改良上睑成形术治疗单睑合并上睑臃肿的应用效果

摘要

目的 探讨使用Y瓣成形的结构性改良法矫正上睑臃肿并形成重睑的方法和效果.方法 2015年10月至2019年2月,广州修志夫医疗美容门诊部收集97例单睑合并上睑臃肿患者,手术松解和释放睑板前至上睑提肌腱膜前的眼轮匝肌后间隙,重睑成形后沿眶缘外侧楔形裁剪其下方的眼轮匝肌下脂肪垫,存在泪腺脱垂的进行悬吊缝合后回纳至眶骨缘下方,最后按上睑解剖对位缝合关闭各层切口.结果 97例术后切口均一期愈合,3例因组织去除保守导致重睑线外侧轻度下垂,2例因组织去除不均衡导致双侧重睑宽度不对称,术后3个月均予以修复手术调整后满意,92例患者随访＞3个月均得到上睑形态较满意的改善,切口愈合痕迹隐蔽且无凹陷.结论 改良上睑成形术上睑层次梳理清晰,多余组织去除到位,重睑定位准确,同时解决单睑合并上睑臃肿患者的美学需求,外形自然逼真.%Objective To explore the method and efficacy of using "Y" flap formed to remold double eyelid structure of blepharoplasty for thickening eyelid.Methods A total of 97 cases of single eyelids and thickening eyelid were treated with surgery,to release the space before tarsus fascia and levator palpebrae aponeurosis to form a continuous interspace of the orbicularis oculi muscle.Then joint fascia was reconstructed to format "Y" flap,on which both sides of the levator aponeurosis and orbital septum fascia were tightened and the redundant fat and fascial organization removed.The lateral fat pad under the orbicular muscle were wedge-shaped sheared along the orbital margin after double eyelid was formed.Few patients presented acrimal glands prolapse,which suspended to return the lower margin of the orbital bone.Finally according to the upper eyelid anatomy suture each layer of incision was closed.Results The 97 cases underwent surgical treatment and the incisions were healed by first intention,in which 3 cases had slight skin ptosis at the lateral double crease due to the conservative tissue removal and 2 cases had the double eyelid width asymmetry due to the tissue was removed unevenly.They were adjusted satisfiedly 3 months later.All cases were followed up for more than 3 months and acquired satisfactory improvement and beautification.Incision was healed hiddenly.Conclusions This method can be used to tease and adjust the upper eyelid levels clearly and completely,which makes redundant tissues removed in place and double eyelid located accurately.By this method single eyelid combined thickening eyelid could be solved aestheticly at the same time and get a natural,popular and natural shape.