Applied Anatomic Study And Clinical Application In The Orbital Septum Of The Lower Blepharoplasty For Asian

BACKGROUND:With the advancement in medical sciences and the improvement of living standards, people's desire and pursue for physical beauty increased greatly.The request for facial rejuvenation is getting stronger.Therefore,the lower blepharoplasty is one of the five most popular operations.Multiple factors contribute to the formation of eye bags, including the skin,the mulses,the ligments and the bones and so on. The looseness of the orbital septum plays an important role in the development of palpebral bags. The key point of the lower blepharoplasty mainly focus on the treatment of the orbital septum. Doctors are used to resuture the opening orbital septum But doctors found the method was complicated and was easier to cause or aggravate the lower eyelid retraction and extropion,and the recurring of the palpebral bags after the lower blepharoplasty.And we found the orbital septum was already very thin and and did not play the supportive effect but hindered the herniation of the orbital fat when the palpebral bags developed. We can reach the same postoperative outcome with unsuturing the orbital septum after opening it. We have done some reseachs on the anatomy and the histology in order to provide the anatomic and histological evidence for the lower blepharoplasty.We also performed the lower blepharoplasty by suturing and unsuturing the orbital septum after opening it in the patients of palpebral bags at random to eplore the different effects of the two methods.OBJECTIVE:1,Study of the orbital tissue to make clear the scope of the orbita septum and their specific relationship with surrounding tissue and its tissue components.2,Study of the morphology and histology of the orbital septum to make sure the change of superior,middle and inferior parts and different ages in order to guide the improvement of operation method and provide the histological evidence for the lower blepharoplasty of opening the orbital septum.3,Study of the lower blepharoplasty by suturing and unsuturing the orbital septum after opening it in the patients of palpebral bags at random to eplore the different effects of the two methods..METHODS:Divided into tow parts,Partâ… :Choose head of adult bodies fixed with 10% formaldehyde solution, irritated in red latex through the radial artery and femoral artery, of six men,three women. With naked eye dissect the body of anatomical specimens, mark anatomical range with marker pen from the external canthus to the internal canthus, along lower blepharoplasty incision,the application of sophisticated orthopedic surgical instruments, stratified on orbital anatomy, observed and photographed. Analog clinical surgical approach, opened the orbital septum so that it fully released the orbital fat. Cut some soft tissue of the orbital septum from the superior 1/3 part,the middle 1/3 part and the inferior 1/3 part of orbital septum, were embedded in paraffin, sliced, HE staining to observe the morphology. We not only undergone the orbital septum anatomic dissection in 10 adult cadavers,but also performed the pathological sections observation and measure from the microtissue of the orbital septum in the opened lower blepharoplasty of 40 patients. Form the incision line to the arcus marginalis,cut some soft tissue of the orbital septum from the superior 1/3 part,the meddle 1/3 part and the inferior 1/3 part of orbital septum, were embedded in paraffin, sliced, HE staining to observe the morphology.Partâ…¡:Applicate different methods of sutureing and unsuturing the opened orbital septum in the lower blepharoplasty and cosmetic and plastic surgery, observing the contrastive effect of surgery.RESULTS:1,Orbital autopsy found that the orbital septum was located in the back of orbicularis oculi muscle and was the thin aponeurosis tissue in the front of the orbital fat.At the same time,the function of the loose orbital septum as the screen of prventing the infection of diffusing and the cancer metastasising was more evident than the one as prevent the herniation of the orbital fat.2,The morphology and histology of the orbital septum displayed that the middle of the orbital septum holded back the orbital fat is the weakest,while the part near the arcus marginalis supporting the orbital fat is the strongest. Moreover the orbital septums of young patients have more intensive connective tissue,and the orbital septums of old patients have rarefactive connective tissue.There are much orbital fat inset the orbital septum.3,80 patients have 70 patients with following-up.A total of 40 patients were operated the Hamar's techcique and 32 of them available for 6 months to 2years postoperative follow-up. While a total of 40 patients were operated the modifid Hamar's techcique and 38 of them available for 6 months to 2 years postoperative follow-up. Both of the techciques have the excellent cosmetic results,without any common complications such as lower eyelid ectropion,the seperation of eyelid and eyeball, orbital margin hollow, hemorrhage and so on.The results are as follows:the modified Hamar's techcique simplify the surgery and spread the orbital fat more evenly for filling the tear trough hollow deformity.CONCLUSION:1,The different thickness and looseness of superior,middle and inferior parts of the orbital septum have an important influence on the development of palpebral bags.The herniation of the orbital fat before and after the lower blepharoplasty is most likely to appear in the middle part of the orbital septum.2,The looseness of the orbital septum plays an important role in the development of palpebral bags.The loose orbital septum does not play the supportive effect but hinders the herniation of the orbital fat.The method of opening the orbital septum and not suturing it has little impact to the shape and function of the orbital part which provides the histological evidence for the lower blepharoplasty of opening the orbital septum..3,Compared with the used technique, the modified Hamar's technique has the postoperative outcome without definite difference and has easier operation,lesser tissue damage,faster recovery and more favorable postoperative formation. It is a simple and reliable surgical approach for the lower blepharoplasty. This surgical methods should be promoted.