Codner Mark A, Wolfli James N, Anzarut Alexander
Atlanta, Ga.; and Edmonton, Alberta, Canada From Paces Plastic Surgery; the Department of Plastic Surgery, Emory University; and the Department of Plastic and Reconstructive Surgery and Epidemiology Coordinating and Research (EPICORE) Center, University of Alberta.
Plast Reconstr Surg. 2008 Jan;121(1):241-250. doi: 10.1097/01.prs.0000295377.03279.8d.
Rejuvenation of the lower eyelid often requires tightening of excess skin and muscle and removal or transposition of orbital fat. Although transcutaneous lower blepharoplasty can accomplish these aesthetic demands, it has been associated with an increased risk of lower lid malposition. Routine lateral canthal support during lower blepharoplasty has recently been advocated to minimize this risk. This study reviewed the outcome of a surgeon's 10-year experience with primary lower transcutaneous blepharoplasty and lateral canthal support consisting of canthopexy, canthoplasty, and orbicularis suspension.
A retrospective chart review of a primary lower transcutaneous blepharoplasty series over a 10-year period was performed. Patients with a history of prior eyelid surgery for blepharoplasty or midface lift were excluded. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical technique and management of complications were determined from operative reports and clinical notes.
There were 264 patients with a median follow-up of 264 days (range, 60 to 2410 days). Lid malposition requiring operative correction occurred in nine patients (3.5 percent). Additional complications included orbital hematoma in one patient (0.4 percent), chemosis in 32 patients (12.1 percent), and blepharitis in 10 patients (3.8 percent). Minor surgical revisions unrelated to lid malposition were performed on 31 patients (11.7 percent) for correction of subciliary incision cysts or granulomas, canthal suture inflammation, and canthal webbing.
Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty to obtain the desired aesthetic result and maintain the natural appearance of the eyelid shape. The associated complication rate is acceptable.
下睑年轻化通常需要收紧多余的皮肤和肌肉，以及去除或移位眶脂肪。尽管经皮肤下睑成形术可以满足这些美学需求，但它与下睑位置异常的风险增加有关。最近有人主张在下睑成形术中常规进行外眦支持，以将这种风险降至最低。本研究回顾了一位外科医生在原发性经皮肤下睑成形术和包括眦固定术、眦成形术和眼轮匝肌悬吊术的外眦支持方面的10年经验结果。
对一个为期10年的原发性经皮肤下睑成形术系列进行回顾性图表审查。排除有过眼睑手术（如睑成形术或中面部提升术）病史的患者。由一名独立观察者评估患者病历中的术前人口统计学和形态学数据以及手术前后获得的标准化照片。从手术报告和临床记录中确定手术技术和并发症的处理情况。
共有264例患者，中位随访时间为264天（范围为60至2410天）。9例患者（3.5%）出现需要手术矫正的睑位置异常。其他并发症包括1例患者（0.4%）出现眶血肿，32例患者（12.1%）出现球结膜水肿，10例患者（3.8%）出现睑缘炎。31例患者（11.7%）进行了与睑位置异常无关的小手术修正，以矫正睑缘下切口囊肿或肉芽肿、眦缝线炎症和眦部蹼状瘢痕。
外眦支持应被视为经皮肤下睑成形术的常规组成部分，以获得理想的美学效果并保持眼睑形状的自然外观。相关并发症发生率是可以接受的。
