Clinical Study Of Structural Bionics And Kinematics Reconstruction Technique In Blepharoplasty

Part Ⅰ Preliminary investigation on the kinematics mechanism of upper eyelid movementBackground:The proportion of bilateral double eyelids in Han Chinese is about 1/2[1].In recent years,due to the public’s aesthetic preference for double eyelids,many beauty pursuers want to change the original upper eyelid appearance through surgery.Serving as the protective structure of the eyeball,the upper eyelid performs the opening and closing function,with exquisite internal anatomical structure and complex kinematics mechanism,which are of great differences from those of single eyelid.Thus,clarifying the kinematics mechanism of upper eyelid and its relationship with appearance is of very important clinical guiding significance for incisional blepharoplasty.Objective:This article is to investigate the kinematics mechanism of upper eyelid,and to clarify its relationship with the upper eyelid external-shape and double eyelid plasty.Methods:1.Literature related to human upper eyelid anatomy was collected in PubMed,CNKI,Wan fang,Vepsa and other databases through keyword and MeSH,and the anatomical levels of the upper eyelid were summarized.2.By proposing the concept of"motor complex" and "relative static zone" of the upper eyelid,the relationship between the kinematics mechanism and external shape of the upper eyelid is discussed.3.The theoretical conclusions are applied to analyze the spontaneous changes in the appearance of the upper eyelid and the two classic incisional blepharoplasty.Results:1.The anatomical level of the upper eyelid is complex,and there are great differences between single eyelid and double eyelid.2.During the process of opening eyes,each anatomical layer of the upper eyelid can be divided into "motor complex" and"relative static zone" according to its movement trend.The shear force generated at the junction of the two zones and its distribution level have a decisive influence on the appearance of the upper eyelid after opening eyes.3.In blepharoplasty,no matter complete removal or complete retention of the orbicularis oculi muscle in front of the tarsus,they can’t simulate the kinematics mechanism of natural double eyelid movement well,and the surgical effect has certain limitationsConclusion:The anatomical structure and the kinematics mechanism have great differences between single eyelid and double eyelid.The blepharoplasty can create a natural and beautiful double eyelid only by realizing the two goals of structural bionics and kinematics reconstruction at the same time.Part Ⅱ Application of structural bionics and kinematics reconstruction technique in blepharoplastyObjective:To explore the surgical technique of shaping natural double eyelid by structural bionics and kinematics reconstruction in blepharoplasty,and to evaluate the feasibility of the surgical technique through postoperative follow-up and result analysisMethods:Beauty pursuers who underwent incisional blepharoplasty at the Nine Department of Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from June 2015 to October 2019 were included in the study.All beauty pursuers signed the informed consent form before operation.The same physician performed the same operation,and photos of these beauty pursuers were taken and collected before and duringoperation.After operation,we have been carrying out outpatient,telephone or Internet follow-up.The innovations applied in these operations mainly include:①deep release of the orbicularis oculi muscle,that is,separation and removal of all the deep fascia of the orbicularis oculi muscle from the lower lip of the incision to the eyelid margin.②superficial release of the orbicularis oculi muscle,that is,separation of about 1 mm downward along the interspace between the the dermis and orbicularis oculi muscle of the lower lip of the incision.③ high suspension of the orbicularis oculi muscle,that is,stretching and thinning of the orbicularis oculi muscle of the lower lip of the incision after release and high fixation to the levator aponeurosis.Results:162 beauty pursuers were included in the study.The suture was removed about one week after operation.One-stage incision healing were achieved in all beauty pursuers A total of 45 beauty pursuers were followed up for at least 6 months after surgery,with a maximum follow-up time of 32 months and an average one of 12 months.Among the beauty pursuers in this part,36 were very satisfied with the surgical results,7 were basically satisfied and and 2 were dissatisfied.All the beauty pursuers had smooth curve of double eyelid line,mild upturned eyelashes.There is no hypophasis or upper eyelid hysteresis,no "meat strip" phenomenon when opening eyes,no depression or step-like appearance of incision when closing eyes.The scar is concealed.3 had mild asymmetry of bilateral double eyelids after surgery.2 had disappearance of unilateral double eyelids,which were repaired by reoperation.2 had mild ectropion of eyelid margin in the early postoperative period,without treatment.Conclusion:Suspension of the orbicularis oculi muscle in front of the tarsus on the levator aponeurosis can simulate the anatomical structure and kinematics transmission of the natural double eyelid,realize structural bionics and kinematics reconstruction,shape the natural beautiful double eyelid,and has a high postoperative satisfaction,which is a new surgical method worth popularizing.