肌皮瓣法睑袋整复术

目的：总结肌皮瓣法睑袋整复术在，临床上应用的操作技巧。方法：对153例患者行肌皮瓣法睑袋整复术，术前设计切口线及去皮量，眶隔膜前肌皮瓣分离，充分显露并去除疝出的脂肪，伤口连续缝合。术前、术后6天拍照存档。结果：共153例患者，1例老年男性患者单侧短期内轻度睑球分离，1例中年女性患者单侧局部轻度血肿，其余患者均Ⅰ期愈合，疗效满意。结论：肌皮瓣法睑袋整复术用于成人松弛衰老性睑袋，解剖层次为自然的疏松间隙，损伤小，手术视野清晰，术后瘀血水肿轻微，患者恢复时间短。     

睑袋整形术Hamra改良术式的临床应用探讨

目的:探讨一种中老年睑袋的整形方法,以矫正中面部老化而出现的下睑皮肤松弛,眶隔脂肪堆积、沟槽畸形,颧部软组织松弛堆积及鼻唇沟加深的改变.方法:对286例睑袋采用Hamra(1995)改良术式,矫正中面部老化的睑袋外观畸形.结果:术后286例随访3月～4年,284例手术效果满意.下睑及颧骨前区皮肤松弛臃肿形态、沟槽畸形、鼻唇沟加深等症状得到明显改善,2例出现轻度下睑退缩.结论:对于中老年性睑袋外观畸形的沟槽畸形、颧骨前区皮肤松弛堆积、鼻唇沟加深等症状采用此法可使中面部老化得到较大的改善.     

改良皮肤切口肌皮瓣法睑袋整复术

目的 探讨改良皮肤入路肌皮瓣法睑袋整复术的方法和效果.方法 术前采用"皮肤捏夹法"确定去皮量,在睑板前眼轮匝肌表面分离皮瓣,至睑板下缘时在眼轮匝肌深面分离形成肌皮瓣,再切除松垂的眶隔脂肪或释放填充眶下缘凹陷.结果 本组求美者50例,术中出血少,术后肿胀轻,恢复快.术后随访3～12个月,3例出现轻度下睑退缩,经外眦锚着术修复后恢复,余者均对手术效果满意.结论 采用术前定位去皮量的皮肤入路肌皮瓣法睑袋整复术,可以降低并发症的发生率,是一种简单、有效的手术方法.     

保留眶脂肪的睑袋整复术

目的 为避免下睑袋整形术常规切除眶隔内脂肪所带来的下睑塌陷畸形。方法 采用术中释放下睑内中外三区域眶脂，带蒂移转至眶下缘凹陷而不切除，并紧缩下轮匝肌瓣及外眦韧带的方法。结果 ４３例术中后睑袋消失，随访３￣１０个月，无一例出现下睑塌陷、睑外翻等并发症。结论 认为保留眶脂肪在恢复下睑丰满呈年轻外观有重要意义，值得注意。     

眶隔脂肪在睑袋整复术中处理方法的探讨

目的 探讨眶隔脂肪在睑袋整复术中的处理方法.方法 在外切口睑袋整形术的基础上.将眶隔脂肪剪除改为眶隔剪开、眶脂释放,眶隔缩紧连带眶隔脂肪缝合固定于眶缘下的附着组织上,以填充眶下缘凹陷区,形成丰满的下睑.结果 本组32例患者,术后局部略有肿胀,随访1～12个月,无明显的出血瘀斑、下睑后缩、睑球分离、下睑外翻等并发症发生.术后效果满意.结论 对伴有眶鼻沟加深、颊部组织松弛的睑袋矫正的患者,将眶隔脂肪重置于眶下缘凹陷区的手术方法值得推广应用.     

保留眶脂肪的睑袋整复术

目的为避免下睑袋整形术常规切除眶隔内脂肪所带来的下睑塌陷畸形。方法采用术中释放下睑内中外三区域眶脂，带蒂移转至眶下缘凹陷而不切除，并紧缩下轮匝肌瓣及外眦韧带的方法。结果４３例术后睑袋消失，随访３～１０个月，无一例出现下睑塌陷、睑外翻等并发症。结论认为保留眶脂肪在恢复下睑丰满呈年轻外观有重要意义，值得注意     

保留眶脂肪的睑袋整复术

目的为避免下睑袋整形术常规切除眶隔内脂肪所带来的下睑塌陷畸形。方法采用术中释放下睑内中外三区域眶脂,带蒂移转至眶下缘凹陷而不切除,并紧缩下轮匝肌瓣及外眦韧带的方法。结果 43例术后睑袋消失,随访3～10个月,无一例出现下睑塌陷、睑外翻等并发症。结论认为保留眶脂肪在恢复下睑丰满呈年轻外观有重要意义,值得注意。     

不同类型的睑袋整复术

目的:总结睑袋矫正的经验,提高临床治疗效果。方法:56例睑袋依其局部病理解剖变化分为4种类型,各类型采用不同术式以切除、提吊、固定整复。结果:56例患者术后效果皆满意,未出现下睑外翻等并发症。结论:在睑袋整复术中应根据其不同的成因、局部病理变化而采用不同术式。     

睑袋整复术进展

睑袋(palpebral bags，eyelid pouches)是指因眶脂肪向前膨出而形成的袋状眼睑畸形(baggy eyelids deformity)，上下眼睑均可发生，但以下睑最为常见。通常所说的睑袋一般指下睑袋。睑袋多见于40岁以上中老年人，男女均可发生，常伴有下睑皮肤松弛。部分年轻人也可发生，多与家族遗传有关，一般下睑皮肤松弛不明显。     

下睑复合肌瓣法睑袋整复术

传统的皮肤人路睑袋整复术有皮瓣法、肌皮瓣法、下睑复合肌瓣法[1-3].单纯皮瓣法、肌皮瓣法虽有操作简单、损伤小、术后下睑恢复较快、外观自然等优点,但如果术中切除了过度的皮肤和肌肉,则可导致下睑外翻或皱纹复发等现象.     

Operative technique for transconjunctival lower blepharoplasty.

In the past 3 years, more than 125 patients have undergone primary and secondary lower blepharoplasty by the transconjunctival method. The ability to adequately remove fat with this approach has been impressive. Exposure of the central and medial fat compartments is excellent. The lateral fat pad area is not as easy to visualize, and care must be taken to assure that adequate fat removal is achieved. Although one might suspect that postoperative conjunctival irritation could be a problem with this procedure, this has been notably absent in our patient population. In addition, there have been remarkably few patients with dry eye complaints following transconjunctival lower blepharoplasty. The question of skin resection must also be addressed. Currently, we believe that the majority of patients seeking improvement of the lower eyelids benefit most by a transconjunctival blepharoplasty without skin resection (Figs. 3 and 4). When there is obvious skin excess, we believe that it is best approached by removing the fat through the transconjunctival incision and then removing skin with a simple skin flap or skin pinch technique. This must be done considerably more conservatively than has been recommended in the past, to retain a natural palpebral fissure. Secondary skin removal, if necessary, is a straightforward procedure that can be readily done under local anesthesia at a later date. Transconjunctival lower blepharoplasty has not been associated with prolonged (exceeding 1 month) lower lid retraction problems in any of our patients. The technique is easy to learn but does require some experience with the anatomy. The technique should become the basic procedure for correction of excess fat in the lower eyelids.     

Laser blepharoplasty in Asians

Traditional blepharoplasty removes periorbital wrinkles by cutting and stretching the skin. However, this method has a substantial risk of producing ectropion or scleral show. In addition, fine periocular wrinkles may persist because this method does not change skin texture. The pulsed CO2 laser has recently become a primary surgical tool in treating aging eyelids. Periorbital wrinkles vary in depth not only from person to person, but also among different races. Compared with whites, most Asians have a thicker dermis, so more laser passes and a higher power may be required to remove periorbital wrinkles, but concerns about hyperpigmentation and prolonged erythema have limited its use on Asian skin. In this study, 346 patients underwent laser blepharoplasty at the Korea University Medical Center and at Dr Choi's Aesthetic Clinic. They were followed for 12 months on average from September 1995 to September 1999. The CO2 laser was used in resurfacing periorbital wrinkles, transcutaneous skin excision, and transconjunctival blepharoplasty, including fat removal. The authors assessed the benefit of using the UltraPulse CO2 laser in Asian blepharoplasty. They found that 291 patients (84%) had good to excellent results. The incidence of side effects was very low. Prolonged erythema occurred in 19 patients (5%) and hyperpigmentation occurred in 35 patients (10%), but the erythema disappeared spontaneously within 2 months and the hyperpigmentation could be managed readily by the topical use of retinoids and hydroquinone cream. Therefore, the authors conclude that postoperative hyperpigmentation is no longer a problem limiting laser resurfacing in Asian blepharoplasty. The UltraPulse CO2 laser is a safe and effective rejuvenation method for treating aging eyelids in Asians.     

Postoperative pain assessment for upper lid blepharoplasty in Asians

This study was undertaken to investigate the pain intensity, time to peak of pain, bruise, swelling, itching, life limitation, blurred vision, and duration of pain after upper lid blepharoplasty using a survey of pain scale, and to provide objective evidence to aid in education and preoperative counseling of our patients. After upper lid blepharoplasty under local anesthesia, patients were asked to rate their pain on a standardized 11-point pain scale (0-10). After pain assessment of the immediate postoperative period, the evaluation was repeated after 2 to 4 hours, 24 hours, 2 days, 3 days, 7 days, and 1 month. Time to peak of pain, bruise, swelling, itching, life limitation, and blurred vision after surgery were investigated. A total of 60 eyelids (30 patients) were included. Average pain score during the immediate postoperative period was 3.5 in males and 2.2 in females. Pain measurement was maintained up to 7 days after surgery. A significant difference in these pain scores according to gender was observed during the immediate postoperative period and up to 24 hours after surgery. Time to peak after upper lid blepharoplasty was as follows: pain 4.4 hours; swelling 17.3 hours; bruise 33.6 hours; itching 21.1 hours; limitation of life 16.6 hours; and blurred vision 8.7 hours. Most severe pain was observed during the immediate postoperative period and up to 2 to 4 hours after surgery. Pain after upper lid blepharoplasty was mostly mild to moderate and did not exceed a score of 4, which would require reevaluation, and could remain persistent for up to 7 days after surgery. Specific pain-targeted assessment and treatment based on these results are warranted.     

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     

小切口去脂术在眼睑整形中的应用

应用微小切口去除睑部脂肪的技术进行睑部美容整形术９８ 例。在上睑，将小切口去脂技术与非切开法重睑术联合应用，增强了缝线法或埋线法重睑形成的稳定性。尤其适用于典型蒙古人种眼要求“西化”者。利用眶内脂肪小叶的滑动性，这种去脂技巧可以很容易的进行并较少合并出血，小切口的位置一般被设计在重睑标记线的内侧或外侧。这种去脂技巧也被用于下睑袋的整形术中，不同的是２ ～４ｍｍ 的小切口被设置在下睑结膜囊侧。这些微小切口均无需缝合。４９ 例受术者被随访，均获满意结果。本文介绍了此技术的优点，适应证选择和手术要点。     

Transconjunctival approach in lower eyelid blepharoplasty

AIM:

To specify interest and indications of the transconjunctival approach in lower-eyelid plastic surgery.

MATERIALS AND METHODS:

Twenty-three cases of inferior blepharoplasty performed through a transconjunctival approach are reported. The authors describe the surgical technique, its indications and results.

RESULTS:

The transconjunctival approach provides excellent access to the inferior fatty chambers and is cutaneous scar free. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported.

CONCLUSION:

In our ‘cosmetic society’, the inferior blepharoplasty through a transconjunctival approach has taken a significant place in the armamentarium of the esthetic surgeon. Juvenile palpebral lipoptosis without skin excess constitutes the best indication for this technique. It is also indicated in secondary blepharoplasty and in patients presenting with a cicatricial risk or with orbital septum distention.     

内眦部改良去皮法在全切重睑术中的应用

目的 通过对全切法重睑术手术切口进行改良,将内眦处皮肤去除范围向下扩大,观察术后重睑线下方皮肤的流畅程度。方法 自2017年1月至2018年4月期间,共有78例患者采用内眦部改良去皮法进行全切重睑术,设为观察组。平卧闭眼状态下设计去皮范围,观察重睑术后不同阶段重睑线下方的皮肤的紧致程度。同时对比2016年1月至2016年12月全切重睑术患者,共89例,设为对照组,统计发生重睑线内侧皱褶出现的概率。结果 观察组78例患者伤口均一期愈合,有4例患者出现内侧皮肤皱褶,发生概率6.4%。对照组89例患者重睑线内侧出现皮肤皱褶的例数为17例,概率为19.1%,差异有统计学意义（P<0.05）。结论 在全切重睑术时采用内眦部改良去皮法可有效地避免重睑线向内侧出现皮肤皱褶样外观,提高患者满意度。     

内眦部改良去皮法在全切重睑术中的应用

目的 通过对全切法重睑术手术切口进行改良,将内眦处皮肤去除范围向下扩大,观察术后重睑线下方皮肤的流畅程度。方法 自2017年1月至2018年4月期间,共有78例患者采用内眦部改良去皮法进行全切重睑术,设为观察组。平卧闭眼状态下设计去皮范围,观察重睑术后不同阶段重睑线下方的皮肤的紧致程度。同时对比2016年1月至2016年12月全切重睑术患者,共89例,设为对照组,统计发生重睑线内侧皱褶出现的概率。结果 观察组78例患者伤口均一期愈合,有4例患者出现内侧皮肤皱褶,发生概率6.4%。对照组89例患者重睑线内侧出现皮肤皱褶的例数为17例,概率为19.1%,差异有统计学意义（P<0.05）。结论 在全切重睑术时采用内眦部改良去皮法可有效地避免重睑线向内侧出现皮肤皱褶样外观,提高患者满意度。