| Objective: To observe the clinical outcome of micro free orbital fat grafts into depression of tear trough in lower eyelid to rectify its deformity during lower eyelid blepharoplasty.Methods: The data of 127 patients with lower eyelid bags underwent lower eyelid blepharoplasty in Plastic Surgery Department of Suzhou Aist Cosmetic Surgery Hospital from October 2015 to July 2017 were retrospectively analyzed in this study,and all enrolled patients suffered from septum fat bulging combined with tear trough deformity.A total of 46patients(92 eyes)underwent micro free orbital fat grafts to correct tear trough deformity were included in group A,and set up two control groups:41 patients(82 eyes)underwent orbital fat-releasing grafts were in group B,and 40 patients(80 eyes)underwent traditional surgical treatment were in group C,every group was further subdivided into three subgroups according to preoperative Barton grading system.the patients in micro free orbital fat grafts group loosen the tear trough ligament,and removed extra fat of orbital septum which were cut into 2mm granulate fat,and freely transplanted into the orbital periosteum in tear trough of lower eyelid,below orbicularis oculi muscle,to correct tear trough deformity.The orbital fat-releasing grafts group loosened the tear trough ligament,and incised septal orbitale,in which the internal and central pedicled fat flaps was unfolded and fixed in the periosteum surface of tear trough.The traditional group only conducted the excision of the bulged fat,without the release of fat in septal orbitale.Postoperative Barton’s grading scores,the ratio of the anatomical structure of tear trough surface before and after the surgery were evaluated.Meanwhile,postoperative complications were statistically observed,and the clinical outcomes of three surgeries were compared by horizontal comparisons to analyse the range of indications for this operation.All the data were statistically analyzed by SPSS20.0 software.Results :(1)Groups A and B had better postoperative Barton’s grading scores than group C,but no significant differences post surgery were found between group A and group B.(2)The anatomical structure of tear trough:the ratios of lower eyelid bag height to palpebral fissure width(LEBH/PFW%)and tear trough deformity height to palpebral fissure width(TTDH/PFW%)were measured.The results showed that the ratio of TTDH/PFW%,and LEBH/PFW% in three groups were all decreased when compared to the treatment before,and significant differences were observed in three groups(P<0.05).(3)Significant differences was found in TTDH/PFW(%)between group A and group C,group B and group C(P<0.05),no significant differences were seen between group A1 and group B1 as well as group A2 and group B2(P>0.05),but group A3 and group B3 showed a significant difference(P < 0.05).(4)There were no significant between-group differences in LEBH/PFW(%)between groups A1,A2,A3 and groups B1,B2,B3(P > 0.05).(5)Postoperative complications consequences showed that the incidence of skin ecchymosis in group A was higher than group B and group C(23.91% vs.21.95%,8.75%),but the incidence of chemosis showed no significant differences among three groups.Mild ectropion occurred in groups A and B,and its incidence rate was lower in group A than group B(2.17% vs.4.88%),subcutaneous induration occurred in 4 cases(4.87%)in group B,but groups A and C were not found the above complications.And obvious lower eyelid depression in one case(1.25%)in group C.No serious complications such as orbital hemorrhage or hematoma,infection occurred in all the patients.Conclusions: Micro free orbital fat grafts to rectify tear trough deformity during lower eyelid blepharoplasty had better long-term clinical outcome than traditional therapies,but orbital fat-releasing grafts surgery is more superior to the therapies that rectify severe tear trough deformity.There is no significant difference in postoperative efficacy was seen in patients with mild to moderate tear trough deformity complicating with septum fat bulging eyelid bags between micro free orbital fat grafts and orbital fat-release grafts surgery.What’s more,micro free orbital fat grafts surgery is featured by simply operation and easily mastery.Meanwhile,the incidence of surgical complications isn’t increased,on the contrary,it reduces the incidence of lower eyelid ectropion and subcutaneous induration than that of orbital fat-release grafts surgery.So it is worthy of clinical application. |
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