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OBJECTIVE@#To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with "super released" orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression.@*METHODS@#A clinical data of 82 patients (164 sides) with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression, who met the selection criteria between September 2021 and May 2022, was retrospectively analyzed. Of the included patients, 3 were males and 79 were females, with an average age of 34.5 years (range, 22-46 years). All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression. The deformities were graded by the Barton grading system as gradeⅠ in 64 sides, grade Ⅱ in 72 sides, and grade Ⅲ in 28 sides. The orbital fat transpositions were performed through the lower eyelid conjunctival approach. The membrane surrounding the orbital fat was completely released, allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state, which is regarded as the "super released" standard. The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space, and percutaneous fixed to the middle face. The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted.@*RESULTS@#There were 3 sides with chemosis after operation, 1 side with facial skin numbness, 1 side with mild lower eyelid retraction at the early stage after operation, and 5 sides with slight pouch residue. No hematoma, infection, or diplopia occurred. All patients were followed up 4-8 months, with an average of 6.2 months. The eyelid pouch protrusion, tear trough, and palpebromalar groove depression were significantly corrected. At last follow-up, the deformity was graded by Barton grading system as grade 0 in 158 sides and grade Ⅰ in 6 sides, with a significant difference compared to the preoperative score ( P<0.001). Patient's self-evaluation satisfaction reached very satisfied in 67 cases (81.7%), satisfied in 10 cases (12.2%), generally satisfied in 4 cases (4.8%), and dissatisfied in 1 case (1.2%).@*CONCLUSION@#The "super released" orbital fat can effectively prevent the retraction of orbital fat, reduce the probability of residual or recurrence of eyelid pouches, and improve the correction effect.
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Male , Female , Humans , Adult , Blepharoplasty , Retrospective Studies , Depression , Eyelids/surgery , Face/surgery , Adipose Tissue/transplantationABSTRACT
Objective:To investigate the clinical application of orbital fat fascia flap in upper eyelid depression correction.Methods:From January 2015 to December 2020, 38 female patients (aged 25-55 years, average 37.5 years) with mild to moderate upper eyelid depression were treated with orbital fat fascia flap at plastic surgery department of Friendship Plastic Surgery Hospital affiliated to Nanjing Medical University. During the operation, the lateral part of the central orbital septal fat was transferred to the upper eyelid depression, and then the upper eyelid depression was corrected.Results:35 cases of upper eyelid depression were significantly improved postoperatively, 2 cases of double eyelid line became shallow after operation, and adjustment was performed again; 1 case had partial depression on one side and received autologous granular fat supplement transplantation. Postoperative effect was satisfied.Conclusions:The method of longitudinal separation and preservation of the capsule below the orbital septal for orbital septal fat transposition can better correct the upper eyelid depression while reducing fat absorption.
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Objective:To evaluate the effectiveness of correction of sunken upper eyelid with central orbital fat transposition during upper blepharoplasty.Methods:We performed 58 cases of upper blepharoplasty with sunken upper eyelids during January 2016 and June 2020. The lateral portion of the central orbital fat was dissected and reversed 180 degrees, and then fixed to the medial fat pad. Photographs before and 6 months post-operatively were measured to determine the degree of the upper eyelid depression. The results were compared statistically. At the consultation 6 months postoperatively, the patients were asked to evaluate the results of the operation using the Clients Satisfying Questionnaire, with the grade between 4 (very satisfactory) and 0 (very dissatisfactory).Results:Sunken eyelids were effectively corrected in 41 of the 52 patients, but 11 patients had minimal effect because of the lack of sufficient central fat volume mostly due to the prior blepharoplasty. At 6 months post-operatively, 52 of the 58 patients finished the satisfaction questionnaire. Forty one of the 52 patients were satisfying with the results. The mean score was 3.3+ 0.73. The degree of the upper eyelid depression was (4.9+ 1.1) mm preoperatively and (2.4+ 0.7) mm postoperatively. There was a statistically significant difference ( P<0.05). Conclusions:The central orbital fat transposition is an effective way to correct the sunken upper eyelids during the upper blepharoplasty. The results are satisfactory with full upper eyelids and smooth double eyelids.
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Objective:To address a new classification method in term of the three-dimensional space of orbit and to present the different surgical approaches correspondingly.Methods:In a retrospect study from April of 2015 to June of 2018, 102 patients were performed lower eyelid blepharoplasty, including 20 males and 82 females, aged 21-65 years, with an average of 45.2 years. These patients were divided into five groups, which were described in term of three-dimensional structure of orbit, based on the following points: the presence and extent of herniated orbital fat, the presence of inferior orbitopalpebral sulcus, amount of excess skin, and the skin wrinkles in the lower eyelid. And then patients in different group were treated with different kinds of blepharoplasty. All patients in this study ranged in follow-up from 1 month to 12 months. With patients＇ permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.Results:In type 1, all the 32 cases healed well, no complications such as hematoma, infection and ectropion occurred. During the follow-up of more than 1 months, the overall effect was good, and the pouch-shaped appearance of lower eyelid pouch was significantly improved. In types 2, 8 cases had no complications, and the incision healed well; the patients were followed up for more than 3 months, the lower eyelid bag and lower eyelid skin relaxation were significantly improved, and the lower eyelid skin was tighter than before. In types 3, there were no complications in these 19 cases, and the incision was healed well. The patients were followed up for more than 3 months, the deformity of lower eyelid bag was improved obviously, and no obvious local bulge was found under static and dynamic expression. In type 4, there were no complications in all 34 cases, and the incision healed well; during the follow-up of more than 3 months, the lower eyelid pouch deformity and lower eyelid skin relaxation were greatly improved, except for 1 case with mild bulge (untreated). In type 5, 9 cases had no complications, and the incision healed well; during the follow-up of more than 3 months, the fold of the lower eyelid skin disappeared.Conclusions:Little information is available about classification of lower eyelid bags. And the exact surgical approach remains controversial and largely dependent upon surgeon preference and a patient＇s stated cosmetic desire. In this study, an objective classification based on clinical appearance combined with forming reasons of lower eye bags is little available, and the appropriate surgical approach remains controversial as well.
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Objective To explore the relationship between the orbital fat volume and the age,gender,orbital anteroposterior and transverse diameter in healthy person.Methods 210 healthy person (105 males and 105 females)were enrolled and equally divided into 7 groups according to the age.The area of the orbital fat,orbital anteroposterior and transverse diameter in all the above groups were measured in axial CT images.Then the volume of the orbital fat were computed using equation.The relationship between the orbital fat volume and the age,gender,orbital anteroposterior and transverse diameter were analyzed in the different gender and age groups.Results The volume of orbital fat was symmetrical in all age groups,and the mean fat volume of bilateral orbital was(18 957±4 143)mm3,in which adults (age＞20 years old)had the average orbital fat volume (20 340±3 514)mm3.The mean values of the orbital anteroposterior and transverse diameter were (5.16±0.37)mm and (3.74±0.23)mm,respectively.The orbital fat volume in male was greater than that in female in all age group,in addition,it was positively correlated with the age,orbital oranteroposterior and transverse diameter (P＜0.001).Conclusion The orbital fat volumes are associated with the age,gender,orbital anteroposterior and transverse diameter in healthy person.In addition,the orbital fat volume in male is greater than that in female.
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Objective To explore the method and effect of orbital lateral fat replacement combined with orbicularis oculi muscle flap for correction of severe upper eyelid depression with multiple eyelid.Methods From January 2014 to January 2017,26 patients with severe upper eyelid sag with multiple eyelid were treated in Department of Plastic Surgery,Huai'an Second People's Hospital,including 18 cases of multiple physiological sag eyelid,improper operation on the formation of 8 cases of multiple eyelid eyelid sag.All the patients adopt outside orbital fat reset with the orbicularis muscle flap folded for the treatment.Results The follow-up time was 6 months to 1 year,with an average of 8.5 months.23 patients with upper eyelid sag with multiple eyelid were rectified,3 cases of upper eyelid depression associated with multiple eyelid depression alleviated,multiple eyelid disappeared,including 5 cases of preoperative patients with mild ptosis,and symptoms improved after surgery.Conclusions The orbital lateral fat replacement combined with orbicularis oculi muscle flap folding is a safe and effective treatment for upper eyelid depression with multiple eyelid.
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Objective@#To observe the effect of the outer orbicularis muscle partial resection combined with orbital fat flap or orbicularis muscle flap transfer to block orbicularis muscle for improvement of crow′s feet.@*Methods@#From October 2010 to May 2015, 82 cases of females (aged from 27 to 54 years old) with crow′s feet were treated with new method(n=41) and traditional method(control, n=41). The new method included partial resection and orbital fat flap or orbicularis muscle flap transfer to block orbicularis muscle. The traditional method was performed to lift the skin and orbicularis oculi muscle to improve the crow′s feet. The operation time, the postoperative recovery time, eyes closing function and hematoma, nerve injury and other complications were recorded. 1, 3, 6 and 12 months after operation, the effect was assessed by one cosmetic surgeon who is unkown the groups. Completely correction was assed as 5 points and no improvement or even worse as 0 point. 12 months after operation, the patients satisfactory rate was recorded.@*Results@#75 cases were followed up, including 39 in new method group and 36 in control group. The operative time and postoperative recovery time were (50±5) min, (58±4) min and (5±1) d, (6.0±1.5) d in the new method group and control group respectively (P<0.05). The two groups both had good eyes closing function, no eyes closing fatigue or difficult or other serious complications such as hematoma, nerve injury. Visual analog scale were 3.2±0.6, 3.5±0.5, 4.2±0.8, 4.3±0.8 and 3.1±0.6, 3.4±0.9, 3.0±0.6, 2.8±0.5 in the new method group and control group at 1, 3, 6, 12 months after surgery respectively . Obviously, the effect in new method group was much better than that in control group after 6 and 12 months with statistical significance (P<0.05). 12 months after surgery, the satisfaction surveys showed satisfactory in 33 cases; fairly satisfactory in 4 cases; dissatisfactory in 2 cases in new method group, and satisfactory in 10 cases; fairly satisfactory in 15 cases; dissatisfactory in 11 cases in the control group, showing significant difference between the 2 groups (P<0.05).@*Conclusions@#The outer orbital orbicularis muscle partial resection combined with orbital fat flap or orbicularis muscle flap is reasonable and reliable to correct crow′s feet with short recovery and less complication. It is a worthy new method for recommendation.
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Objective To discuss the surgical methodology for sunken upper eyelid and its curative effect by eyelid orbital fat reset.Methods 26 patients with the sunken upper eyelid were operated,in which blepharoplasty incision was used to open musculus orbicularis oculi and septum orbitale,dissected levator,displaced orbital fat were extended and replaced to the sunken region of upper eyelid,to mild-to-moderate ptosis evator tendon membrane folding suture was carried out at the same time and the wound was routinely sutured through 7-0 nylon thread.Results All cases were followed up for 12 months after operation.There was no obvious complication occurred,All cases got ideal outcomes,with smooth and symmetry lid folds.Conclusions The postoperative effects of upper eyelid orbital fat reset for correction of eyelid sunken are satisfactory,without inequality complications,and therefore it is worth promoting.
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AIM: To evaluate the clinical efficacy of surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia. ●METHODS: A total of 22 eyes of 11 patients received surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia were included. Objective and subjective duration of the operation, degree of cooperation during surgery, postoperative recovery, recurrence and complications were observed. ●RESULTS: In the process of surgery, patients without pain and being-cooperated were recorded in 17 eyes. The patients who occasionally felt slight pain, but within endurance after adding topical anesthesia once and the operation was completed successfully were recorded in 5 eyes ( the second eye surgery ) . The operation was successfully completed in all the patients. Compared the coordination degree during surgery of Gradel with GradeⅡ, the difference was statistically significant ( t=-3. 123, P ● CONCLUSION: The surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia can ensure satisfactory anesthetic effect and get better quality of operation. It′s a simple, safe and effective anesthesia method for spontaneous subconjunctival orbital fat prolapse.
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Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12–18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.
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El enoftalmos es un motivo de consulta poco frecuente en la práctica médica. La mayor parte de los casos se debe a un aumento de la cavidad ósea orbitaria de origen traumático. Presentamos el caso de una mujer de 63 años que consultó por enoftalmos progresivo de su ojo izquierdo, de doce años de evolución. El examen oftalmológico reveló la presencia de un marcado enoftalmos del lado izquierdo, que mejoraba notablemente con maniobras de Valsalva. Una tomografía computarizada y una resonancia magnética de la órbita permitieron diagnosticar una várice orbitaria no complicada. Las várices orbitarias son infrecuentes y por lo general se manifiestan por episodios de exoftalmos intermitente. Sin embargo, en raras ocasiones, la distensión y colapso repetidos pueden llevar a un enoftalmos progresivo por atrofia de la grasa orbitaria.
The enophthalmos is a rare cause of consultation in medical practice. The majority of cases are due to orbital space enlargement of traumatic origin.We report the case of a 63 year old patient with progressive enophthalmos of the left eye, with twelve years of evolution. Ophthalmologic examination revealed the presence of a marked enophthalmos on the left side, which improved significantly with Valsalva maneuvers. A CT scan and an MRI of the orbit allowed diagnosing uncomplicated orbital varices. Orbital varices are rare and usually manifest by episodes of intermittent exophthalmos. However, on rare occasions, repeated distension and collapse can lead to progressive enophthalmos by orbital fat atrophy.
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Female , Humans , Middle Aged , Enophthalmos/etiology , Orbit/blood supply , Varicose Veins/complications , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Varicose Veins/diagnosisABSTRACT
PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
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Humans , Diagnosis, Differential , Muscles , Muscular Diseases , Orbit , Orbital MyositisABSTRACT
Palpebral bag of the lower eyelid & tear trough groove is regarded as a sign of aging. This is mainly caused by weakening of the orbital septum, atrophy of the orbicularis oculi muscle and slackness of the skin. This palpebral bag is usually combined with a depression along the inferior orbital rim which is called a tear trough groove. In the past, the surgical excision of the fat pad has been the mainstay of the management of lower palpebral bag in cosmetic blepharoplasty. But, excision of the protruded orbital fat as a treatment for palpebral bag may contribute in long term to the senile enophthalmos due to a volume reduction of the intraorbital adipose tissue. Recently, fat pad sliding method with septal incision has been performed for preservation of orbital fat. This technique, however, causes problems such as lid ecchymosis, chemosis, lid contour irregularity, ectropion, and retrobulbar hematoma formation. The authors propose to restore the functional integrity of orbital septum. Attenuated orbital septum with orbital fat was stretched and transposed to cover the bony framework. The orbital septum with orbital fat meticulously sutured to the periosteum of inferior orbital rim with 5-0 nylon. This technique of septal draping over the inferior orbital rim was performed in 54 consecutive individuals(108 lower eyelids) for 27 months period. The overall results obtained, with the exception of mild degree of puffiness encountered soon after the surgery, were satisfactory and morbidity was minimal.
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Adipose Tissue , Aging , Atrophy , Blepharoplasty , Depression , Ecchymosis , Ectropion , Enophthalmos , Eyelids , Hematoma , Nylons , Orbit , Periosteum , SkinABSTRACT
PURPOSE: To investigate the long term survival of orbital fat grafted on a Medpor(R) implant as a method of preventing porous polyethylene orbital implant (Medpor(R)) exposure in anophthalmic sockets. METHODS: In one orbit in each of 8 rabbits, a small amount of retrobulbar orbital fat was grafted between the anterior surface of the Medpor(R) implant and overlying conjunctiva, during the enucleation and Medpor(R) implantation procedure. Two rabbits were sacrificed at 2, 4, 8 and 12 weeks postoperatively and grafted orbital fats were examined by light microscopy. RESULTS: Grafted orbital fat was well-maintained at 2 and 4 weeks, postoperatively. However, fat amounts were significantly reduced at 8 weeks, and viable fat was barely visible at 12 weeks. CONCLUSIONS: In rabbits, orbital fat grafted on Medpor(R) implants was gradually resorbed, and the fat-occupied volume was not maintained.
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Rabbits , Animals , Time Factors , Porosity , Polyethylene , Orbital Implants , Graft Survival , Follow-Up Studies , Biocompatible Materials , Adipose Tissue/cytologyABSTRACT
A subconjunctival orbital fat prolapse is frequently confused with a dermolipoma clinically. These two entities have similar clinical appearances, but are clearly distinct. The clinical features, differential diagnosis, and treatment modalities of subconjunctival orbital fat prolapse and dermolipoma are discussed.
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Adult , Female , Humans , Male , Middle Aged , Adipose Tissue/pathology , Lipoma/diagnosis , Orbit/pathology , Orbital Diseases/diagnosis , Orbital Neoplasms/diagnosis , ProlapseABSTRACT
A subconjunctival orbital fat prolapse is frequently confused with a dermolipoma clinically. These two entities have similar clinical appearances, but are clearly distinct. The clinical features, differential diagnosis, and treatment modalities of subconjunctival orbital fat prolapse and dermolipoma are discussed.