Chung Seungil, Ahn Byungjoon, Yang Wonyong, Burm Jansik, Kim Kiyup, Kang Sangyoon
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemoon-gu, Seoul, 130-702, Korea,
Aesthetic Plast Surg. 2015 Feb;39(1):17-24. doi: 10.1007/s00266-014-0420-5. Epub 2014 Dec 17.
The purpose of this paper is to report the outcome of retrotarsal tucking of Müller muscle-levator aponeurosis for the correction of borderline to moderate ptosis in conjunction with esthetic blepharoplasty in Asian eyelids and to explore the relationship between the extent of advancement and change in the eyelid position (MRD1).
The medical records of 290 consecutive patients who underwent retrotarsal tucking of Müller muscle-levator aponeurosis from February 2005 to November 2011 were reviewed. Of those, 26 patients (51 eyelids) were statistically analyzed. The correction was performed through an external upper blepharoplasty approach. Once the orbital septum was opened, the Müller muscle-levator aponeurosis was advanced and tucked under the posterior surface of the tarsus by a single lifting suture. The average follow-up period was 20.6 months, with a range of 3-68 months.
In 26 patients (51 eyelids), satisfactory results were recorded for 49 of 51 eyelids (96.1 %). The margin reflex distance-1 (MRD1) increased from 1.56 ± 0.70 mm preoperatively to 3.86 ± 0.94 mm postoperatively (p < 0.001, Wilcoxon signed rank test). When 6.1 mm of advancement was implemented, an average MRD1 of 1 mm was achieved. For 7.2 and 8.3 mm of advancement, the average MRD1 achieved was 2 and 3 mm each. A noteworthy complication, although not included in statistical analysis, was one patient who had developed corneal irritation caused by the conjunctival exposure to the non-absorbable suture 3 years after the surgery, which led the subject to have the suture removed.
The author concludes that this procedure is one of the most effective surgical options in correcting borderline to moderate blepharoptosis in conjunction with esthetic blepharoplasty. The main advantage of such a method is that once the orbital septum is opened, Müller muscle-levator aponeurosis is easily advanced and tucked under the posterior surface of the tarsal plate without extensive dissection or resection, which is less traumatic and gives a more vertical lifting vector, thus producing excellent cosmetic results and quick recovery.
本文旨在报告在亚洲人眼睑中，联合美容性睑成形术，采用 Müller 肌-提上睑肌腱膜后徙折叠术矫正轻度至中度上睑下垂的效果，并探讨上睑提升程度与眼睑位置变化（MRD1）之间的关系。
回顾 2005 年 2 月至 2011 年 11 月期间连续 290 例行 Müller 肌-提上睑肌腱膜后徙折叠术患者的病历。其中 26 例患者（51 只眼睑）进行了统计学分析。矫正通过外部上睑成形术入路进行。打开眶隔后，通过单根提拉缝线将 Müller 肌-提上睑肌腱膜向前推进并折叠于睑板后表面下方。平均随访期为 20.6 个月，范围为 3 - 68 个月。
26 例患者（51 只眼睑）中，51 只眼睑中的 49 只（96.1%）取得了满意的效果。边缘反射距离-1（MRD1）从术前的平均（1.56 ± 0.70）mm 增加至术后的（3.86 ± 0.94）mm（p < 0.001，Wilcoxon 符号秩检验）。当推进 6.1 mm 时，平均 MRD1 达到 1 mm。推进 7.2 mm 和 8.3 mm时，平均 MRD1 分别达到 2 mm 和 3 mm。一个值得注意的并发症（虽未纳入统计分析）是 1 例患者在术后 3 年因不可吸收缝线暴露于结膜导致角膜刺激，该患者因此拆除了缝线。
作者得出结论，该手术是矫正轻度至中度上睑下垂并联合美容性睑成形术最有效的手术选择之一。这种方法的主要优点是，一旦打开眶隔，Müller 肌-提上睑肌腱膜很容易向前推进并折叠于睑板后表面下方，无需广泛的解剖或切除，创伤较小，且提升向量更垂直向上，从而产生出色的美容效果并实现快速恢复。
