Anatomical Observation Of Middle And Old Aged Patients With Deformity Of Tear Trough And Palpebral Sulcus,and Discussion Its Plastic Surgery Method

Objective:To investigate the tear trough and palpebral sulcus malformation of the lower eyelid plane by anatomical dissection of the lower eyelid planea and its sagittal plane,discussion on the anatomical features of middle and old aged patients with tear trough and palpebral sulcus,and personalized plastic surgery.Methods:Three groups of cadaver specimens(group of youth,middle age group and elderly group)were selected.Five cases of female specimens and three cases of male specimens were observed from the lower eyelid plane and its sagittal plane anatomical observation The thickness of the lower eyelid skin,the thickness of the zygomatic fat pad,the distance between the second group and the third group of orbital fat,and the mean value and the standard deviation were calculated.In the past two years,there have been 30 cases of clinical cases of tears channel and eyelid cheek groove deformity.Among them,26 cases of middle-aged and old aged patients.30 cases were based on Hirmand classification standard.According to different degree of tear groove and eyelid cheek groove sag width and depth,lower eyelid weak and drooping,and the expansion of fat of different age groups,divided into six types.The main method of operation is to loosen the limiting ligament of the orbicularis oculi muscle,to fill the grooves with the orbital septum fat,to remove the pouch and to improve the lower eyelid.Different types of malformations,different specific operation modes.Results:Based on the observation and measurement of gross specimens and tissue sections of ear trough and palpebral sulcus in different age groups,the results were statistically analyzed:1.The thickness of the lower eyelid skin:group of youth(0.35±0.08)mm;middle age group(0.31 ± 0.06)mm;elderly group(0.26 ± 0.05)mm.2.The youth group of zygomatic fat pad covered with the upper edge of the tongue and eyelid buccal groove,where the thickness of(3.18±0.15)mm;the middle age group of zygomatic fat pad atrophy down and the thickness of(1.16±0.13)mm,the elderly group,zygomatic fat pad atrophy down significantly,no fat covered in the tear trough and palpebral sulcus.3.In the middle age group,the layers of the lower eyelid were slightly weak,loose and downward,the orbital septum fat was mild or moderate relaxation bulge,and the tear trough and palpebral sulcus were slightly sunken.3.In the elderly age group,the layers of the lower eyelid were moderately weak,loose and downward,the orbital septum fat was relaxation bulge in different degrees,and the tear trough and palpebral sulcus were moderately and senerely sunken.In addition,both the medial and lateral ligament of the orbicularis oculi muscle were closely connected with the periosteum.Clinical application:30 patients were followed up for 3 to 6 months,achieve the improvement of the tear trough and palpebral sulcus deformity,and remove the pouch and improve the lower eyelid.The effect of follow-up was evaluated according to Barton grade,lower eyelid lifting effect classification and patient satisfaction.Objective to evaluate the follow-up results:the patients were basically satisfied.Howwever,the older,the effect of the improvement of the tear trough and palpebral sulcus deformity and the lower eyelid drooping is worse than that of young patients.Conclusion:In the thickness of the eyelid and zygomatic,with the growth age,the strength of the fixation of the medial.and lateral limiting ligament of orbicularis oculi muscle,and the downward force caused by gravity,lead in tear trough and palpebral sulcus deformity.According to the reason of its occurrence,combined with the objective assessment and classification before operation,different plastic surgery methods were selected to achieve satisfactory results.