Millman A L, Williams J D, Romo T, Taggert N
Department of Ophthalmology, New York Eye and Ear Infirmary, New York, USA.
Ophthalmic Plast Reconstr Surg. 1997 Jun;13(2):84-9. doi: 10.1097/00002341-199706000-00003.
Lower lid blepharoplasty can present a significant challenge to the facial plastic surgeon. Routine findings of periorbital fat herniation and dermatochalasia of the lower lid are often associated with the presence of more occult findings, e.g., tarsoligamentous laxity and ectropion. Traditional surgical approaches to the aging lower eyelid utilize the skin flap, the skin-muscle flap, and the transconjunctival technique. The limitation of any one of these procedures alone is that of not addressing the multiple problems of the aging eyelid; this may lead to common postoperative problems of lower lid blepharoplasty, including lid retraction, lagopthalmos, scleral show, rounding of the lateral canthus, and ectropion. We present an integrated surgical solution to the functional and anatomical defects of both the anterior and posterior lamellae, and, when indicated, lateral canthal support. The procedure incorporates a small lateral subciliary and lateral canthal incision with a myocutaneous advancement flap developed in a plane deep to the orbital septum, combined with transconjunctival blepharoplasty for removal of herniated orbital fat. It allows for simultaneous management of the multiple defects of the aging lower eyelid and complete restoration of the relevant anatomy, while avoiding the common pitfalls of lower lid blepharoplasty. We present our experience of 64 patients who underwent bilateral combined septal-myocutaneous advancement flap and transconjunctival blepharoplasty. Indications and postoperative results are reviewed. No complications, including scleral show or ectropion, have been noted over the 4-year postoperative period.
下睑成形术对面部整形外科医生来说可能是一项重大挑战。眶周脂肪疝出和下睑皮肤松弛等常见表现往往与更隐匿的表现相关，例如睑板韧带松弛和睑外翻。传统的针对衰老下眼睑的手术方法包括皮瓣法、皮肤肌肉瓣法和经结膜技术。单独使用这些手术方法中的任何一种的局限性在于无法解决衰老眼睑的多种问题；这可能导致下睑成形术常见的术后问题，包括眼睑退缩、兔眼、巩膜外露、外眦圆钝和睑外翻。我们提出一种综合手术解决方案，用于解决前后层的功能和解剖缺陷，并在必要时提供外眦支持。该手术包括一个小的外侧睑缘下切口和外眦切口，以及在眶隔深层平面形成的肌皮推进瓣，同时结合经结膜睑成形术以去除疝出的眶脂肪。它能够同时处理衰老下眼睑的多种缺陷并完全恢复相关解剖结构，同时避免下睑成形术的常见陷阱。我们介绍了64例接受双侧联合隔肌皮推进瓣和经结膜睑成形术患者的经验。对手术适应症和术后结果进行了回顾。在术后4年期间未发现包括巩膜外露或睑外翻在内的并发症。
