Goldberg R A
Orbital and Ophthalmic Plastic Surgery Division, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, Calif., USA.
Plast Reconstr Surg. 2000 Feb;105(2):743-8; discussion 749-51. doi: 10.1097/00006534-200002000-00044.
Rejuvenation of the lower eyelid complex is based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. When a deep groove is present along the orbital rim in the area of the tear trough deformity, it is advantageous, rather than removing orbital fat, to reposition the fat over the orbital rim through the opened arcus marginalis onto the superior face of the maxilla. Orbital fat repositioning can be accomplished through a transconjunctival approach. The arcus marginalis is exposed and incised, and a subperiosteal pocket is created over the superior face of the maxilla. The subperiosteal pocket shape and location are customized based on the desired location of the orbital fat pedicle; often the origins of the levator superioris labialis and the levator alae nasi muscles are partially dissected. Medial and central fat pedicles are created and rotated over the orbital rim into the subperiosteal pocket. A 6-0 polypropylene externalized sutured is used to fixate the fat pedicle in position. The suture can be removed after 3 to 5 days. Twenty-four patients were followed clinically after orbital fat repositioning, with follow-up ranging from 6 to 30 months. Although the fat pedicle undergoes some variable resorption, the viability of the graft, the texture and contour of the repositioned fat after a healing period of 1 to 2 months, and the excellent patient acceptance are indicative of the viability of orbital fat repositioning.
下睑复合体年轻化基于这样的原则，即表征衰老的轮廓变化不仅涉及眶脂肪脱垂，还包括颊部组织下移，导致眶缘和泪沟加深。当泪沟畸形区域的眶缘出现深沟时，通过打开眶缘弓将脂肪重新定位到上颌骨上表面，而不是去除眶脂肪，是有益的。眶脂肪重新定位可通过经结膜入路完成。暴露并切开眶缘弓，在上颌骨上表面创建一个骨膜下袋。骨膜下袋的形状和位置根据眶脂肪蒂的期望位置定制；通常部分解剖上唇提肌和鼻翼提肌的起点。创建内侧和中央脂肪蒂并将其旋转越过眶缘进入骨膜下袋。使用6-0聚丙烯外置缝线将脂肪蒂固定到位。缝线可在3至5天后拆除。24例患者在眶脂肪重新定位后接受临床随访，随访时间为6至30个月。尽管脂肪蒂会发生一些不同程度的吸收，但移植物的存活、1至2个月愈合期后重新定位脂肪的质地和轮廓以及患者的良好接受度都表明眶脂肪重新定位是可行的。
