Lee Ju-Hyang, Kim Yoon-Duck, Woo Kyung In, Johnson Owen N
Seoul, Republic of Korea; and Baltimore, Md. From the Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine; and the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine.
Plast Reconstr Surg. 2015 Apr;135(4):680e-690e. doi: 10.1097/PRS.0000000000001099.
Postoperative cosmetic deformities can be encountered after surgical treatments for upper eyelid retraction. The authors described a preaponeurotic fat advancement technique and investigated the effectiveness in patients who underwent levator recession for upper lid retraction.
This retrospective comparative case series included 44 patients (57 eyelids) who underwent levator recession surgery with (flap group, n = 31) or without (no-flap group, n = 26) the preaponeurotic fat advancement flap procedure. Comparisons of the marginal reflex distance 1, palpebral fissure, upper palpebral fissure area, pretarsal show, eyelid asymmetry, and cosmetic complications were made between the two groups. Lid position outcomes (good, fair, and poor), which were grouped according to eyelid asymmetry, marginal reflex distance 1, and the position of upper eyelid margin, and cosmetic complications were assessed.
In the flap group, lid position outcomes were graded as good in 16 patients (72.7 percent), fair in four patients (18.2 percent), and poor in two patients (9.1 percent). In the no-flap group, lid position outcomes were good in 15 patients (68.2 percent), fair in five patients (22.7 percent), and poor in two patients (9.1 percent). There were no differences between the two groups in achieving acceptable eyelid lowering and eyelid symmetry (90.9 percent in both groups). However, cosmetic outcomes demonstrated some differences. There were no multiple lid creases in the fat advancement group, compared with six eyes (23.1 percent) without fat advancement.
Preaponeurotic fat advancement flap is an effective method with which to prevent unintended multiple lid creases and provide satisfactory cosmetic outcomes in levator recession.
上睑退缩手术治疗后可能会出现术后美容畸形。作者描述了一种腱膜前脂肪推进技术，并研究了其在接受上睑提肌后退术治疗上睑退缩患者中的有效性。
这项回顾性比较病例系列研究纳入了44例患者（57只眼），这些患者接受了上睑提肌后退手术，其中31例采用了腱膜前脂肪推进皮瓣手术（皮瓣组），26例未采用（非皮瓣组）。比较了两组的边缘反射距离1、睑裂、上睑裂面积、睑板前外观、眼睑不对称情况及美容并发症。根据眼睑不对称、边缘反射距离1和上睑缘位置对眼睑位置结果（优、良、差）进行分组，并评估美容并发症。
在皮瓣组中，16例患者（72.7%）的眼睑位置结果评为优，4例患者（18.2%）评为良，2例患者（9.1%）评为差。在非皮瓣组中，15例患者（68.2%）的眼睑位置结果评为优，5例患者（22.7%）评为良，2例患者（9.1%）评为差。两组在实现可接受的眼睑下垂和眼睑对称方面无差异（两组均为90.9%）。然而，美容结果显示出一些差异。脂肪推进组未出现多条睑皱襞，相比之下，未进行脂肪推进的有6只眼（23.1%）出现多条睑皱襞。
腱膜前脂肪推进皮瓣是一种有效的方法，可预防意外出现的多条睑皱襞，并在上睑提肌后退术中提供令人满意的美容效果。
