Goldberg Robert Alan, McCann John D, Fiaschetti Danica, Ben Simon Guy J
Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-7006, USA.
Plast Reconstr Surg. 2005 Apr 15;115(5):1395-402; discussion 1403-4. doi: 10.1097/01.prs.0000157016.49072.61.
The purpose of this study was to identify the anatomical basis for perception of lower eyelid bags in patients seeking aesthetic surgery and to evaluate the cumulative contribution of different anatomic characteristics before surgery.
The histories and photographs of patients whose motivation for aesthetic consultation was lower eyelid bags were analyzed. Six categories of anatomic basis for the lower eyelid bags were identified. For each patient, a score from 0 to 4 was given in each category. The cumulative contribution score for each category was calculated as total points for that category for all patients, divided by the 456 total available points. The authors also developed a "uniqueness score" to reflect the percentage contribution of the worst identified anatomic problem compared with the other problems. This was calculated for each patient as the maximum score in one category, divided by total points for that patient.
A total of 114 consecutive cases were evaluated (67 men and 47 women; mean age, 52 +/- 11 years; age range, 23 to 76 years). The cumulative contribution score for each anatomic variable was as follows: cheek descent and hollow tear trough, 52 percent; prolapse of orbital fat, 48; skin laxity and sun damage, 35; eyelid fluid, 32; orbicularis hyperactivity, 20; and triangular cheek festoon, 13. Prolapsed orbital fat and tear trough deformity both received the higher score and were more common in men as compared with women. The average uniqueness score was 38 percent, with a range of 20 to 75 percent. No one category played a dominant role for most patients. Tear trough depression, skin laxity, and triangular malar mound were significantly more common in patients older than 50 years. Linear regression analysis showed that recommendation for surgery is based on the extent of fat prolapse, skin elasticity, and midface descent. Significant positive correlations were found in all six categories and in uniqueness scores calculated by different observers (r values ranged from 0.31 to 0.73; p < 0.001, Pearson correlation), with the highest score in agreement with the contribution of eyelids fat (r = 0.73) and skin laxity (r = 0.66); the uniqueness score correlation was r = 0.45 (p < 0.001).
Eyelid bags do not have a single anatomic basis. For different anatomic problems, different treatments are recommended.
本研究的目的是确定寻求美容手术的患者下睑袋感知的解剖学基础，并评估手术前不同解剖特征的累积作用。
分析了因下睑袋而进行美容咨询的患者的病史和照片。确定了下睑袋的六类解剖学基础。为每位患者在每一类中给出0至4分。每一类的累积作用得分计算为该类所有患者的总分除以456的总可用分数。作者还制定了一个“独特性得分”，以反映最严重的已确定解剖问题相对于其他问题的贡献百分比。这是为每位患者计算的，即一类中的最高分除以该患者的总分。
共评估了114例连续病例（67例男性和47例女性；平均年龄52±11岁；年龄范围23至76岁）。每个解剖变量的累积作用得分如下：脸颊下垂和泪沟凹陷，52%；眶脂肪脱垂，48%；皮肤松弛和阳光损伤，35%；眼睑水肿，32%；眼轮匝肌活动亢进，20%；以及三角形脸颊皮赘，13%。与女性相比，眶脂肪脱垂和泪沟畸形得分更高且在男性中更常见。平均独特性得分为38%，范围为20%至75%。对于大多数患者，没有一个类别起主导作用。泪沟凹陷、皮肤松弛和颧部三角丘在50岁以上患者中明显更常见。线性回归分析表明，手术建议基于脂肪脱垂程度、皮肤弹性和中面部下垂情况。在所有六类以及不同观察者计算的独特性得分中均发现显著正相关（r值范围为0.31至0.73；p<0.001，Pearson相关性），其中得分最高的与眼睑脂肪（r = 0.73）和皮肤松弛（r = 0.66）的贡献一致；独特性得分相关性为r = 0.45（p<0.001）。
下睑袋没有单一的解剖学基础。对于不同的解剖问题，建议采用不同的治疗方法。
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