Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2012 Sep;130(3):690-699. doi: 10.1097/PRS.0b013e31825dc39d.
The senior author's (H.S.B.) endoscopic brow and midface lift technique has a series of periorbital suture points. This study evaluated the efficacy of endoscopic treatment of the difficult lower eyelid and identifies the preoperative predictive patterns for additional suture placement and ancillary procedures within this population.
Patients who underwent endoscopic brow and midface lift performed by the senior author were stratified into categories of preoperative lower eyelid morphologies, including lower eyelid retraction, negative canthal tilt, negative vector orbit, exorbitism, and a deep tear trough. Intraoperative treatment and postoperative course were recorded and postoperative photographs were evaluated objectively. The data were analyzed to determine preoperative predictive patterns of endoscopic lower eyelid treatment.
Three hundred patients who underwent an endoscopic brow and midface lift between 1999 and 2008 were included in the study, with an average follow-up of 1 year. Most patients were treated with endoscopic orbicularis oculi repositioning combined with midface elevation. Additional suture points were used in 12 percent, with preexisting scleral show being the most common indication for additional endoscopic suture placement. There were no cases of postoperative lower eyelid retraction. Skin resurfacing and volumetric filling were the most common revision procedures.
The difficult lower eyelid can be treated effectively with endoscopic orbicularis repositioning and midface elevation. This technique preserves the innervation and continuity of the orbicularis oculi muscle, decreasing postoperative complications. Additional suture application is needed in only a minority of patients, and ancillary lower eyelid procedures can be performed safely in the same operative setting.
资深作者（H.S.B.）的内镜眉骨和中面部提升技术有一系列眶周缝线点。本研究评估了内镜治疗困难下眼睑的效果，并确定了该人群中额外缝线放置和辅助手术的术前预测模式。
将接受资深作者行内镜眉骨和中面部提升术的患者分为术前下眼睑形态类别，包括下眼睑退缩、负性眦角倾斜、负性向量轨道、眼球突出和深泪槽。记录术中治疗和术后过程，并对术后照片进行客观评估。对数据进行分析，以确定内镜下眼睑治疗的术前预测模式。
1999 年至 2008 年间，共有 300 例患者接受了内镜眉骨和中面部提升术，平均随访 1 年。大多数患者接受了内镜眼轮匝肌复位术联合中面部提升术治疗。12%的患者使用了额外的缝线点，其中最常见的指征是存在巩膜暴露，需要进行额外的内镜缝线固定。术后无下眼睑退缩病例。皮肤打磨和容积填充是最常见的修复手术。
内镜眼轮匝肌复位和中面部提升术可有效治疗困难的下眼睑。该技术保留了眼轮匝肌的神经支配和连续性，减少了术后并发症。只有少数患者需要额外的缝线应用，并且可以在同一手术环境中安全地进行辅助下眼睑手术。
