From the Department of Plastic and Reconstructive Surgery, Huashan Hospital, Fudan University, Shanghai.
Department of General Surgery, Gastric Caner Center, General Surgery Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Plast Surg. 2024 Aug 1;93(2S Suppl 1):S98-S102. doi: 10.1097/SAP.0000000000004006. Epub 2024 Jun 17.
Dermatochalasis with lateral hooding and medial orbital fat loss are common signs of aging in the upper eyelid. Removing the excess skin in this area through infrabrow skin excision can effectively lift the loose skin of the upper eyelid and minimizes visible scarring. Additionally, we have identified three compartments of orbital fat prolapse based on orbital anatomy. Transferring volume from the lateral compartment to the intermediate region can flatten the lateral upper eyelid and create medial fullness, which ultimately rejuvenates the upper eyelid. This study presents an operative method for correcting age-related changes in the upper eyelid using this technique.
A total of 34 eyelids from 17 patients underwent a surgical procedure involving infrabrow skin excision, along with repositioning and lifting of lateral orbital fat. The inclusion criteria consisted of patients with moderate to severe upper eyelid dermatochalasis, coupled with middle fat loss and lateral hooding. To correct lateral hooding and restore midfacial fullness, lateral orbital fat was repositioned to an intermediate position, and the orbicularis oculi muscle was fold-sutured to the corrugator supercilii muscle.
The mean age of the patients was 55.59 ± 3.20 years, with a range of 48 to 61 years. The mean follow-up period was 9.94 ± 1.35 months, ranging from 8 to 12 months. Patients were evaluated at 1-month, 3-month, and 6-month intervals. The Strasser system was used to evaluate the surgical outcomes at 3 months. All patients achieved good surgical outcomes, expressed through satisfactory cosmetic improvements, and improved visual field. The procedure effectively corrected lateral hooding and loss of middle orbital fat through infrabrow skin excision. No complications, such as wound dehiscence, lagophthalmos, noticeable scarring, ocular dyskinesia, or sensory changes, were observed.
The combination of infrabrow skin excision, repositioning of lateral orbital fat, and lifting of the orbicularis oculi muscle effectively addresses moderate to severe dermatochalasis, lateral hooding, medial fat loss, and improves elasticity of the anterior wall of the upper lid in our patients. This procedure can produce satisfactory and long-lasting aesthetic results with an inconspicuous scar beneath the brow.
外侧睑颊沟和内侧眶隔脂肪丢失是上睑衰老的常见征象。通过眉下皮肤切除术去除该区域的多余皮肤，可以有效提升上睑松弛的皮肤，并最大限度地减少可见的疤痕。此外，我们根据眼眶解剖学确定了眶隔脂肪膨出的三个腔室。将外侧腔室的容量转移到中间区域可以使外侧上睑变平并形成内侧丰满度，从而最终使上睑年轻化。本研究提出了一种使用该技术矫正上睑与年龄相关变化的手术方法。
17 例患者的 34 只眼睑接受了手术治疗，包括眉下皮肤切除、外侧眶隔脂肪的重新定位和提升。纳入标准为中重度上睑皮肤松弛合并中隔脂肪丢失和外侧睑颊沟的患者。为了矫正外侧睑颊沟并恢复中面部丰满度，将外侧眶隔脂肪重新定位到中间位置，并将眼轮匝肌折叠缝合到皱眉肌。
患者的平均年龄为 55.59±3.20 岁，范围为 48 至 61 岁。平均随访时间为 9.94±1.35 个月，范围为 8 至 12 个月。患者在 1 个月、3 个月和 6 个月时进行评估。Strasser 系统用于评估术后 3 个月的手术效果。所有患者均获得了良好的手术效果，表现为满意的美容改善和改善的视野。该手术通过眉下皮肤切除有效矫正了外侧睑颊沟和中隔眶隔脂肪丢失。未观察到任何并发症，如伤口裂开、睑裂闭合不全、明显的疤痕、眼运动障碍或感觉变化。
眉下皮肤切除术、外侧眶隔脂肪重新定位和眼轮匝肌提升相结合，可有效治疗中重度皮肤松弛、外侧睑颊沟、内侧脂肪丢失，并改善上睑前壁的弹性。该手术可以产生令人满意且持久的美学效果，且眉下的疤痕不明显。
