatment of face veins with a cryogen spray variable pulse width 1064 nm Nd:YAG Laser: a prospective study of 17 patients.

BACKGROUND: Through the 1990s laser treatment of leg veins has been a challenge. Newer, longer wavelength lasers with variable pulse width have shown promising results for both telangiectasia and reticular leg veins. Experience with these lasers for treatment of facial telangiectasia and periorbital reticular veins is scant. OBJECTIVE: To our knowledge this is the first prospective study to evaluate a variable pulse width, cryogen spray-equipped 1064 nm Nd:YAG laser for the treatment of facial telangiectasia and larger periorbital reticular veins. METHODS: Seventeen volunteers, ages 32-67 years, skin types I-IV, with facial telangiectasia and reticular periorbital/temporal veins were treated once with the Nd:YAG laser at fluences of 125-150 J/cm2 with a 6 mm spot size and pulse widths of 25 msec for small vessels and 75-100 msec for reticular veins. Patients were examined 1 week and 1 month after the treatment. Pre- and posttreatment 35mm photographs were taken. Improvement was judged by two experienced physicians, both visually on patients and by comparison of pre- and posttreatment photographs. Results were graded as percent resolution, in five groups: 0%, 0-25%, 25-50%, 50-75%, and 75-100%. RESULTS: All 17 patients completed the study. Thirty-two sites were treated (24 cheek, nose, and chin telangiectases, and 8 periorbital reticular veins). Greater than 75% improvement was observed in 97% of the treated sites. Greater than 50% improvement was observed in 100% of the treated sites. Notably, 100% of the facial reticular veins treated have essentially 100% resolution. Pain during treatment was variably perceived by patients, but occasionally sufficient for patients to express reservations about additional future treatment. Transient erythema and edema were common, but fine crusting was rare. Small areas of purpura were also quite rare. CONCLUSION: The cryogen spray-equipped 1064 nm Nd:YAG laser was remarkably effective and safe for skin type I-IV patients. It is an excellent tool for treatment of facial telangiectasia with minimal risk of purpura. For the first time we appear to have a simple, safe, and effective treatment for 1-2 mm periorbital reticular veins. The use of topical anesthesia may be needed for some patients.     

Blepharoplasty. Surgical versus chemical—Surgical plus chemical

The decision of whether to perform a blepharoplasty is based upon consideration of a number of physical characteristics, including the presence of excess eyelid skin, of thick rugal folds, and of pads of herniated periorbital fat. Patients whose problem is thick rugal folds wil benefit most from a facelift and chemical peel; for those with weathered skin alone, a chemical peel may be sufficient to improve the appearance. In the absence of significant herniated periorbital fat of the lower lid, lower blepharoplasty is rarely indicated. In most cases, an upper blepharoplasty with a face-lift provides a satisfactory solution.     

病灶内注射糖皮质激素和口服普萘洛尔治疗眶周血管瘤的回顾性研究

目的比较病灶内注射糖皮质激素和口服普萘洛尔治疗眶周血管瘤的效果。方法从2006年1月至2013年12月,25例眶周血管瘤患者纳入研究,其中16例患者接受糖皮质激素(复方倍他米松注射液)病灶内注射治疗,8名患者接受口服普萘洛尔治疗,1例患者先后接受上述两种治疗。结果所有患者随访6~60个月。在接受激素注射治疗的患者中,13例患者瘤体完全或接近完全消退,3例患者瘤体部分消退。口服普萘洛尔治疗的患者中,8例患者瘤体完全或接近完全消退。1例患者首先接受激素治疗,瘤体无明显变化,然后改用普萘洛尔治疗,瘤体缓慢消退。激素治疗组的不良反应包括局部组织萎缩、溃疡和库欣样症状,分别发生于3例患者。普萘洛尔治疗组仅有1例患者发生轻微腹泻。结论病灶内注射糖皮质激素和口服普萘洛尔治疗眶周血管瘤都能取得很好的疗效。从治疗的有效性和安全性来比较,口服普萘洛尔更具优势,可以推荐为优选治疗方法。但对于不适合普萘洛尔的患者,病灶内注射糖皮质激素仍不失为一个可以选择的治疗方法。     

股前外侧脂肪筋膜瓣血管三维结构的研究及应用

目的 研究股前外侧脂肪筋膜瓣的血供模式以便合理应用于临床。方法 对8具16侧成人下肢标本灌注后解剖观察股前外侧脂肪筋膜瓣的血供特点，并作血管结构的三维分析。在此基础上，采用吻合血管的股前外侧游离脂肪筋膜瓣移植矫治进行性半侧颜面萎缩瘢痕挛缩或发育不良15例，双侧隆乳术1例。结果 16例股前外侧脂肪筋膜瓣血管三维结构特点相同，由轴型血管营养，逐层发布，血供丰富。临床应用16例17块组织瓣全部成活，随访6个月－11年，远期效果稳定，无吸收，形态满意。供区无功能障碍，外观影响不大。结论 股前外侧脂肪筋膜瓣血供丰富，可即期修薄塑形，是软组织缺损用带血运的组织充填修复较理想的材料。     

Hepatic dysfunction during hyperalimentation.

Liver biopsy specimens were studied in 26 patients in whom liver function abnormalities developed during intravenous hyperalimentation (IVH). The clinical manifestations and duration of IVH were evaluated in relation to the morphological changes seen in the liver. Early hepatic changes consisted of fatty metamorphosis, and progressive intrahepatic cholestasis developed as IVH was continued. Essential fatty acid deficiency, amino acid imbalance, caloric excess, and toxic manifestations of certain amino acids are postulated as causative factors. The hepatic steatosis secondary to IVH may be treated by lowering the dextrose concentration of the infusion or by administering dextrose-free amino acid solutions. The clinical importance of this common complication of IVH is the difficulty in distinguishing it from other causes of cholestasis in seriously ill patients.     

Periorbital reconstruction using variations of the upper eyelid flap.

Tissues that have characteristics identical or similar to periorbital soft tissue are preferred for reconstruction in the eye region. The upper eyelid is part of the periorbital area that provides an ideal reserve of tissue for this purpose, without producing a donor-site deformity. We used the upper eyelid flap with different pedicle designs in various parts of the periorbital region in 21 patients, and achieved favourable results. The flap was medially-based in five, superomedially-based in seven, laterally-based in eight, and superolaterally-based in one. The tissue defects were the result of the excision of tumours in 18 patients, and of injury in three. The defects were located in the upper eyelid in two, the lower eyelid in five, the medial canthus in eight, the lateral canthus in four, and in the neighbouring orbitonasal zones in two. Different sized flaps were used according to the dimensions of the defects, which ranged from about 1 to 8 cm2. The upper eyelid flap is versatile, and provides tissue of ideal colour and texture. The procedure can be done quickly in one stage with minimal morbidity.     

Beware frontotemporal dermoids - they may have intracranial extension: a case of a middle cranial fossa cyst

Congenital orbitofacial dermoid cysts are epithelial lined structures of ectodermal origin that may be associated with sinus tracts and variable deep extension. Midline lesions may extend intracranially, while lateral lesions are thought never to do so. Consequently only midline lesions are usually imaged prior to surgery. We describe a lateral dermoid sinus communicating with an intracerebral dermoid cyst within the middle cranial fossa in a 3 year-old with recurrent periorbital cellulitis and intermittent discharge from a small pimple in the temporal region. This case demonstrates that some lateral "dermoids" need to be treated with more caution if there are unusual features such as dimpling, discharge of material or recurrent wider infection, and preoperative imaging should be carried out to exclude intracranial extension.     

Treatment of Multiple Facial Syringomas with the Carbon Dioxide (CO2) Laser

BACKGROUND: Syringomas are benign tumors of eccrine origin most commonly found in the periorbital area. Previously reported treatments for syringomas include excision, electrodesiccation and curettage, dermabrasion, and carbon dioxide (CO2) laser resurfacing. The ideal treatment of syringomas should be destruction of the tumor with minimal scarring and no recurrence. OBJECTIVE: The objective is to present a treatment method for multiple syringomas without scarring or recurrence. METHOD: Ten patients with multiple periorbital syringomas were treated with a high energy, scanned carbon dioxide laser. Settings of 5 watts, 0.2 second scan time, and 3mm spot size were used. Two passes were performed, but some lesions required four passes. In some cases the entire lower periorbital area was treated. Results were evaluated clinically by both physicians and patients over a span of 1 to 24 months. RESULTS: Elimination of the syringomas was successful in all patients. Each patient remains free of recurrence 1 to 24 months after therapy. Prolonged erythema was the most common side effect, but no scarring was seen. Four out of the ten patients required repeat spot treatments. CONCLUSION: The CO2 laser is a dependable, safe, and nonscarring method for the treatment of periorbital syringomas.     

Comprehensive Treatment of Periorbital Region with Hyaluronic Acid

The periorbital subunit is one of the first facial regions to show signs of aging, primarily due to volume depletion of the soft tissue and bony resorption. Surgical and office-based nonsurgical procedures form an important basis for periorbital rejuvenation. It is important to make a detailed clinical evaluation of the patient to indicate the most appropriate procedure to be performed. With the objective of showing a nonsurgical procedure for the rejuvenation of the periorbital area, the authors describe a technique of applying fillers in the upper and lower periorbital regions, paying attention to the anatomy of this facial region and the type of product to be used besides the expected results of the procedure and its possible adverse effects and complications. The nonsurgical rejuvenation of the periorbicular region with hyaluronic acid is a new and innovative technique. In the opinion of the authors, it is a great aesthetic impact area and consequently brings high satisfaction to patients.Maintaining a youthful and pleasant appearance of the face in today’s culture impacts quality of life in many patients. The facial contour remodeling is being revolutionized by new nonsurgical techniques.Facial aging is a complex and dynamic process. All people age differently as a result of imbalance, disharmony, and disproportion of the aging process between the overlying soft tissue and the underlying bony frameworks.1 The upper periorbital subunit is one of the first facial regions to show signs of aging, and even minor changes in its structure and volume can distort the perceived emotions and health of patients.2 An aesthetic and youthful upper periorbital subunit is characterized by a well-defined brow of appropriate height and shape, fullness of the upper periorbit, a crisp and well-defined upper eyelid crease, minimal skin excess, and good skin quality.3,4In the aging process of this facial area, one group of patients displays signs of aging due predominantly to soft tissue ptosis of the upper eyelid, requiring surgical excision. Another group presents with volume depletion of the soft tissue and bony resorption of the orbit. The loss of septal support, leading to brow prolapse and an exacerbation of upper eyelid fullness and congestion, can also contribute to the aging process. This appearance is characterized by deflation of the upper eyelid as well as hollowing and visibility of the supraorbital bony rim, leading to a sunken, hollow, and skeletonized orbit, which can make the patient appear sickly, anorexic, and old. In recent years, modern facial rejuvenation surgery has evolved toward volume restoration in addition to tissue suspension.2Comprehensive analysis of both soft tissue and bony structural changes are essential for the periorbital rejuvenation. Surgical procedures and office-based nonsurgical procedures form an important basis for periorbital rejuvenation, including cosmeceuticals, chemical peels, laser and light treatments, neurotoxins, and fillers. Improved understanding of the pathophysiology of aging and technical advancements in nonsurgical techniques has enabled us to achieve better and more comprehensive improvement for patients.5     

隆鼻层次与SMAS的关系

目的：为了明确鼻部表浅肌肉系统（SMAS）、隆鼻术硅胶假体置放的层次与它们之间的关系。方法：应用显微解剖及组织切片检查18成人尸体鼻部,结果：鼻部软组织分为皮肤、表浅脂肪、肌肉及其筋膜、深脂肪、（疏松组织）、骨膜及软骨膜五层;深脂肪（疏松组织）层容易剥离形成腔隙。结论：隆鼻术硅胶假体置入层次为深脂肪（疏松组织）层,鼻部表浅肌肉系统的特点有助于假体的稳定。     

透明质酸钠注射导致眶周血管栓塞的临床治疗效果观察

目的探讨透明质酸钠注射导致眶周血管栓塞引发视力损害及皮肤软组织损伤的紧急对症处置及后续治疗效果。方法自2013年1月至2021年1月辽宁省人民医院整形科对收治的18例面部注射透明质酸钠导致眶周血管栓塞的患者给予综合治疗,包括透明质酸酶注射、扩血管、改善局部组织微循环、抗感染、营养神经、高压氧舱、局部软组织清创换药等。结果本组共18例患者,均为透明质酸钠注射术后血管栓塞伴有不同程度的视力损伤、眼肌麻痹及皮肤软组织坏死,通过综合治疗后效果较满意。结论对于透明质酸钠面部注射引起的眶周血管栓塞,采取及时、积极的对症治疗后,可有效地缓解减轻眼部视力损害、眼肌麻痹和皮肤软组织坏死等并发症,可获得良好的愈后效果。     

扩张皮瓣修复眶周软组织缺损睑外翻的预防方法

目的探讨应用扩张皮瓣修复眶周软组织缺损时预防睑外翻的方法及效果。方法 2015年4月至2019年12月,中国医学科学院整形外科医院收治176例眶周软组织病损患者,男79例,女97例,年龄4~53岁,病损范围1 cm×1 cm~6 cm×10 cm。术前根据病损的部位及大小选择合适的扩张器;一期埋置扩张器,按期注水扩张;二期将扩张皮瓣转移覆盖眶周缺损创面,切除部分包膜,并将皮瓣固定于骨膜,恢复眼睑位置与形态,预防睑外翻;术后佩戴弹力头套3~6个月进行塑形。术后对皮瓣成活情况及并发症进行随访。结果 176例患者埋置的扩张器容积为30~400 ml, 扩张时间1~6个月,所获扩张皮瓣大小为3 cm×3 cm~6 cm×9 cm。术后随访2个月至4年,皮瓣全部成活。其中出现睑裂轻度闭合不全13例,为皮肤扩张不充分所致,未影响眼睑功能,患者拒绝再次治疗;下睑外翻8例,包括术后瘢痕挛缩5例,固定皮瓣的线结脱落1例,扩张器长期牵拉使下睑支撑组织松弛2例,其中5例行皮瓣修整术后矫正,3例未再次治疗;其余均获得满意效果。缝线固定皮瓣所留凹陷在术后1~6个月内消失。结论以扩张皮瓣修复眶周软组织缺损时,在术前、术中及术后分别实施针对性的干预措施,以减小或分散扩张皮瓣的回缩力,可最大程度地避免睑外翻发生,获得良好的修复效果。     

采用SMAS悬吊与骨膜下悬吊技术的微创化面中部除皱术

目的 探讨一种同时解决下睑袋、颧部皮肤和肌肉松弛、鱼尾纹,并整体上提面中部,改善鼻唇沟过深,以最小的切口获得最大的面部年轻化效果的手术方法.方法 通过下睑袋切口入路,在面中部骨膜下广泛剥离,然后再通过颞部除皱切口悬吊眼轮匝肌和颧大肌,使面中部上提,实现面中部以及颞部的年轻化.结果 2003年至2008年,采用此种方法为42例患者进行治疗,得到比较满意效果.结论 此方法简单易行,安全性高,创伤小,恢复快,效果持续时间长,可作为面中部年轻化微创化手术的很好选择.     

眶骨骨折眼球移位的矫正

目的：探索矫正眶周外伤，肿瘤造成的眶骨骨折眼球移位的有效安全的手术方法。方法：截骨或去除挤占正常眼球位置的碎骨块或肿瘤组织，给眼球复位提供空间，于眼球复位后所出现的空间植骨或置入组织代用品，采用此种手术方法进行眶周肿瘤切除眼球复位2例，各种原因外伤导致的眶上壁，眶内侧壁，眶下壁骨折眼球移位复位4例，结果：2例肿瘤患者均为良性向眶内生长的占位性病变，手术完整切除，眼球位置恢复正常。4例外伤骨折中的1例内眦韧带附着处骨折，内眦韧带复位不佳，余3位术后效果满意。结论：眼眶，眼球移位修复是较为困难的课题，我们介绍的手术方法实用可靠。     

眶区眼轮匝肌蒂岛状皮瓣在眶周皮肤缺损修复中的应用

目的 探讨应用眶区眼轮匝肌蒂岛状皮瓣修复眶周皮肤全层缺损的方法与手术技巧。方法 根据缺损的部位、形态及面积,分别应用以上、下眶区眼轮匝肌内侧为蒂的岛状皮瓣修复眶周的皮肤缺损,供区直接缝合。结果 2003年7月至2009年10月,应用上述方法共修复24例,除l例术后皮瓣远端部分坏死,经换药愈合,2例皮瓣表皮坏死未行处理,自行愈合外,其余皮瓣均成活良好。随访6 ～ 24个月,所有皮瓣色泽、质地均良好,与周围组织无明显差别,供区瘢痕不明显,外形满意。结论选择以眼轮匝肌眶部内侧为蒂的岛状皮瓣一期修复眶周皮肤缺损,血供良好,供区隐蔽,术后效果满意。