Transconjunctival upper blepharoplasty: a safe and effective addition to facial rejuvenation techniques

Transconjunctival techniques for eyelid rejuvenation are now well accepted in the lower eyelid. Transconjunctival upper blepharoplasty is a relatively new technique for which overall experience has been limited. Since October 1998, the authors performed 42 bilateral transconjunctival upper blepharoplasties on patients undergoing facial and eyelid rejuvenation. They describe the essential anatomy and technique of the procedure. The CO2 laser is used concomitantly for treating fine rhytids and tightening loose upper eyelid skin. This procedure is an effective method of removing medial upper eyelid fat with minimal complications.     

下睑袋整复术同期矫正内眦赘皮

目的：探讨一种伴有内眦赘皮下睑皮肤松弛者于行下睑袋整复术的同期进行内眦赘皮矫正术,使内眦部位瘢痕隐藏在下睑袋切口上的一项手术方法。方法：2005年1月～2009年12月共为97例下睑皮肤松弛伴内眦赘皮者施行内眦赘皮矫正手术。设计内眦赘皮横行切口线,平行于下睑缘画出下睑袋切口线。横行剪开内眦赘皮的长度达新设计的内眦点,纵行剪开部分内眦韧带前脚,将内眦韧带前脚的内眦侧断端向鼻侧牢固地固定在鼻背筋膜上。常规行下睑袋整复术。结果：97例下睑皮肤松弛伴内眦赘皮者施行矫正手术后,睑裂增大2～4mm,内眦赘皮消失,术后瘢痕位于睑缘下下睑袋切口上隐藏性好,外形满意。结论：该手术方法简单,内眦部位瘢痕隐蔽在下睑袋切口上,效果满意。     

Bipolar coagulation-assisted orbital (BICO) septoblepharoplasty: a retrospective analysis of a new fat-saving upper-eyelid blepharoplasty technique

BACKGROUND: Upper eyelid blepharoplasty generally is performed as a combination of excess skin reduction and fat resection. Fat resection can in the long term result in a hollow orbit. Therefore, treatment of the lax orbital septum, in combination with skin reduction, seems a more preferable approach than fat resection.The authors describe a technique of upper-eyelid blepharoplasty: a combination of excess skin reduction and shortening of the stretched lax orbital septum by means of bipolar coagulation. This procedure is called bipolar coagulation-assisted orbital septoblepharoplasty, ie, BICO septoblepharoplasty. The aim of this retrospective study is to report on our initial experience with this technique. METHODS: We retrospectively analyzed 296 patients in whom an upper-eyelid blepharoplasty was performed during the past 4 years using the BICO septoblepharoplasty technique: first, excess skin is removed, then a small rim of orbicularis muscle is excised to expose the bulging orbital septum, and finally, before closure of the wound, bipolar coagulation of the exposed orbital septum is performed. This results in shrinkage of the septum and thus in repositioning of the pseudoherniated fat pads. RESULTS: At discharge from follow-up, which varied from 9 weeks (72% of the patients) up till 2 years after surgery (28% of the patients), in all patients ultimately a satisfactory result was achieved and ultimately all were satisfied or very satisfied with the result of the procedure. There were only 3 patients with minor complications: 1 patient with a slightly retracting scar, which resolved spontaneously, and 2 patients with slight asymmetry requiring additional skin resection. CONCLUSIONS: BICO septoblepharoplasty of the upper eyelid seems to be an effective way to treat blepharochalasia of the upper eyelid; the bipolar coagulation of the orbital septum will lead to shrinkage of the septum, thereby repositioning the prolapsing medial and central fat pads. Secondary fibrosis will reinforce the orbital septum postoperatively.     

Reconstruction of the orbital region with the “blepharoplasty flap”

A modified technique of unipedicled orbicularis oculi myocutaneous flap raised along an upper or lower blepharoplasty incision line for reconstruction of the orbital region is described. This procedure provides excellent aesthetic improvement in older patients with a standard blepharoplasty being performed on the other eyelid.     

合并复杂情况的重睑成形术

目的探讨单睑并发内眦赘皮、轻中度上睑下垂、上睑臃肿、上睑皮肤松垂或睑黄瘤,以及重睑成形术失败再修复等复杂类型重睑成形术的手术方法、注意要点。方法2000年1月～2005年12月间,共进行了148例复杂类型的重睑成形术,手术主要包括以下步骤:术前评估,切口设计,麻醉,切开并去除多余的皮肤、肌肉和脂肪,同时选择合适的手术方法矫正合并的内眦赘皮、上睑下垂、上睑臃肿、上睑皮肤松垂或者睑黄瘤等,最后按重睑成形术操作完成手术。结果共115名女性和33名男性实施了手术,并进行了3个月～5年的随访。术后平均7～14d局部消肿,4周～3个月重睑弧度基本恢复自然,睑形秀美,未发生任何并发症。结论通过术前对实际情况的仔细评估和准确测量,精确设计合适手术方案,应用切开法术重睑成形术的同时进行相关问题的矫正,可使重睑成形术的美学效果更趋完美。     

下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的效果观察

目的探讨下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的临床效果。方法于下睑缘睫毛根下1mm处平行下睑缘设计切口,由内眦至外眦,经外眦处与水平线呈15°～30°处向外下方斜行切开3～7mm,先向下皮下剥离约5mm,再切开眼轮匝肌,形成上方为皮瓣下方为肌皮瓣的复合瓣,复合瓣后方的眶隔脂肪充分显露,以眶下缘平面为基准,直视下切除疝出的眶隔脂肪,对有“泪槽”凹陷者将眶隔脂肪转移填充凹陷至下睑平整,最后,扇形切除多余的皮肤和肌肉,间断缝合切口。按照睑袋切除术后满意度标准,对术后效果进行评价,并记录各种并发症的发生情况。结果术后随访1～12个月,按照术后满意度评定标准,患者的满意率82％（262／319）;基本满意率14％（45／319）;不满意率4％（12／319）。本组中43例出现并发症,如轻度复视、轻度睑外翻、血肿等,均经术后7d至3个月逐渐恢复。但14例血肿患者中,有2例在术后6个月行手术切除血肿后,外观改善;6例术后7d拆线时出现切口裂开,经医用胶水粘合后恢复。所有患者术后睑袋畸形均得到不同程度地矫正,下睑皮肤皱纹明显减少或消失,瘢痕不显,无严重的并发症发生。结论采用下睑缘切口皮瓣延伸肌皮瓣法修复中老年人下睑皮肤松弛,效果良好,并发症少,值得临床推广应用。     

特殊类型的重睑成形术

目的探讨单睑并发内眦赘皮、轻中度上睑下垂、上睑臃肿、上睑皮肤松垂或睑黄瘤,以及重睑成形术失败再修复等特殊类型重睑成形术(切开法)的手术方法、注意要点。方法手术主要包括以下步骤:术前评估,切口设计,麻醉,切开并去除多余的皮肤、肌肉和脂肪;同时,选择合适的手术方法矫正合并的内眦赘皮、上睑下垂、上睑臃肿、上睑皮肤松垂或者睑黄瘤等,最后按重睑成形术操作完成手术。结果共148例,其中女115例,男33例,并进行了3个月至5年的随访。术后平均7~14d局部消肿,4周至3个月重睑弧度基本恢复自然形态,睑形秀美,未发生任何并发症。结论通过术前对实际情况的仔细评估和准确测量,精确设计合适手术方案,应用切开法重睑成形术的同时进行相关问题的矫正,可使重睑成形术的美学效果更趋完美。     

Improving the Lateral Fullness of the Upper Eyelid

The lateral fullness of the upper eyelid is its convex surface area from the eyebrow to the eyelid crease. Rejuvenation of upper eyelids can be achieved by accenting their fullness. An S-shaped fusiform skin segment is removed from the upper eyelid, with care taken to spare the orbicularis occuli muscle. Approximately 1 ml of fat tissue is excised from the medial compartment by transmuscular incision. The fat is placed in the crease, and the orbicularis occuli muscle is stitched together over the transplanted fat tissue. Imbrication of the orbicularis occuli muscle and insertion of 1 ml of fat tissue into the muscle layers increase the lateral fullness and significantly emphasizes the aesthetic result of upper eyelid blepharoplasty.     

The surgical management of upper eyelid hooding

A technique is described that aesthetically corrects brow ptosis and upper eyelid hooding in selected patients. This procedure is performed through a standard upper eyelid blepharoplasty incision and addresses the common findings of soft tissue fullness below the brow due to excessive suborbicularis fat and hypertrophied orbicularis oculi muscle.Presented at IXth Congress of the International Society of Aesthetic Plastic Surgery, New York New York October 1987Presented at 20th annual meeting of The American Society of Aesthetic Plastic Surgery, Los Angeles, California, March 1987     

小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症

目的探讨小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症的方法及疗效。方法采用小切口额部提紧术联合重睑术治疗中重度眼睑皮肤松垂症25例,通过发迹内或发迹缘小切口行帽状腱膜下剥离,眉毛及发迹缘行埋没导引缝合悬吊额眉部软组织,额眉组织提升后再行重睑成形术。结果本组切口平均0.9(0.8～1.0)cm,术后5～10d消肿,术后1月眼部形态恢复,额眉眼比例恢复。无一例大血肿、皮肤坏死等并发症。术后平均随访32个月(3个月～6年),所有患者上眼睑皮肤提紧,手术疤痕不明显。结论小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症简单、有效,不需特殊设备,在解除眼部症状的同时,又能达到良好的美容效果。     

特殊类型上睑重睑术方法探讨

目的：探讨几种特殊类型单睑者的理想重睑成形术式。方法：对83例特殊类型单睑者行重睑美容手术治疗，根据不同上睑类型分别施行去除上睑脂肪组织、上睑多余皮肤、上睑多余皮肤及部分眶部眼轮匝肌的重睑成形术。结果：随访3个月到半年，所有病例上睑外形均明显改善，手术效果满意。结论：施行重睑术，应全面评估，根据不同上睑类型选择不同术式，才能达到满意的美容效果。     

睑袋整复的术式及其适应证

目的　观察不同的术式对不同成因的睑袋的整复效果 ,为睑袋的整复积累临床经验。方法　对 2 36例睑袋患者 ,根据具体情况采用结膜径路的眶脂去除术 (4 1例 )、单纯松弛皮肤去除术 (2 5例 )、单纯眼轮匝肌整复术 (8例 )、皮肤径路的眶脂去除下睑支持结构加固术 (149例 )以及保留眶脂的睑袋整复术 (13例 )进行整复。结果　 2例患者因双侧下睑区不规则膨出 ,1例患者下睑切口位置高低不一 ,进行了再次整复术 ;3例患者早期下睑皮肤瘀斑明显 ,2例患者早期有轻度睑球分离 ,随着时间的延长 ,症状都消失 ;其余患者都取得了满意的效果。结论　睑袋形成的原因各异 ,患者的年龄、职业以及对手术的期望值差别较大 ,术前对患者的情况有一个正确的认识 ,选择合适的术式 ,术中注意处理每一个环节 ,绝大多数患者都能取得满意的效果     

睑袋整复的术式及其适应证

目的　观察不同的术式对不同成因的睑袋的整复效果,为睑袋的整复积累临床经验。方法　对236例睑袋患者,根据具体情况采用结膜径路的眶脂去除术(41例)、单纯松弛皮肤去除术(25例)、单纯眼轮匝肌整复术(8例)、皮肤径路的眶脂去除下睑支持结构加固术(149例)以及保留眶脂的睑袋整复术(13例)进行整复。结果　2例患者因双侧下睑区不规则膨出,1例患者下睑切口位置高低不一,进行了再次整复术;3例患者早期下睑皮肤瘀斑明显,2例患者早期有轻度睑球分离,随着时间的延长,症状都消失;其余患者都取得了满意的效果。结论　睑袋形成的原因各异,患者的年龄、职业以及对手术的期望值差别较大,术前对患者的情况有一个正确的认识,选择合适的术式,术中注意处理每一个环节,绝大多数患者都能取得满意的效果。     

Central (third) fat pad of the upper eyelid.

A clinical study on the surgical anatomy of the upper-eyelid fat pads was performed on 55 consecutive patients who underwent a blepharoplasty. It was confirmed that the periorbital fat is encapsulated in compartments and that the number of fat pads varies. In 56% of the cases there were two fat pads and in the 44% three fat pads in the upper eyelid. The third fat pad is anatomically and histologically an accessory medial extension of the lateral fat pad. However, for the sake of clarity, the term central fat pad of the upper eyelid is proposed as a denominator of this structure. The purpose of this article is to make the less experienced surgeons aware of variations in the configuration of the periorbital fat and to remind them that after two fat pads are removed from the upper eyelid there might still be a third.     

改良三点式重睑成形术的临床应用研究

目的:探讨改良三点式重睑术的临床应用疗效。方法:2012年6月-2019年6月,共165例单睑患者采用了改良三点式重睑术,沿术前标记线将三点处皮肤切开,剪刀将切口下唇的眼轮匝肌适当去除,同时将切口与切口在皮下层打通,剪除切口与切口之间的眼轮匝肌,6-0可吸收线挂睑板前筋膜或提上睑肌腱膜及切口下唇皮下组织缝合,三点切口各缝1针。再用6-0单丝尼龙线按照常规重睑线缝合方法挂切口下唇皮肤、睑板前筋膜或提上睑肌腱膜及切口上唇皮肤缝合打结,三点切口各缝1针。伴内眦赘皮者同时行内眦赘皮矫正术。结果:152例患者获得随访,随访患者大部分获得了比较满意的重睑,睁眼重睑流畅、自然,闭眼刀口痕迹不明显。2例患者出现内侧重睑线变浅,1例患者出现外侧重睑线变浅,所有患者均未出现重睑消失。5例患者双侧重睑线有轻度不对称。患者总体满意率为94.7%(144/152)。结论:改良三点式重睑术具有创伤小、并发症少、效果逼真、不易脱落、手术痕迹不明显等优点,值得推广应用。     

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.     

Central (third) fat pad of the upper eyelid

A clinical study on the surgical anatomy of the upper-eyelid fat pads was performed on 55 consecutive patients who underwent a blepharoplasty. It was confirmed that the periorbital fat is encapsulated in compartments and that the number of fat pads varies. In 56% of the cases there were two fat pads and in the 44% three fat pads in the upper eyelid. The third fat pad is anatomically and histologically an accessory medial extension of the lateral fat pad. However, for the sake of clarity, the term central fat pad of the upper eyelid is proposed as a denominator of this structure. The purpose of this article is to make the less experienced surgeons aware of variations in the configuration of the periorbital fat and to remind them that after two fat pads are removed from the upper eyelid there might still be a third.Presented at the 10th Congress of the International Society of Aesthetic Plastic Surgery, Zürich, Switzerland, September 11, 1989     

切除眼轮匝肌下脂肪垫在肿泡眼重睑成形术中的应用

目的：通过对眼轮匝肌下脂肪垫（SOOF）的解剖观察，探讨其部分切除在肿泡眼重睑术中的应用效果。方法：对215例肿泡眼施行切开重睑术，在常规切除肥厚的眼轮匝肌和膨隆的眶隔脂肪以减轻上睑臃肿的同时，去除部分上睑外侧肥厚的眼轮匝肌下脂肪垫。结果：临床解剖观察表明眼轮匝肌下脂肪垫在肿泡眼眼睑中较丰富，它位于眼轮匝肌下，覆盖在外侧眶缘上，向外伸展指向眉弓的末端，在眼睑的眶外缘形成檐盖状膨隆，该脂肪垫在上睑外1／3处肥厚更明显，组织较致密。肿泡眼患者重睑术中适当去除部分肌下脂肪垫后上眼睑变薄，重睑弧度自然，形态逼真。术后随访3个月～1年，均获满意效果。结论：只要熟悉眼睑的解剖层次，并谨慎操作，术中适当切除该脂肪垫，可明显提高肥厚眼睑重睑后的美容效果。     

Asian Blepharoplasty with a Short-Pulsed Contact Nd–Yag Laser: Limited-Incision Resectable Laser Double Fold with Internal Medial and Lateral Functional Epicanthoplasty

The double-fold operation is the most common aesthetic procedure in Asia, but complications such as gross asymmetry, loss of folds, and scars on the medial canthal region and upper eyelid are relatively common. To prevent these complications, caused by displacement of fixation sutures secondary to excessive edema or hematoma, we use fine fiber-delivered contact surgical Nd–Yag (Japan SLT) laser for incision, excision, coagulation, dissection, ablation, and fusion of the soft tissue. Comparing this laser treatment to conventional electrocautery techniques or to CO₂ laser blepharoplasty, this contact short-pulsed Nd–Yag laser gives us a tactile sensation, providing a more precise, controlled surgical procedure without lateral thermal damage, and it is possible to operate through a small incision. A long-term follow-up study shows that there was no gross asymmetry, loss of folds, or visible or hypertrophic scars on the upper eyelid and medial canthal regions.