基于上睑皮肤松垂机制的眉脂肪垫应用解剖学研究

目的 为重置眉脂肪垫以改良上睑皮肤松垂整形术提供解剖学基础。 方法 对14侧新鲜尸头标本的眉区进行解剖，观察并测量眉脂肪垫重要毗邻关系及解剖参数。 结果 眉脂肪垫位于额肌、眼轮匝肌眶部与骨膜之间的筋膜脂肪层中，与眼轮匝肌衔接致密，而与骨膜和眶隔膜连接松散。眉脂肪垫向上逐渐变薄呈筋膜状态，向下移行插入眼轮匝肌下脂肪层，内侧为滑车上神经血管束，向外与颞浅筋膜脂肪层相延续，呈现横径较长的扁椭圆形态，在体表映射范围位于眉峰和眉梢，最大厚度(1.33±0.30)mm，最大垂直宽度(15.51±0.53)mm，最大水平长度(34.44±0.67)mm，其主要血供源于眶上动脉向颞侧发出的分支；眉脂肪垫在眶隔和肌肉之间形成一个滑动空间，利于眉毛活动，但会导致眉外侧没有足够支撑力抵抗重力作用，使眶外侧软组织随年龄增长而下垂。 结论 可以通过重置眉脂肪垫改良上睑皮肤松垂整形术，将其固定在眶缘骨膜上，不仅可以调整眉位置，还能增强眶缘上方软组织的支撑结构，避免出现眉下垂，稳定手术效果，改善眉及上睑形态。

Applied anatomical study of eyebrow fat pad based on the mechanism of upper eyelid skin ptosis

Objective To provide anatomical basis for the replacement of eyebrow fat pad to improve the blepharoplasty of upper eyelid skin ptosis. Methods The eyebrow regions of 14 fresh frozen cadaver heads were dissected. The important adjacent relationship and anatomical parameters of eyebrow fat pad were recorded and measured. Results The eyebrow fat pad was located in the fascial fat layer between the frontalis muscle, the orbital part of the orbicularis oculi muscle and the periosteum, and it was closely connected with the orbicularis oculi muscle. While the connection between eyebrow fat pad and periosteum and orbital diaphragm was loose. The eyebrow fat pad gradually thinned upward to a fascia state, and moved downward into the fat layer under the orbicularis oculi muscle The medial side was the supra-trochlear neurovascular bundle, which continued outward with the fat layer of the superficial temporal fascia, showing a flat oval shape with a long transverse diameter. The mapping range on the body surface was located in the peak and tip of the eyebrow. The maximum thickness, vertical width, and horizontal length of eyebrow fat pad were (1.33±0.30) mm, (15.51±0.53) mm, (34.44±0.67) mm. Its main blood supply came from the branches of the supraorbital artery to the temporal side. The eyebrow fat pad formed a sliding space between the orbital septum and the muscle, which was conducive to eyebrow movement, but it would cause the lateral eyebrow to have insufficient support against gravity, resulting in the lateral orbital soft tissue sagging with the increasing of age. Conclusions The skin ptosis of the upper eyelid can be improved by replacing the eyebrow fat pad and fixing it on the periosteum of the orbital margin, which can not only adjust the position of the eyebrow, but also enhance the supporting structure of the soft tissue above the orbital margin, avoid the appearance of eyebrow ptosis, stabilize the surgical effect and improve the morphology of eyebrow and upper eyelid.