An anatomical structure which results in puffiness of the upper eyelid and a narrow palpebral fissure in the Mongoloid eye.

The typical Mongoloid eye differs from the Occidental one in puffiness of the upper eyelid and narrowness of the palpebral fissure. We surmised that an anatomical structure might exist in the preaponeurotic fat space, which determines the features of the Mongoloid eye. The upper eyelids of 720 Japanese patients and eight Japanese cadavers were macroscopically investigated, and sagittal slices of the central upper eyelid of one patient and nine cadavers were microscopically analysed. Another, lower-positioned transverse ligament different from the higher-positioned Whitnall's one was identified just above the fusional line between the orbital septum and the levator aponeurosis in almost every upper eyelid. A robust ligamentous structure was observed in 331 patients (46%) with puffier eyelids and a narrower palpebral fissure, a diaphanous retinaculum in 381 patients (53%) and no transverse ligamentous tissue in eight patients (1%). Histological evaluation demonstrated that this ligament was composed of tight bundles of collagen fibres containing few elastic fibres. Examination of the preaponeurotic fat space indicated that the superficial expansion of the levator aponeurosis turned up around this transverse ligament to become the orbital septum. When the levator muscle contracts, the deep expansion of the levator aponeurosis retracts the tarsus, the middle expansion retracts the pretarsal orbicularis oculi muscle and skin, and the superficial expansion retracts the preaponeurotic fat against this ligament. This structure thus determines the low position of the preaponeurotic fat and restricts the vertical width of the palpebral fissure, causing the features of the Mongoloid eye.     

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。     

眼轮匝肌下脂肪垫的解剖学及整形外科学的研究

目的：研究眼轮匝肌下脂肪垫的解剖结构,和相邻组织结构的关系,评价其在眼部年轻化手术中的应用效果。方法：对成人头颅部人体标本7具（14侧眼部标本）进行眶部解剖研究;对50例术前有明显面部老化征象患者进行了眼部手术,手术中将眼轮匝肌下脂肪垫部分去除。结果：在眼轮匝肌下和上颌骨、颧骨骨膜的浅面,存在有脂肪垫,其大部分分布在眼眶外围,并与周围脂肪垫相连续。50例眼袋患者,术后下睑区平展,眶隔脂肪袋消失,下眶缘沟消失,眶下外侧骨缘轮廓平和。其中19例伴有上睑臃肿下垂患者,术后眼裂增宽,眼睑变薄,无上睑外侧臃肿表现。结论：眼部年轻化手术适当去除眼轮匝肌下脂肪垫,可明显改善手术效果。     

多技术综合应用下睑成形术矫正下睑汨槽畸形

目的：探讨多项技术综合应用下睑成形术矫正下睑泪槽畸形的可行性，总结手术操作技巧及经验。方法：经皮肤肌皮瓣手术入路，采用弓状缘眶隔脂肪释放、眶内脂肪保留、眶隔紧缩重置技术及眶肌筋膜韧带提紧悬吊相结合的综合手术方法。结果：本组56例患者，术后无明显出血、瘀斑，无睑球分离、下睑外翻等并发症出现。随访2～30个月，下睑部皮肤平整，泪槽畸形明显改善，患者自感外观效果满意。结论：多项技术综合应用下睑成形术矫正下睑泪槽畸形是获得面中部年轻化的行之有效的手术方法。     

MRI findings of the upper eyelid and their relationship with single- and double-eyelid formation

Before the invention of magnetic resonance imaging (MRI), it was impossible to observe an architectural deformation of the eyelid because of its movement. The authors observed MRI films of 15 eyelids in both closed and opened positions and obtained new information on the architecture of the upper eyelid and also the mechanism of single and double eyelids, and sunken eye formation. (1) Orbital fat is transposed when the lid moves. If the fat can not return into the orbit when the lid opens, it droops and interferes with the fold formation of the lid. (2) The thickness of the eyelid skin is associated with double-eyelid formation. The skin fold is observed at the junction between thick skin with subcutaneous fat and thin skin without it. (3) We could not confirm Doxanas and Anderson's assertion that septal insertion was lower in Orientals. However, we observed pretarsally drooped or herniated orbital fat in many slit-eye Orientals. (4) There are three angles at the tarso-levato-aponerotic line: one at the junction with transverse ligament, one at the point of septal insertion, and another at the aponeurotic terminal on the tarsus.Presented at the Third International Conference of OSAPS, Beijing, China, October 22-25, 1992     

Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.     

Correction of true periorbital fat herniation in cosmetic lower lid blepharoplasty

The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.     

眶隔后脂肪移位睑袋成形术

目的 探索眶隔后脂肪移位睑袋成形的手术方法及效果。方法 采用睑缘切口,显露眶隔及眶隔后脂肪,将内侧脂肪团释放并向下睑中央拉拢缝合于睑囊筋膜的弓状扩张部,以横向收紧松弛的下睑,在此基础上再修补加强眶隔及处理肌肉和皮肤、睑袋。结果 38例术后效果满意。结论 眶隔后脂肪移位消除睑袋成形的方法,可以减少出血,防止眼球内陷,减少术后复发概率,远期效果更为理想。     

眶脂肪瓣转移矫正上睑凹陷的围术期护理

目的:探讨眶脂肪瓣转移矫正上睑凹陷的围术期护理方法。方法:选择2008年1月～2010年5月采用眶脂肪瓣转移术矫正上睑凹陷92例患者,围术期给予积极的心理疏导、合理的饮食指导、眼部护理,对患者的病情进行密切的观察,遵医嘱适时服用抗生素。结果:92例患者术后随访观察无眼部血肿及眼部神经损伤,上睑平整自然,外形改善明显。88例(95.65%)上睑完全修复。结论:开展眶脂肪瓣转移矫正上睑凹陷术的围手术期护理,在术前对患者进行有效的心理干预,做好皮肤的护理,术中防止眼部感染,术后做好患者心理护理、饮食护理、创面护理,同时积极预防各种并发症,可以提高手术的成功率,值得临床借鉴。     

重睑成形术联合泪腺复位术治疗眼睑松弛症的临床效果

目的 探讨重睑成形术联合泪腺复位术治疗眼睑松弛症的临床效果.方法 10例（20只眼）眼睑松弛症患者均在停止发作并静止1年以上手术.按照切开法重睑成形术设计手术切口,酌情去除上睑松弛的皮肤和部分眼轮匝肌,以及疝出的眶隔脂肪,泪腺脱垂全层缝合泪腺组织固定于眶泪腺窝处的骨膜上,上睑下垂视上睑提肌腱膜有无断裂,采取上睑提肌腱膜修复或折叠术,睑裂横径缩短将外眦韧带缝合固定于外侧眶缘骨膜.结果 10例术后均取到满意治疗效果,皮肤松弛得到明显改善,并形成满意的重睑形态,泪腺复位,其中上睑下垂、睑裂横径缩短也均得到满意矫正.随访3个月至1年,1例术后3个月于颞上方穹窿下仍可见到脱垂的部分泪腺,其余脱垂泪腺均得到良好复位,无复发.结论 眼睑皮肤松弛症可通过手术治疗得到有效矫正,经双重睑切口联合脱垂泪腺复位手术效果良好,可达到美容与功能治疗的目的.     

Eyelid reconstruction with a composite radial forearm palmaris longus tendon flap.

We performed reconstruction with a composite radial forearm palmaris longus tendon flap in patients with wide defects of upper or lower eyelids. In one upper eyelid reconstruction, a palmaris longus tendon was fixed to the frontal muscle to make it possible to open the eye. In the lower eyelid reconstruction, the tendon was fixed to both the medial palpebral ligament and the lateral orbital rim to support the flap. In wide upper and lower eyelid reconstruction with a forearm flap, it is convenient to utilise the palmaris longus tendon to support the flap.     

眶区年轻化策略——王韧带松解及提紧的睑袋整形术（待续）

目的 研究眶区老化改变的动态解剖，下睑眶区筋膜韧带功能和睑袋手术方法的改进。方法通过尸体解剖和数千例睑袋手术的临床实践，阐明眶肌筋膜韧带（王韧带）的解剖，及其在睑袋手术中的应用；结合文献复习，对下睑眶区韧带的作用进行了比较性研究，并进行了下睑老化的分类和睑袋手术方法的改进。结果在眶区老化中，皮肤、皮下组织、肌肉的松弛较韧带的松弛明显。采用眶肌筋膜韧带松解、提紧睑袋整形术。较其他手术方法更能提紧下睑松弛皮肤3～5mm。不仅提紧了下睑皮肤，而且可提紧颧眶区松弛的组织。结论王韧带松解、提紧睑袋整形术，其方法创伤小，能够有效地矫正下睑松弛，使眶区达到年轻化的效果。     

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。     

内眦蒂眼轮匝肌瓣在眶缘凹陷睑袋整复术中的应用

目的 探讨睑袋整复术中眼轮匝肌瓣的转位利用和效果.方法 在经皮肤入路下睑袋整复术中,还纳疝出的眶隔脂肪,将眶隔膜收紧缝合固定于眶缘.提紧眶肌筋膜韧带,将多余的松弛眼轮匝肌形成内眦蒂肌皮瓣,转位填充于眶下缘与睑囊筋膜之间.结果 自2006年3月至2008年7月,共施术97例,3例术后内眦部小丘状隆起,1～2个月恢复;2例下睑区硬化,经局部热敷、按摩,2～3个月软化;1例出现轻度的睑球分离,2个月后自然恢复.其中93例患者获随访3～15个月,均获得了满意的效果,睑袋、眶缘凹陷均得以矫正,睑颊过渡区恢复年轻态,无皮下索状隆起和异物感,无下睑退缩、睑外翻等并发症发生.结论 内眦蒂眼轮匝肌瓣在修复眶缘凹陷的同时,加强眶隔膜作用,恢复眶前壁的张力,进而恢复年轻化的眶区生理结构,效果理想持久.     

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     

Fat repositioning in lower blepharoplasty to maintain infraorbital rim contour

The objective of facial rejuvenative surgery is to restore a youthful contour. With age, changes occur in the lower eyelid and cheek that involve descent of the cheek tissues as well as prolapse of orbital fat in the lower eyelid. This often results in the formation of a tear trough groove at the level of the inferior orbital rim. Lower eyelid rejuvenation surgery can then be achieved through the transposition of this fat over the orbital rim on to the superior face of the maxilla. In this article describe the transconjunctival approach to orbital fat repositioning.     

眶脂肪保留和眼轮匝肌瓣悬吊法整复睑袋畸形

目的预防睑袋整复术后出现下睑凹陷和巩膜过多显露等并发症。方法术中沿眶下缘松解眶隔,释放出眶脂肪,将其充填眶下缘凹陷,并设计下睑眼轮匝肌瓣,用以缩紧悬吊松弛下垂的下睑肌肉与皮肤。结果从１９９６年９月至１９９７年５月,共以此法整复睑袋畸形３０例。２６例得到３～８个月随访,除１例因一侧眼轮匝肌瓣固定不牢致下睑轻度外翻外,其余均获满意效果。结论此法既可有效地矫正睑袋畸形,又可避免术后出现下睑凹陷和巩膜过多显露状况,同时具有颊提升效果,可使全中面部变得年轻化。     

经结膜入路眼袋并睑眶沟畸形矫正术的临床效果

目的:探讨经结膜入路眼袋并睑眶沟畸形矫正术的临床经验。方法:2016年6月至2018年7月,南京中医药大学附属江苏省中医院整形美容科收集去除眼袋和睑眶沟畸形矫正患者67例,其中男3例、女64例;年龄18~28岁,平均22岁。均为下睑袋伴不同程度的眶隔后脂肪疝出,无或轻度下睑皮肤松弛;不同程度的睑眶沟呈现,骨性眶缘轮廓感...     

眶脂肪保留和眼轮匝肌瓣悬吊法整复睑袋畸形

目的 预防睑袋整复术后出现下睑凹陷和巩膜过多显露等并发症。方法 术中沿眶下缘松解眶隔,释放出眶脂肪,将其充填眶下缘凹陷,并设计下睑眼轮匝肌瓣,用以缩紧悬吊松驰下垂的下睑肌肉与皮肤。结果 从1996年9月至1997年5月,共以此法整复睑袋畸形30例。26例得到3－8个月随访,除1例因一侧眼轮匝肌瓣固定不牢致下睑轻度外翻外,其余均获满意效果。结论 此法既可有效地矫正睑袋畸形,又可避免术后出现下睑凹陷和巩膜过多显露状况,同时具有颊提升效果,可使全中面部变得年轻化。     

Total upper and lower eyelid reconstruction using deltopectoral flap

Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.KEY WORDS: Deltopectoral flap, total eyelid reconstruction, total upper and lower eyelid reconstruction with DP flap