Oculoplastica Bernardini, Genova, Italy.
Ophthalmic Plast Reconstr Surg. 2013 Jul-Aug;29(4):308-15. doi: 10.1097/IOP.0b013e318291662a.
The forehead/brow complex, the temporal region, the upper eyelid, the zygomatic area, the lower eyelid, and the cheek comprise the periocular esthetic unit. The combination of variable degrees of tissue descent and fat deflation of the component parts of the unit determine its appearance with age. The authors report the results of tissue repositioning through a minimal incisions vertical endoscopic lift and volume restoration used in combination to restore the natural youthful appearance of the periocular esthetic unit.
The authors retrospectively reviewed the charts of patients who underwent minimal incisions vertical endoscopic lift and fat grafting over a 12-year period in 3 different centers. Patients results were evaluated with standardized pre- and postoperative pictures graded by masked observers in a scale from poor, fair, satisfactory, to very satisfactory results. Patient satisfaction was self-graded in the same manner.
The study consists of 400 patients, of whom 337 (85%) were women and 63 (14.8%) were men, with a mean age of 46 years (range 38-67) for women and mean age of 53 years (range 48-65) for men. Mean follow up was 16 months (range 6 months-8 years); in 180 patients follow up was 2 years or longer. Additional procedures included lower blepharoplasty in 205 patients (51%), neck lift in 102 patients (26%), upper blepharoplasty in 63 patients (15.7%), lateral canthoplasty in 9 patients (2.3%), and upper eyelid ptosis in 6 patients (1.5%). The results were graded as satisfactory or very satisfactory by 95% of patients and by 91% of observers.
On the basis of the anatomical changes that occur in the periocular esthetic unit, tissue repositioning is indicated to address the descent of the superior complex and in minor part of the inferior complex, while volume restoration is indicated to address the volume depletion of the inferior and the lateral complexes and for refinements of the superior complex. The authors propose a systematic combination of lifting and filling to naturally restore the youthful appearance of the periocular esthetic unit. Conservative blepharoplasty can be associated in selected cases for result optimization.
额/眉复合体、颞区、上眼睑、颧骨区、下眼睑和脸颊构成了眼周美学单位。该单位各组成部分的组织下垂程度和脂肪萎缩程度的组合决定了其随年龄增长的外观。作者报告了通过小切口垂直内镜提升和联合容积恢复来重新定位组织的结果，以恢复眼周美学单位的自然年轻外观。
作者回顾了在 3 个不同中心进行小切口垂直内镜提升和脂肪移植的 12 年期间的患者图表。通过对标准化术前和术后照片进行分级，由掩蔽观察者在从差、一般、满意到非常满意的评分量表中对患者的结果进行评估。患者满意度以同样的方式进行自我评分。
该研究共纳入 400 例患者，其中 337 例（85%）为女性，63 例（14.8%）为男性，女性平均年龄为 46 岁（38-67 岁），男性平均年龄为 53 岁（48-65 岁）。平均随访时间为 16 个月（6 个月-8 年）；180 例患者随访时间为 2 年或更长时间。其他手术包括 205 例（51%）下眼睑成形术、102 例（26%）颈部提升术、63 例（15.7%）上眼睑成形术、9 例（2.3%）外侧眦成形术和 6 例（1.5%）上眼睑下垂。95%的患者和 91%的观察者将结果评为满意或非常满意。
基于眼周美学单位发生的解剖变化，需要进行组织重新定位以解决上复合体的下垂和下复合体的轻微下垂，同时需要进行容积恢复以解决下复合体和外侧复合体的容积缺失，并对上复合体进行精细调整。作者提出了一种系统的提升和填充组合，以自然恢复眼周美学单位的年轻外观。在选定的情况下，可以联合保守性眼睑成形术以优化结果。
