下睑缘切口新型眼袋成形术在面中部年轻化中的应用研究

doi:10.3969/j.issn.1674-8115.2025.03.016

摘要/Abstract

摘要：

目的·探讨经下睑缘切口的新型眼袋成形术在面中部年轻化中的应用效果。方法·选择2019年9月—2022年9月上海交通大学医学院附属同仁医院整形外科收治的35例下睑袋、睑颊沟凹陷伴面中部软组织下垂患者作为研究对象，实施经下睑缘皮肤切口眶隔脂肪重置术联合面中部提升术。该术式采用下睑缘切口，钝性分离眶颧间隙和上颌间隙，打开眶隔释放出眶隔脂肪瓣。将脂肪瓣向下平铺，覆盖眶下缘固定脂肪于颧骨骨膜上。分离上颌间隙至眶颧韧带下方，将眶下区复合组织向外上方悬吊固定，下睑外侧眼轮匝肌悬吊固定于眶外侧外眦上方骨膜上，提升面中部松弛软组织。缝合上下眼轮匝肌形成卧蚕，恢复眶下原有组织结构形态。术后第1、3、6个月门诊随访，数码相机拍摄正位、左侧位、右侧位照。记录术后并发症，包括皮下瘀斑、肿胀，结膜水肿、血肿，睑球分离，下睑外翻，复视、斜视，眼球干燥、溢泪等。术后6~12个月不定期随访，观察患者术后远期效果。结果·35例下睑袋伴随面中部松弛患者术后随访6~12个月，切口均一期愈合，下睑袋及睑颊沟凹陷、鼻唇沟皱褶均得到明显改善，面中部下垂组织均得到复位，效果满意。无下睑退缩、睑外翻、感染等并发症发生。结论·经下睑缘切口新型眼袋成形术可使下眼睑及面中部明显年轻化。该方法创伤较小、效果显著，简单且易于推广。

关键词: 面中部年轻化, 睑袋, 睑颊沟, 鼻唇沟

Abstract:

Objective ·To explore the application effect of a new type of blepharoplasty with a lower eyelid margin incision in the mid-face rejuvenation. Methods ·From September 2019 to September 2022, 35 patients with lower eyelid pouches, eyelid-cheek junction depression, and mid-face sagging were treated in Department of Plastic Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine. The surgical procedure involved incising the lower eyelid margin of the patient, bluntly separating the orbital zygomatic space and maxillary space, and opening the orbital septum to release the orbital fat flap. Subsequently, the fat flap was spread downward to cover the infraorbital margin and fixed onto the zygomatic bone membrane. Then, the maxillary space was separated below the orbital zygomatic ligament, and the composite tissue in the infraorbital area was suspended and fixed outward and upward. The lateral orbicularis oculi muscle of the lower eyelid was suspended and fixed on the periosteum above the lateral orbital canthus, lifting the relaxed soft tissue in the mid-face. The upper and lower orbicularis oculi muscles were sutured to form a reclining silkworm, restoring the original tissue structure and morphology under the orbit. Outpatient follow-up visits were conducted at 1, 3, and 6 months postoperatively, with digital cameras capturing frontal, left lateral and right lateral views. Postoperative complications were recorded, including subcutaneous bruising, swelling, conjunctival edema, hematoma, eyelid separation, lower eyelid eversion, diplopia, strabismus, dry eyeball, and tear overflow. The patients were followed up irregularly 6‒12 months after surgery to observe the long-term effects. Results ·All 35 patients were followed up for 6 to 12 months after surgery, with all incisions healing primarily. The blepharoplasty, palpebral sulcus depression, and nasolabial sulcus folds were significantly improved. The sagging tissue of the mid-face was reduced, and the effect was satisfactory. No complications, such as lower eyelid retraction, ectropion, or infection, occurred. Conclusion ·The new type of eyelid blepharoplasty through the lower eyelid margin incision can significantly rejuvenate the lower eyelid and mid-face. This method has less trauma, less bleeding, reliable effect, and is easy to promote.

Key words: mid-face rejuvenation, eyelid pouch, eyelid-cheek junction, nasolabial fold

中图分类号:

R622

葛文佳, 许瑾. 下睑缘切口新型眼袋成形术在面中部年轻化中的应用研究[J]. 上海交通大学学报（医学版）, 2025, 45(3): 381-386.

GE Wenjia, XU Jin. Application of a new type of eyelid blepharoplasty through the lower eyelid margin incision in mid-face rejuvenation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(3): 381-386.

图/表 4

图1 术中眶隔脂肪固定位置示意图Note： The orbital fat was fixed to the periosteum of the zygomatic bone.

Fig 1 Schematic diagram of the fixed position of the orbital fat

图2 年轻女性患者术前术后对比Note：A‒C. Preoperative photos: frontal view (A), right lateral view (B), and left lateral view (C). The patient′s eyelid bags were loose and the mid-face was sunken. D‒F. Six months after surgery: postoperative frontal view (D), right lateral view (E), and left lateral view (F). The patient′s lower eyelid bags and tear troughs significantly improved, and the mid-face was elevated.

Fig 2 Comparison of preoperative and postoperative outcomes in a young female patient

图3 年轻男性患者术前术后对比Note： A‒C. Preoperative photos: frontal view (A), right lateral view (B), and left lateral view (C). The patient′s eyelid bags were loose, with obvious fine lines under the eyes and a depression in the mid-face. D‒F. Six months after surgery: postoperative frontal view (D), right lateral view (E), and left lateral view (F). The patient′s lower eyelid bags and tear troughs significantly improved, and the mid-face was elevated.

Fig 3 Comparison of preoperative and postoperative outcomes in a young male patient

图4 老年男性患者术前术后对比Note： A. Preoperative frontal view. B. Postoperative frontal view 12 month after surgery. The patient′s eyelid bags and fine lines significantly improved, and the fullness in the mid-face increased.

Fig 4 Comparison of preoperative and postoperative outcomes in an old male patient

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