| BackgroundAs the medical and health-care cause is improved together with people's health consciousness. Aesthetic Plastic Surgery is also developing and expanding with times. In particular, when the problem of food and clothing has no longer been the basic living issue people extremely concerned and the shortage of doctors and medicine has become past records, people get to pursue the quality of life, varying from length of life to length of life plus width of life, namely, it's no longer wide wish for a few people to improve their own life quality within limit life cause. With the intense demand of market, scholars and professionals in Aesthetic Plastic Surgery is studying the each esthetical index of human body. It is one of the topics to maintain beautiful eyes forever for enthusiasts in cosmetic beauty and surgeons in Aesthetic Plastic Surgery are concerned.As first one of five sense organs, the eye can be deemed as window of heart and place great impact on the one's appearance. no matter the eyes are born with beautifulness and charm and whatever cosmetics and fitness maintenance we adopted, we can't manage to resist the natural law of aging completely, but we can postponing the process of aging. As preventing the arrival of aging and stopping aging are impossible, the aging signs firstly appears on our eyes-our window of heart-first one of five sense organs. For lower eyelid, eye bag and crow's feet turn into the supreme perplex for beauty lover. So the youth of lower eyelid is gathering more and more attention. One of the most defining features of a youthful lid is a shorter, fuller eyelid.2 This is in stark contrast with the aged eyelid, which clinically appears longer and deflated and demonstrates anatomic features such as laxity, loss of volume, and pseudoherniation of orbital fat through a weakened orbital septum. The aging signs of the lower eyelid, including lower eye bag and crow's feet, emerge gradually with time.What are causes to formation of lower eyelid bag?There are many fresh opinions on the cause of formation of lower baggy eyelids recently, among which the main causes are concluded as below:①redundant orbital fat;②thick orbicularis oculi muscle;③declined muscular tension of skin and orbicularis oculi muscle;④the bulging, transposition and prolapsus of orbital fat caused by degeneration relaxation, loss of resilience, weaken bearing capacity of orbital septum;⑤The orbitofrontal organization consists of relaxation and contraction of supportive ligament and change of anatomy location, which destroy the balanced relation between orbital fat volume and supportive structure of lower eyelid and make orbitolfrontal bone outline obvious and various sag under infraorbital rim;⑥Many researches show that bone remodeling plays an important role in the aging process of mid-facial fracture. Various displacement of facial bone will emerges with natural aging of organism. Bone remodeling aggravates the tendency of orbital fat prolapse and herniation;⑦Thick fat pat under orbicular muscle or the relaxation of partial tissue make fat pat protruding and lower eyelid deformed (lower baggy eyelids).Among which①②are common in young people with respect to genetic factor. There are a lot of Clinical classification formulations on lower baggy eyelids; however, there is no unified standard at present. The formulations can be classified into four groups according to its clinical manifestation and anatomy features:①skin flabby type;②orbital fat prolapse type;③thick orbicular muscle(special pattern);④mixed type.There are non-surgical and surgical type on treatment of lower baggy eyelids, the effectiveness of non-surgical type is not as good as that of the surgical treatment in practice. More and more clinical researches on surgical treatment are emerging. The traditional surgical treatment on lower baggy eyelids contains trans-conjunctival approach and extradural approach. The trans-conjunctival approach refers to trans-conjunctival route, leaving no skin incision scar, with rarely eruption of lower eyelid retraction or eyelid ectropion. However, because of no resection of eyelid skin, there are many drawbacks:narrow applicable range because that this approach can not deal with flabby lower eyelid skin, orbicular muscle, orbitofrontal diaphragm simultaneously. The extradural approach refers to skin incision. The traditional lower lid blepharoplasty mainly cut off redundant skin, partial orbicular muscle and bulging orbital fat through skin incision under lower eyelash. Such as Pure resection of the orbicularis muscle, pure resection of skin, skin resection + resection of orbital fat, all the approaches haven't disposed with flabby and frail supportive structure of lower eyelid in special way. It has been known recently that the formation of the lower baggy eyelids is not caused by increased orbital fat (excluding the congenital eyelid bag patient who has redundant orbital fat). On the contrary, Camirand points out in his study:the orbital fat content is constant or decreasing with aging, but the loose and frail supportive structure of lower eyelid are main causes to formation of secondary lower baggy eyelids. Since the 1970s, the lower lid blepharoplasty which reserves and utilizes lower baggy eyelids of orbital fat emerges gradually to strengthen supportive structure of lower eyelid but not to strengthen the excision of orbital fat. Although the traditional operation can resolve many basic questions from beauty-lovers, they examine operation effect in fastidious attitude for the reason of the new age in which people pursue the beauty in more and more fastidious way, so it's very common mentality of beauty-lovers to chase after more perfect and individual face at present. Consequently, traditional operation has no longer satisfied the psychological demand from beauty-lovers who desire for perfect eyes, putting forward higher requirement for workers in Clinical and Aesthetic & Plastic Surgery. Based on long-term accumulation of clinical experience and collection of rich cases, workers in Aesthetic & Plastic Surgery also take a review and check advantages and disadvantages in past meanwhile propose queries to the relevant operations.Therefore, with the expansion of the Aesthetic & Plastic Surgery, it turns into the ultimate goal for workers in Aesthetic & Plastic Surgery to meet the fastidious Aesthetic psychological demand from vast beauty-lovers to a maximum, manage to lessen operational injury and keep more natural appearance and more enduring effect in the meantime. Based on traditional operation, the subject focuses on special treatment on orbital fat in lower eyelid and orbicular muscle, shaping young, pretty and natural appearance of lower eyelid after operation, positions beautiful appearance of lower eyelid from medical and aesthetic perspective. The final purpose of the subject lies in making the person who undergoes surgery have young lower eyelid and more natural and prettier and stronger 3D appearance of lower eyelid in vision in the meantime.Part one:Treatment of after the orbital septum fat:Baggy eyelids anaplasty through posterior orbital septum fat displacementObjective:To explore the baggy eyelids anaplasty through posterior orbital septum fat displacement.Methods:Orbital septum and posterior orbital septum fat were exposed through palpebral margin incision, internal orbital fat was released and sutured with arcuate expansion of capsulopalpebral fascia at the middle lower eyelid, which was taken as the function of tighting the flaccid lower eyelid at transverse direction. On such a basis, the muscle and skin were repaired and so did orbital septum and baggy eyelids.Results:Of the 38 patients with this operation,. In addition to the lower eyelid skin with mild bleeding, the lower eyelid are smooth, no depression, and lower eyelid ectropion back, hematoma and bleeding. follow-up:after 3 months follow up 28 cases,5 cases followed up after 3 years,5 cases were lost. baggy eyelids anaplasty were achieved satisfactory results.Conclusion:The method of baggy eyelids plasty through posterior orbital septum fat displacement could reduce hemorrhage, prevent Enophthalmos and decrease baggy eye palindromia, with better long-term effects.Part two:Treatment of pre-tarsal orbicularis oculi:Repair of baggy deformity with lower eyelid step reservationObjective:To explore the operation method and effect of repairing baggy deformity with lower eyelid step reservation.Methods:The method of skin flap and musculo cutaneous flap with pretarsal orbicularis oculi reservation was adopted through palpebral margin incision, then the preseptal orbicularis oculi muscle and orbital part, orbital septum and orbital septum fat of orbitalis muscle were treated suitably to remove appropriate amount of skin,the lower eyelid step was reserved and repair of blepharoptosis was performed simultaneously.Results:The 58 cases, including 10 cases of orbicularis muscle hypertrophy, the part of orbicularis muscle was removed by surgery, the results were satisfactory.28 cases with different degrees of orbital fat herniation, repair of eyelid bags was satisfactory after the orbital septum is strengthened.10 cases of orbicularis muscle hypertrophy, the appearance of lower eyelids swollen was improved after the part of orbicularis muscle was removed. preservation tarsus orbicularis muscle 3～5mm in this group, so the formation of lower eyelid step in postoperation. eyelid bags is disappeared in postoperation, eyelid cheek area is natural, good shape. None of the complications.all of patients followed up for 6 months to 2 years, baggyeye taxis was achieved satisfactory results, lower eyelid shape was very nice, the eyes were natural and more three-dimensional appearance. Conclusion:The method of repair baggy deformity with lower eyelid step reservation could not only solve problem of eye bags,which produces a more desirable appearance, but also meet aesthetic requirements and rejuvenative appearance.Part three:Treatment of orbital of orbicularis oculi:Crow's feet ablation of clamp damage orbicularis oculi muscleObjective:To explore a surgical method to remove crow's feet.Methods:To repair baggy deformity by palpebral margin lower incision,at the same time clamp damage the department of outer canthal orbicularis oculi muscle and to reduce the external canthus dynamic formation of wrinkles.Results:In 36 cases, On time for removal of stitches postoperation, swelling is dissipated after 7-15 days,3 cases of temporal and outer canthal corner bruising, in gradually subsided after 12 days, but no case of other complications occurred, all of patients followed up for 4 months to 18 months, crow's feet was improved significantly after surgery, outer canthal shape well, scar in not obvious, results were satisfactory.Conclusions:to remove crow's feet surgical method through clamp damage orbicularis oculi muscle is simple, feasible, effective and reliable operation with bags under the eyes at the same time. |
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