Pascali Michele, Botti Chiara, Cervelli Valerio, Botti Giovanni
Rome and Salò, Italy.
From the Department of Plastic and Reconstructive Surgery, University of "Tor Vergata"; and Villa Bella Clinic.
Plast Reconstr Surg. 2017 Jul;140(1):33-45. doi: 10.1097/PRS.0000000000003452.
Lower eyelid retraction can be the unfortunate result of aesthetic surgery, trauma, disease, or the aging processes. The purpose of this article is to assess whether midface lifting based on purely vertical repositioning constitutes an effective procedure for its correction.
A retrospective study was carried out on 199 patients (311 eyelids) operated on between January of 2004 and January of 2014. The various causes of eyelid retraction in this population included cosmetic blepharoplasty (56.8 percent), involutional ectropion (23.1 percent), tumor resection (9.5 percent), facial nerve paralysis (8.5 percent), and trauma and related surgery (2 percent). The study was restricted exclusively to cases of moderate and severe lower eyelid retraction addressed by means of midface lifting. The mean follow-up time was 16.8 months. All of the patients were subjected to midface lifting with strengthening of the lateral canthus. A spacer graft was also used in 37.7 percent of the cases.
One hundred ninety-five patients (97.9 percent) displayed objective improvement of the eyelid retraction and a marked degree of improvement both in aesthetic terms and as regards the functional disorders reported. Only four patients (2 percent) presented complications such as needing another operation.
Midface lifting based on purely vertical repositioning makes it possible to recruit a considerable amount of "new" skin at the lower eyelid, thus ensuring a decrease in vertical distraction and correct recovery of the height of the external lamellar plane.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
下睑退缩可能是美容手术、外伤、疾病或衰老过程导致的不幸后果。本文旨在评估单纯基于垂直重新定位的中面部提升术是否是一种有效的矫正方法。
对2004年1月至2014年1月间接受手术的199例患者（311只眼睑）进行回顾性研究。该人群中眼睑退缩的各种原因包括美容性睑成形术（56.8%）、老年性睑外翻（23.1%）、肿瘤切除（9.5%）、面神经麻痹（8.5%）以及外伤和相关手术（2%）。该研究仅局限于通过中面部提升术治疗的中重度下睑退缩病例。平均随访时间为16.8个月。所有患者均接受了中面部提升术并加强了外眦。37.7%的病例还使用了间隔移植。
195例患者（97.9%）的眼睑退缩在客观上得到改善，在美学和所报告的功能障碍方面均有显著改善。只有4例患者（2%）出现了需要再次手术等并发症。
单纯基于垂直重新定位的中面部提升术能够在下睑募集大量“新”皮肤，从而确保减少垂直牵张并正确恢复外板平面的高度。
临床问题/证据水平：治疗性，IV级。
