中老年人切开法重睑术后重睑线末端分叉的原因及预防

目的:探索中老年人切开法重睑术后出现重睑线末端分叉的原因及其预防措施。方法:根据中老年上睑的解剖学特点,在中老年切开法重睑手术中,酌情去除外眦部位下垂松弛的眼轮匝肌组织,使重睑线尾端自然上翘,避免产生末端分叉的外观。结果:本组共64例患者,术后随访6～12个月,均未出现重睑线末端分叉外观,重睑形成线条流畅,眼部的整体效果得到明显改善。结论:去除外眦部位的眼轮匝肌,重新形成重睑线,使原有物质基础彻底消除,是解决中老年人重睑术后外眦鱼尾外观的关键。     

提升重睑线末端下垂的一种改良重睑术式

目的：探索行重睑术同时提升重睑线末端下垂的一种改良手术方法。方法：通过尸体解剖观察眼轮匝肌形态及走向,采用常规重睑术切口,依据患者局部情况酌情去除外眦部一个三角形眼轮匝肌组织,改善组织臃肿下垂状况,使重睑线尾部形态自然上翘。结果：2009年9月～2010年9月共对153例（306只眼睛）就医者进行手术,其中110例获6个月以上随访,对随访者的重睑形态进行评估,重睑线外形流畅,末端自然略上翘,效果理想。结论：本术式能够改善外眦上方组织臃肿松弛,使重睑线形态更流畅,末端略上翘,术后形态良好,是一种效果肯定,结果满意的方式。     

保留眼轮匝肌三点固定切开法重睑术的临床应用

目的:探寻一种恢复快、效果稳定自然、操作简便的重睑手术方法。方法:沿设计好的重睑线切开皮肤全层后,保留眼轮匝肌,并通过眼轮匝肌不连续微切口,将眼轮匝肌与上睑提肌腱膜固定,然后间断缝合皮肤,术后观察临床效果。结果:本组共105例就医者,术后效果均较好,术后7~14d基本恢复自然,不良反应轻微,手术操作简单易行,就医者及医生均较满意。结论:保留眼轮匝肌的三点固定切开法重睑术是简单高效的手术方法。     

外段一点埋线术治疗原有重睑线的中青年上睑松弛

目的：介绍外段一点埋线术治疗原有重睑线的中青年上睑松弛的手术方法。方法：在患者原有重睑线中外1/3交界处上方2mm的位置标记手术埋线的部位,应用6-0无损伤缝合线行真皮与眶隔或睑板之间埋线。结果：2008年6月～2009年12月治疗原有重睑线的中青年上睑松弛患者32例,术后重睑线形态良好,上睑均无明显红肿。29例患者术后随访3个月～1年,上睑明显年轻化。结论：外段一点埋线术是治疗原有重睑线的中青年上睑松弛的一种简单有效方法。     

眶隔固定切开法重睑术和经典切开法重睑术的效果比较

比较眶隔固定切开法重睑术和经典切开法重睑术的效果。方法 选取2021年1月-2022年12月于我院拟行切开重睑术的60例患者为研究对象,按照随机数字表法分为常规组与观察组,每组30例。常规组予以经典切开法重睑术,观察组予以眶隔固定切开法重睑术,比较两组术后形态改善情况、并发症发生情况及满意度。结果 观察组术后总改善率为100.00%,高于常规组的66.67%（P ＜0.05）;观察组并发症发生率为3.33%,低于常规组的20.00%（P ＜0.05）;观察组满意度为96.67%,高于常规组的66.67%（P ＜0.05）。结论 眶隔固定切开法重睑术可有效改善患者术后重睑形态,提高满意度,是一种安全性较高的术式。     

重睑术后并发症探讨和处理

我院自1985年至2005年共行重睑术6783例．术后不理想590例（8．7％）。主要并发症有：双侧不对称、重睑线变浅或消失、内外眦成形不满意、多层重睑、三角眼、上睑窝过度凹陷、缝线外露、皮下囊肿、上睑下垂、上睑瘢痕、角膜损伤。出现并发症不满意者经重新手术修复，术后效果满意。重睑术有三种术式，即压线法、埋线法及切开法重睑术。由于眼型差异及术者经验的不同，术后常出现各种并发症，本文分析其原因，并简述治疗方法。     

运用重睑术矫治藏族人上睑松弛

上睑成形术中，上睑皮肤松弛的病人占有相当人的比例。皮肤切除过量会引起睑外翻，切除不足又会矫形不佳，术后效果不好。因此，如何准确把握上睑皮肤的去除宽度就成为手术成功的关键之一。笔者在援藏三年期间，第一年采用常规皮肤夹持法去皮，结果60％出现切除不足，无一例睑外翻发生。第二、三年除采用皮肤夹持法去皮外，另外去除平均宽约2mm的皮肤，结果也无一例睑外翻发牛，仅1％出现切除不足。效果满意，现报道如下。     

再论保留皮下静脉的切开法重睑术

目的　为了减轻切开法重睑术后的肿胀和缩短恢复时间。方法　在3520例的术中将上睑0.2mm左右直径的皮下静脉分离出来,不损伤,不切断。结果　甚为满意,手术时间并不比传统切开法长,术中出血及术后肿胀均甚轻微,术后1～2天即可恢复正常生活。结论　本法简单、有效,值得推广使用。     

重睑成形术和眉上提术矫正上睑皮肤松弛

人开始衰老以后，上睑皮肤出现不同程度的松弛下垂，轻者遮盖自然的重睑线，重者形成老年性三角眼，不仅影响美观，严重者遮盖视野，影响视力。上睑皮肤松垂的矫正手术可分为二类：一是重睑成形术去除上睑松弛的皮肤，二是眉上提术矫正上睑皮肤松垂。笔者根据患者的眉部具体情况，分别采用两种不同方法矫正上睑松弛症状，均获得了良好的效果。     

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.     

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.     

Ectropion after blepharoplasty prevention and treatment

Ectropion is the most common serious complication following blepharoplasty for the correction of baggy eyelid deformity. Although blepharoplasty may be considered one of the most gratifying plastic operations, if an ectropion results it then becomes one of the most distressing to patient and surgeon alike.Ectropion complication of the upper eyelid is very rare. This is mainly due to the anatomy of the upper lid with its larger tarsal plate, which permits rather extensive resection of redundant and sagging skin.Ectropion of the lower lid, on the other hand, is a common and very distressing complication. The most important single cause for this complication is excessive excision of skin, which can and must be prevented in every case.I limit the skin resection in the lower lid to a wedge varying from 4 to 6 mms. below the subciliary incision line in most cases. I may resect as much as 8 mms. in severe cases of atonic and relaxed skin.I feel that with the limited resection of skin and a lateral superior tensioning of the skin and relaxed orbicularis muscle underneath ectropion is preventable even in cases of baggy lids in elderly patients.The principal causes of this complication, its prevention, and management once it has occurred are discussed in detail in this article.     

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.     

重睑成形术后睑粘连畸形的修复

目的针对临床上常见的由于重睑成形术失误所遗留的严重畸形,尤其表现为重睑线异常宽阔,上睑凹陷粘连并伴有眼轮匝肌下脂肪垫不足者,探索一种能有效改善外观畸形的简便方法。方法在原畸形的重睑切口线痕迹下设计新的重睑线,去除其间的多余皮肤,彻底松解眼睑内组织粘连,切除异常的瘢痕组织,将移位的眼睑结构彻底复位,分离眼轮匝肌下脂肪垫并将其形成蒂在上方的脂肪瓣,在不影响此脂肪瓣血运的前提下,将其向内下旋转达睑板上缘的合适位置固定,充填上睑的腔隙,若仍有残余空间,可以在进行确定重睑皱襞外形及缝合上下缘皮肤的操作后,行自体游离颗粒脂肪进行最后的补充。结果2年中对42例（共80只眼）重睑成形术后上睑粘连畸形进行治疗,其中32例为只应用眼轮匝肌下脂肪垫形成脂肪瓣充填矫正,10例另加颗粒脂肪注射补充,随访30例（共60只眼）,外观改善显著,多数受术者十分满意。结论此方法简单易行,效果好,可在临床推广应用。     

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.     

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.     

Lower lid blepharoplasty with skin flap and muscle split

A skin flap, muscle split lower eyelidplasty is recommended for the management of excess skin of the lower eyelids associated with herniated infraorbital fat pads. Precise fat pad removal and skin excision are necessary.     

Power of the pinch: pinch lower lid blepharoplasty

Lower lid blepharoplasty is performed with great variation in technique. Conventional lower lid blepharoplasty with anterior fat removal via the orbital septum has a potential lower lid malposition rate of 15% to 20%. Lower lid malposition and the stigma of obvious lower lid surgery have led plastic surgeons to continue to change their approach to lower lid rejuvenation. In recent years, some surgeons have come to rely on alternative procedures like laser resurfacing alone or in conjunction with transconjunctival fat removal and canthopexy in an effort to avoid such complications. The pinch blepharoplasty technique removes redundant skin without undermining. This allows for more controlled wound healing, predictable recovery, and potential for simultaneous laser resurfacing. The combination of pinch blepharoplasty with transconjunctival fat removal leaves the middle lamella intact and reduces the chance of scleral show or ectropion. The purpose of this series is to demonstrate that pinch excision of redundant lower eyelid skin can be safely performed and that it can be used with laser resurfacing and/or transconjunctival fat removal for optimal treatment of the aging eye. A retrospective review of 46 consecutive patients who underwent pinch blepharoplasty, either in isolation or with other periorbital procedures was performed. Follow-up was at least 4 months (range of 4-24 months). In addition, we performed a prospective study of 25 consecutive patients to quantify the amount of skin removed and evaluate results and complications. An average of 8 mm of skin was resected (range of 4-12 mm) with the pinch blepharoplasty technique. Of these patients, 5.6% also underwent transconjunctival blepharoplasty, laser resurfacing, and/or fat grafting of the nasojugal groove. Despite the addition of simultaneous laser resurfacing, we did not see an increase in lower lid malposition. Three of the 71 patients had temporary scleral show that resolved with lower lid massage. In total, only 4 patients had isolated pinch lower lid blepharoplasty. Twelve patients had orbicularis suspension and 15 had either canthopexy or canthoplasty. Five patients who had orbicularis suspension, canthopexy, or canthoplasty had periorbital edema. Two also had pronounced chemosis. Four patients had mild rounding of the lower lid. Pinch blepharoplasty is a versatile technique that produces consistent results. This study confirms that more skin from the lower lid can be resected than classically described. Pinch blepharoplasty can be performed safely in combination with other procedures to enhance lower lid appearance. The absence of skin undermining allows for safe simultaneous laser resurfacing. Preserving the middle lamella and supporting it when necessary allows one to resect significant amounts of lower lid skin without significant risk of scleral show, lower lid rounding, and ectropion. Patients with poor lid tone or laxity may benefit from supportive procedures such as the canthopexy or canthoplasty.