Arcus Marginalis Release II Via Endoscopic Midface-Lift

Tear troughs in combination with midfacial ptosis may be early and synergistic signs of aging. Premaxillary and suborbicularis oculi fat (SOOF) descent decreases soft tissue volume covering the orbital rim, while prolapsing retroseptal fat actually underscores the resulting tear trough shadow. This volume change precedes skin redundancy. Thus, volume redistribution avoiding external skin incisions is the adequate treatment. De la Plaza’s transconjunctival lower lid blepharoplasty is a reliable tool for arcus marginalis release. For patients also requiring an endoscopic midface-lift, even the transconjunctival incision for intraorbital fat compartment realignment can be avoided by performing the release of the lower orbita septum via the buccal mucosa incision. Presented in part at the XXth anniversary meeting of the Mediterranean Society of Plastic Aesthetic Surgery, Nice France, 13–15 April 2007     

眶脂肪弓状缘释放联合眶肌筋膜韧带悬吊下睑袋整形术在面部年轻化中的应用

目的:探讨眶脂肪弓状缘释放联合眶肌筋膜韧带悬吊行下睑袋整形的美学效果。方法:选择笔者医院2017年2月-2018年1月行下睑袋整形术的60例中老年女性患者资料,采用眶脂肪切除法患者纳入对照组(29例,58眼),采用眶脂肪弓状缘释放联合眶肌筋膜韧带悬吊法纳入研究组(31例,62眼),术后6个月比较两组患者术后临床疗效及美学修复满意度。结果:研究组患者术前泪槽沟及眶颊沟分级比较差异无统计学意义(P>0.05);术后两组患者泪槽沟及眶颊沟分级均较术前下降,研究组泪槽沟及眶颊沟分级低于对照组,差异有统计学意义(P<0.05)。研究组年轻化分级比较优于对照组,差异具有统计学意义(P<0.05)。对照组患者美学满意率为69.0%,研究组患者美学满意度为95.2%,组间比较差异具有统计学意义(P<0.05)。对照组并发症发生率为6.9%,研究组并发症发生率为4.8%,组间比较差异无统计学意义(P>0.05)。结论:眶脂肪弓状缘释放联合眶肌筋膜韧带悬吊行下睑袋整形能够有效改善中老年女性眼部老化形态,达到眼部年轻化效果,具有较高的美学满意度。     

Combined Arcus Marginalis Release,Preseptal Orbicularis Muscle Sling,and SOOF Plication for Midfacial Rejuvenation

Improvements have been made throughout the history of medicine, causing physicians to abandon a technique or medications clearly shown to be suboptimal. Unfortunately, this has not happened with rejuvenative surgery. Conventional lower eyelid procedures continue to include removal of orbital fat in most cases, and facelift procedures remain primarily a lateral vector pull. The unfortunate results of these traditional procedures are becoming easy to recognize. Optimal rejuvenation of the lower eyelid complex should be based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat, but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. Although the necessity of preserving fat and repositioning the soft tissues of the midface has been widely accepted, there still is wide disagreement among authors as to the best approach and surgical technique. This report describes a surgical technique for lower lid midfacial rejuvenation that is a composite of several previously published approaches with some modifications, particularly in the way the Sub-Superficial Musculo Aponeurotic System (SMAS) fat pad is plicated and the midfacial tissues suspended. The technique is simple and safe, resulting in a pleasing natural midface contour.     

Asian Blepharoplasty: The Indian Perspective

The upper eyelid crease is an indentation at the level where fibers from the levator aponeurosis insert into the skin. Typically, Asian eyes are described as creaseless and puffy and the aim of blepharoplasty is to achieve an eyelid crease, without losing the ethnicity of the individual. We aim to describe the most commonly performed technique as well as the peculiar points to be kept in mind from the Indian perspective.     

Myopic Change After Transconjunctival Blepharoplasty Using Carbon Dioxide Laser: Case Report

The case of a patient who experienced temporary myopic change after transconjunctival blepharoplasty using the carbon dioxide (CO₂) laser is reported. Transconjunctival lower lid blepharoplasty using the CO₂ laser, one of the most frequent laser procedures performed in aesthetic surgery, is considered to be a safe and reliable approach that does not incur significant complications. This report describes temporary myopia in a 38-year-old woman as a rare complication after this procedure. As for the possible etiology of the postoperative myopia, the authors strongly suspect a temporary mild deformity of the eyeball leading to the change in refraction, including scleral edematization and/or retinal indentation attributable to thermal injury as a result of CO₂ laser irradiation adjacent to the eyeball. The purpose of this case report is to inform others of the complication the authors encountered and to discuss the possible etiology.     

72例睑袋整复术的临床分析

目的总结睑袋矫正的经验,提高临床治疗效果。方法72例睑袋依其局部病理变化分为4种类型,各类型采用不同术式以切除、提吊、固定整复。结果72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。     

重睑就医者社会心理因素与术后满意度相关性研究

目的:探究重睑就医者社会心理因素与术后满意度的相关性。方法:以重庆医科大学附属第一医院整形外科149例重睑就医者为研究对象。术前采用自制问卷,术后采用满意度调查问卷,术前临床访谈和术后追踪回访相结合。研究重睑就医者社会心理因素特征及其与术后满意度的相关性。结果:预期效果与手术满意程度呈现正相关,对手术效果的期待与手术满意程度呈负相关(P<0.05);手术信任度与手术满意程度呈现正相关,肿胀消退情况与手术满意程度呈现正相关,术后效果评价、术前预期效果、家人朋友对该手术满意度与术后手术者满意度呈正相关(P<0.01)。社会因素中就医者年龄、性别、职业、收入、婚姻状况、术式等与术后满意度无明显相关性。结论:重睑术后满意度评价存在较大的主观性,术前对就医者做好预期效果、手术信任度调查,针对不同调查结果做好心理护理及专业指导,同时术中、术后的肿胀预防及处理可提高术后满意度。     

剥离弓状缘眼轮匝肌在伴有泪槽和睑颊沟的眼袋整复中的应用

目的 探讨伴有明显泪槽和睑颊沟的眼袋整形手术方法.方法 2007年1月至2011年6月,对56例眼袋伴泪槽和睑颊沟畸形者,在术中充分剥离松解弓状缘眼轮匝肌,尤其是附着在内侧泪槽处眶下缘骨膜面的眼轮匝肌,将眶隔脂肪释放重置并缝合固定于眶下缘下方4 ～6 mm处骨膜面上,进行泪槽和睑颊沟充填.结果 术后随访3 ～18个月,54例眼袋消失,无下睑凹陷、不平整等;1例术后1个月出现下睑皮下局部凹凸不平,3个月后经结膜入路修复后改善;1例出现下睑缘轻度退缩,经局部理疗后睑缘退缩消失.结论 剥离松解弓状缘眼轮匝肌,行眶隔重置,对矫正伴有泪槽及睑颊沟畸形的眼袋效果良好.     

The Concentric Malar Lift: Malar and Lower Eyelid Rejuvenation

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.Publication presented at the meeting of the Societe Francaise des Chirurgiens Esthetiques et Plasticiens 23 June 1996, and at the meeting of the Australian Society of Plastic Surgery 9 March 2002     

Lower Lid Blepharoplasty—The Transconjunctival Approach: Extended Indications

The transconjunctival blepharoplasty is an elegant and secure technique especially in young people and helps to avoid the hazard of a scar. In older patients, it saves them the possible sequelae such as rounding sclero show or possible ectropion after a classical operation. Because there is no visible scar, the transconjunctival approach respects the integrity of the functional structure of the orbital septum and the orbicular muscle, the active support of the lower eyelid.     

眉下切口行上睑松弛矫正术联合外入路下睑袋切除术共同矫治眼周衰老的手术效果

目的 探究眉下切口行上睑松弛矫正术联合外入路下睑袋切除术共同矫治眼周衰老的手术效 果。方法 选择2022年1月11日-2023年3月25日于我院行眼周情况观察及衰老矫治的200例患者为研究对象, 根据入院时间不同分为对照组和观察组,每组100例。对照组采用眉下切口行上睑松弛矫正术,观察组采 用眉下切口行上睑松弛矫正术联合外入路下睑袋切除术,比较两组临床疗效、并发症发生情况及满意度。 结果 观察组治疗总有效率为98.00%,高于对照组的90.00%,差异有统计学意义（P＜0.05）;观察组并发症 发生率为3.00%,低于对照组的12.00%,差异有统计学意义（P ＜0.05）;观察组治疗满意度为97.00%,高 于对照组的85.00%,差异有统计学意义（P ＜0.05）。结论 眉下切口行上睑松弛矫正术联合外入路下睑袋 切除术共同矫治眼周衰老的手术效果良好,相比于单一应用上睑松弛矫正术,联合治疗的总有效率更高, 术后并发症发生几率更低,手术安全性得到保障,且患者对矫治方案的满意度也得到了有效提升。     

Percutaneous Trigger Release in Non-Triggering Digits: Infiltration of Normal Saline into Tendon Substance to Induce Triggering

Percutaneous trigger release is recognized as an effective minimally invasive procedure with a low complication rate. One prerequisite for percutaneous trigger release is a trigger of Quinnell Type II or higher; that is, a digit that is actively triggering. We describe an additional step in percutaneous trigger release, which enables the surgeon to perform the procedure in digits that are not actively triggering at the point of surgery. This step involves the infiltration of normal saline into the tendon substance distal to the A1 pulley in order to induce triggering.     

内镜下腕管松解术与常规腕管切开松解术治疗腕管综合征的Meta分析

目的对内镜下腕管松解术（endoscopic carpal tunnel release,ECTR）和常规腕管切开松解术（open carpal tunnelrelease,OCTR）治疗腕管综合征的疗效进行系统评价。方法按照Cohrane系统评价的方法,计算机检索MEDLINE（1966年~2010年3月）、EMBASE（1966年~2010年3月）、Cochrane图书馆（2010年1月）及中国生物医学文献数据库（1979年~2009年12月）,并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,采用Cochrane协作网提供的软件Revman4.2.2进行Meta分析,以获得ECTR与OCTR治疗腕管综合征的疗效及其安全性是否有差异的相关证据。结果共纳入8个随机对照试验进行评价,Meta分析显示,ECTR组与OCTR组的术后并发症发生率、主观满意率、手术时间及术后手握力和捏力功能恢复差异无统计学意义（P〉0.05）;ECTR组术后疼痛发生率和恢复工作时间显著低于OCTR组（P〈0.05）。结论与OCTR相比,ECTR可降低腕管综合征的术后疼痛发生率,缩短恢复工作时间;2种手术方式术后并发症发生率、主观满意度、手术时间、术后握力与捏力无统计学差异。因研究质量及样本的局限性,2种手术方法与手术时间和手功能的关系有待于进一步研究。