Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2018 May;71(5):658-664. doi: 10.1016/j.bjps.2017.11.029. Epub 2017 Nov 28.
We evaluated the relationship between infraorbital fat herniation and age-related changes in the bony orbit and orbital fat density using computed tomography. Two hundred and sixty-five patients were enrolled (60 patients were evaluated for changes in the bony orbit and 205 for changes in orbital fat density). Five measurements using parasagittal sections and one measurement using three-dimensional images were obtained. Intraorbital fat herniation length was positively correlated with orbital rim inclination. Lowering of the inferior orbital rim, which is connected to the orbicularis retaining ligament, tear trough ligament and orbital septum, can cause mechanical stretching of the lower eyelid and may contribute to infraorbital fat herniation. A strong and significant negative correlation was observed between orbital fat density and age, indicating that existing orbital fat can accommodate an enlargement in bony orbit volume without orbital fat hyperplasia/hypertrophy. In other words, an increased orbital fat volume may be a by-product of the adaptation of orbital fat to changes in bony orbit volume. Mechanical stretching of the lower eyelid due to ageing of the bony orbit and weakening of the lower eyelid due to age-related factors such as dermal/fat/muscle atrophy and loss of muscle tone can together result in anterior drooping of the lower eyelid. Therefore, age-related changes in the bony orbit contribute to intraorbital fat herniation.
我们使用计算机断层扫描评估了眶下脂肪疝出与骨性眼眶和眶脂肪密度随年龄变化的关系。共纳入 265 名患者（60 名患者评估骨性眼眶变化，205 名患者评估眶脂肪密度变化）。获取了五个使用矢状位切片的测量值和一个使用三维图像的测量值。眶内脂肪疝出长度与眶缘倾斜度呈正相关。连接眼轮匝肌保留韧带、泪槽韧带和眶隔的下眶缘下降，会导致下眼睑机械性拉伸，可能导致眶下脂肪疝出。眶脂肪密度与年龄呈强烈显著负相关，表明现有的眶脂肪可以适应骨性眼眶体积的增大而不发生眶脂肪增生/肥大。换句话说，眶脂肪体积的增加可能是眶脂肪适应骨性眼眶体积变化的副产品。骨性眼眶的老化导致下眼睑的机械性拉伸，以及与年龄相关的因素（如皮肤/脂肪/肌肉萎缩和肌肉张力丧失）导致下眼睑的弱化，这些因素共同导致下眼睑的前垂。因此，骨性眼眶的年龄变化导致眶内脂肪疝出。
