Lee Won, Kwon Soon-Beom, Oh Se-Kwang, Yang Eun-Jung
Yonsei E1 Plastic Surgery Clinic, South Korea.
Ohkims Plastic Surgery, South Korea.
J Plast Reconstr Aesthet Surg. 2017 Dec;70(12):1768-1775. doi: 10.1016/j.bjps.2017.05.003. Epub 2017 May 24.
Sunken upper eyelid is a commonly found deformity among Asians, mostly due to the aging process and excessive orbital fat removal during oriental blepharoplasty procedures. This deformity is frequently accompanied by multiple, poorly defined upper eyelid folds and blepharoptosis. To date, autologous fat graft has been the treatment of choice for this group of patients. However, accurate placement of the graft in the orbital fat is quite challenging, and it can result in contour irregularities when injected into the preseptal plane.
From 2008 to 2013, 60 patients with sunken upper eyelids were treated with either an orbital fat transposition flap or a dermofat graft according to the severity of the deformity. Mild sunken upper eyelids were corrected during upper blepharoplasty by exposing the central orbital fat sac and transposing it in a flap-like manner. In more severe cases, a dermofat graft harvested from the intergluteal crease was used.
Postoperative complications included difficulty in eye opening because of the weight of the dermofat graft and swelling of the periorbit, which gradually resolved with time. Mild bruising, tenderness, asymmetry, and blepharoptosis were also noted, but no additional treatments were necessary. During the 13-month follow-up period, two patients from the orbital fat transposition flap group and one patient from the dermofat graft group underwent revision surgeries.
Anatomy of the orbit, prior surgical history, and sunkenness of the upper eyelid were all considered during preoperative planning. Either an orbital fat transposition flap or a dermofat graft was applied, according to the severity of the deformity, with successful results. Particularly in mild cases of sunken upper eyelid deformity, an orbital fat transposition flap is an easy and effective method that requires no additional procedures.
上睑凹陷是亚洲人常见的一种畸形，主要是由于衰老过程以及东方人双眼皮手术中眶脂肪过度去除所致。这种畸形常伴有多条界限不清的上睑皱襞和上睑下垂。迄今为止，自体脂肪移植一直是这类患者的首选治疗方法。然而，将移植脂肪准确放置于眶脂肪中颇具挑战性，且注入眶隔前平面时可能导致外形不规则。
2008年至2013年，根据畸形严重程度，对60例上睑凹陷患者采用眶脂肪转移瓣或真皮脂肪移植进行治疗。轻度上睑凹陷在双眼皮手术中通过暴露中央眶脂肪囊并将其以瓣状方式转移来矫正。在更严重的病例中，使用从臀沟采集的真皮脂肪移植。
术后并发症包括因真皮脂肪移植重量导致的睁眼困难以及眶周肿胀，这些随着时间逐渐消退。还注意到有轻度瘀斑、压痛、不对称和上睑下垂，但无需额外治疗。在13个月的随访期内，眶脂肪转移瓣组有2例患者和真皮脂肪移植组有1例患者接受了修复手术。
术前规划时考虑了眼眶解剖结构、既往手术史和上睑凹陷情况。根据畸形严重程度应用眶脂肪转移瓣或真皮脂肪移植，效果良好。特别是在上睑凹陷畸形的轻度病例中，眶脂肪转移瓣是一种简单有效的方法，无需额外操作。
