Division of Plastic Surgery, University of California San Diego, 4150 Regents Park Row Suite #300, La Jolla, San Diego, CA 92037, USA.
Aesthetic Plast Surg. 2011 Aug;35(4):563-8. doi: 10.1007/s00266-011-9665-4. Epub 2011 Feb 27.
Orbital fat repositioning in association with subperiosteal midface elevation has been variably described via both the transconjunctival and skin muscle flap approaches. Poor visualization, middle and posterior lamellar cicatricial fibrosis, technical difficulty, and incomplete release are disadvantages commonly ascribed to the transconjunctival approach. Lower eyelid malposition and retraction also are commonly seen in association with skin muscle flap approaches. A simple technique using the intraoral approach to release the orbital septum and postseptal fat is described in this report. This procedure avoids complications associated with the violation of key lower eyelid anatomic structures and markedly improves visualization through an incision allowing a much larger access.
A retrospective review of six patients who underwent endoscopically assisted midface elevation in combination with lower eyelid fat repositioning via a transoral approach since 2009 and were followed up for at least 1 year is presented. A pre- and postoperative assessment of tear trough depth, lower eyelid fat herniation, and midface descent is made. Four of the six patients presented also underwent concurrent additional facial rejuvenation procedures including endoscopically assisted brow-lift, genioplasty, structural fat grafting to the nasolabial folds, and lower eyelid "pinch" blepharoplasty. Standard upper buccal sulcus access incisions were used for subperiosteal midface elevation and exposure of the lower orbital septum. Fat redraped over the orbital rim was not secured with fixation sutures as is commonly performed using lower eyelid approaches. Human cadaveric dissection with endoscopic visualization also was performed to demonstrate the reported technique.
During this study, one complication developed for a single patient who experienced a temporary dense right zygomatic and frontal branch nerve palsy lasting 8 weeks. No evidence of lower eyelid malposition, ectropion, entropion, incomplete release, or asymmetry was otherwise encountered. Improvement in tear trough appearance, lower eyelid herniation, and midface descent was noted in all six patients.
A novel approach for lower eyelid fat transposition in combination with midface lift using the intraoral approach is presented. Excellent visualization, decreased operative times, technical ease, and improved outcomes all are potential advantages of this technique over standard approaches in which access to lower eyelid fat is achieved through the conjunctiva or a skin muscle flap.
眶隔脂肪重新定位与骨膜下中面部提升术相结合，通过经结膜和皮肤肌肉瓣两种方法有不同的描述。经结膜入路的缺点通常包括：视野不佳、中后板层瘢痕性纤维化、技术难度大和不完全释放。与皮肤肌肉瓣入路相关的还有下眼睑位置不当和回缩。本报告介绍了一种使用口腔入路释放眶隔和眶隔后脂肪的简单技术。该手术避免了破坏关键下眼睑解剖结构相关的并发症，并通过允许更大进入的切口显著改善了视野。
回顾性分析了 2009 年以来通过经口腔入路行内窥镜辅助中面部提升术联合下眼睑脂肪复位的 6 例患者，随访时间至少 1 年。对术前和术后泪槽深度、下眼睑脂肪疝出和中面部下降进行评估。6 例患者中有 4 例还同时进行了其他面部年轻化手术，包括内窥镜辅助提眉术、颏成形术、结构性脂肪移植到鼻唇沟和下眼睑“捏合”双眼皮成形术。标准的上颊沟入路用于骨膜下中面部提升和暴露下眶隔。像通常使用下眼睑方法那样，眶隔脂肪重新定位后不使用固定缝线固定在眶缘上。还进行了人体尸体解剖和内窥镜可视化以演示报道的技术。
在这项研究中，有 1 例患者发生了 1 例并发症，表现为右侧颧骨和额支神经暂时性致密麻痹，持续 8 周。未发现下眼睑位置不当、外翻、内翻、不完全释放或不对称。6 例患者的泪槽外观、下眼睑疝出和中面部下降均得到改善。
提出了一种新的经口腔入路的下眼睑脂肪转位联合中面部提升术的方法。与通过结膜或皮肤肌肉瓣获得下眼睑脂肪入路的标准方法相比，这种技术具有出色的可视性、缩短手术时间、操作简便和改善效果等潜在优势。
