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.     

Skin-muscle flap lower lid blepharoplasty

Lateral to medial dissection in the "potential space" between the orbicularis oculi muscle and the septum orbitale simplifies the skin-muscle flap lower lid blepharoplasty. The procedure is safe, rapid, and atraumatic.     

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.     

睑袋成形术并发泪囊功能不全

目的 探讨睑袋成形术导致泪囊功能不全的原因和治疗方法。方法 对睑袋成形术后无睑外翻出现溢泪的患者，进行泪道功能检查，功能不全者行下睑睑部眼轮匝肌缩短或断端吻合，下睑眶部眼轮匝肌上移手术。结果 28例患者因睑袋成形术后并发泪囊功能不全，再次手术时均发现有过量切除或未能缩紧（或缩紧不足）睑部眼轮匝肌。经手术加强睑部眼轮匝肌张力后，泪囊“泵”功能恢复，溢泪消失。结论睑袋成形术中，对多余及松弛组织去除量的控制不当，或术中未能有效地恢复下睑各层结构张力的平衡，尤其是下睑睑部眼轮匝肌张力明显减弱时，其泪囊的“泵”作用消失，出现功能性溢泪。通过手术恢复下睑轮匝肌张力的“泪泵”功能，有效地治疗了因睑袋成形术所并发的泪囊功能不全。     

睑袋成形术并发泪囊功能不全

目的探讨睑袋成形术导致泪囊功能不全的原因和治疗方法。方法对睑袋成形术后无睑外翻出现溢泪的患者,进行泪道功能检查,功能不全者行下睑睑部眼轮匝肌缩短或断端吻合,下睑眶部眼轮匝肌上移手术。结果28例患者因睑袋成形术后并发泪囊功能不全,再次手术时均发现有过量切除或未能缩紧(或缩紧不足)睑部眼轮匝肌。经手术加强睑部眼轮匝肌张力后,泪囊“泵”功能恢复,溢泪消失。结论睑袋成形术中,对多余及松弛组织去除量的控制不当,或术中未能有效地恢复下睑各层结构张力的平衡,尤其是下睑睑部眼轮匝肌张力明显减弱时,其泪囊的“泵”作用消失,出现功能性溢泪。通过手术恢复下睑轮匝肌张力的“泪泵”功能,有效地治疗了因睑袋成形术所并发的泪囊功能不全。     

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.     

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.     

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     

Nonsurgical fat removal in cosmetic blepharoplasty: a new technique

A new technique of minimally invasive fat removal during cosmetic blepharoplasty is described. This lipolytic diathermy technique has been used successfully in more than 100 patients during the last 3 years and is compared with routine excisional fat removal. The main advantage of this technique lies in its ability to dissolve the fat without surgical excision, thus obviating the inherent complications that arise from such dissection. The technique uses a diathermy unit to cause lipolysis of the fat pockets within their intact septal compartments and can be used for both upper and lower lid herniated fat. This procedure has been found to be exceptionally efficient and predictable and adds another level of safety to cosmetic blepharoplasty.     

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。     

睑袋整复术后下睑退缩的矫正

目的：探讨矫正睑袋整复术后并发的下睑退缩的理想方法。方法：对5例（8只眼）下睑退缩较轻者，单纯施行经眦眦固定术缩紧外眦腱使下睑缘上移复位；对15例（27只眼）下睑退缩较重者，施行经眦紫固定术同时行Hamra释放弓状缘和保留眶脂肪的下睑成形术，以在缩紧外眦腱的同时松解下睑眶隔和眶脂肪层的瘢痕挛缩，悬吊眼轮匝肌及提升中面部皮肤补充下睑前层不足。结果：术后14例（25只眼）得到6－12个月的随访，除1例（1只眼）较重的下睑退缩矫正不全外，其余均获得满意效果。结果：①经眦眦固定术是矫正轻度下睑退缩简单而有效的方法；②施行经眦眦固定术同时行Hamra下睑成形术是矫正较重度下睑退缩的理想选择。     

睑袋整形及其眶缘凹陷的整复

目的　消除下睑“囊袋”并平复下睑眶缘凹陷。方法　①选择结膜径路 :切除眶内膨出的脂肪并将之或即时回植充填 ( 11例 )、或在切除眶脂后 3个月取自体脂肪移植充填 ( 2例 )于凹陷的下眶缘 ;②亦可选择皮肤径路 :切开近眶缘端的眶隔膜后 ,将膨出的脂肪以“脂肪瓣”的形式适量提出 ,间断缝合于眶缘骨膜上 ( 14例 )。结果　脸颊平整自然 ,外形改善明显 ,随访 3～ 15个月 ,效果满意。结论　用眶脂回植充填或眶脂肪瓣转移充填 ,既能消除下睑局部的“囊”状膨出 ,又能平复下睑眶缘的凹陷 ,不失为修复眶缘凹陷型下睑袋的一种改进方法。     

下睑袋整形术中眶隔脂肪的保留和利用

随着年龄的增长，眶周缘可出现凹陷和骨轮廓显露。为获得年青、自然的睑颊过渡外貌，作者在下睑袋整形术中采用将疝出部分的眶隔脂肪不去除或少量去除，而用其充填于眶下缘的凹陷处。１９９５年１１月～１９９６年６月，１１例年龄３８～６５岁的女性病人接受了这种方法的手术，效果满意，睑颊过渡年青、自然，且无睑外翻等并发症。     

Prevention of ectropion by horizontal shortening of the lower lid during blepharoplasty

Vertical wedge excision of the lower lid is advocated in selected patients undergoing blepharoplasty to prevent postoperative ectropion. Candidates for "V" excision include patients with a predisposition for senile ectropion. Diagnosis and surgical technique are described.