Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, 5, Fu-Hsin StreetTaoyuan 333, Kwei-Shan, Taiwan, ROC.
Aesthetic Plast Surg. 2022 Jun;46(3):1224-1236. doi: 10.1007/s00266-021-02643-3. Epub 2021 Nov 19.
This study aimed to propose a novel four-type deformity and treatment-oriented classification of the lower eyelids that directs the therapeutic combination of three-step lower blepharoplasty for Asian populations.
We reviewed 183 patients who underwent a therapeutic combination of three steps of lower blepharoplasty after being diagnosed with four types of lower eyelid deformities between July 2018 and April 2021. The three-step lower blepharoplasty includes: (1) mid-face and lower eyelid augmentation, (2) transconjunctival eye bag removal, and (3) skin pinch removal. Consecutive digital images, detailed fat graft volume, fat removal amount, skin pinch removal amount, complications, and patient's satisfaction and aesthetic improvement score were recorded.
The overall patient's satisfy score is 91. Aesthetic improvement score is 80.2 and 83.3 among lay persons and experts, respectively. The volume of the fat graft ranges from 2 to 3 mL per orbit according to the severity of the deformity. The amount of fat removed was 0.53 ± 0.36 and 0.61 ± 0.40 mL per orbit in types II and III patients, respectively. There is no lower lid malposition. Eleven patients had over-correction of fat grafting, and they need steroid injection; 20 patients had under-correction of fat grafting, and they need secondary fat grafting. Ten patients need secondary skin pinch excision due to post-op skin redundancy. Two patients had conjunctiva wound granuloma.
The combination of three-step lower blepharoplasty according to the novel classification is a straightforward and effective method to correct lower eyelid deformities. The complication rate was low with high patient satisfaction.
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本研究旨在提出一种新的四种类型的下眼睑畸形和治疗导向分类，为亚洲人群的三步下眼睑成形术提供治疗组合。
我们回顾了 2018 年 7 月至 2021 年 4 月期间，183 名被诊断为四种下眼睑畸形的患者接受三步下眼睑成形术联合治疗的病例。三步下眼睑成形术包括：（1）中面部和下眼睑填充，（2）经结膜眼袋去除术，（3）皮肤夹除术。连续的数字图像、详细的脂肪移植体积、脂肪去除量、皮肤夹除量、并发症以及患者的满意度和美学改善评分均被记录。
总体患者满意度评分为 91 分。外观改善评分分别为非专业人士 80.2 分和专业人士 83.3 分。脂肪移植体积根据畸形的严重程度，每眼眶 2-3 毫升。Ⅱ型和Ⅲ型患者每眼眶去除的脂肪量分别为 0.53±0.36 和 0.61±0.40 毫升。没有下眼睑位置不正。11 例患者脂肪移植过度矫正，需要类固醇注射；20 例患者脂肪移植不足矫正，需要二次脂肪移植。10 例患者因术后皮肤冗余需要二次皮肤夹除。2 例患者出现结膜伤口肉芽肿。
根据新分类，三步下眼睑成形术联合治疗是一种矫正下眼睑畸形的简单有效的方法。并发症发生率低，患者满意度高。
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