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Objective:To investigate the effect of folding and filling the orbicularis muscle flap of the inferiorcentral pedicle in correction of sunken upper eyelids.Methods:From August 2020 to April 2022, 39 female patients aged 36-63 (47.1±6.3) years with dermatochalasis and sunken upper eyelid were admitted to the Plastic Surgery Department of the First Affiliated Hospital of Air Force Medical University. During the surgery, the orbicularis oculi muscle in the skin resection area was preserved and a muscle flap was formed with the central part of the lower margin of the incision as the pedicle, which was folded deep and filled in the anterior orbital septal space. 6 months after surgery, the Park method was used to compare the effects before and after surgery, and the doctors and patients were scored on the Global Aesthetic Improvement Scale, respectively.Results:Unilateral upper eyelid hematoma appeared in 1 patient and healed after local acupuncture and aspiration, unilateral incision induration appeared in 2 patients, and gradually disappeared after 6 months of follow-up. The wounds of other patients healed in one stage. All the 39 patients were followed up for 6-12 months. The scores of the Global Aesthetic Improvement Scale at 6 months after surgery were (4.12±0.95) for doctors and (3.82±1.27) for patients. Park method showed that the degree of sunken upper eyelid after surgery was significantly better than that before surgery, and the difference was statistically significant ( Z=-7.721, P=0.000). Conclusions:The folding and filling of the orbicularis muscle flap of the eye with the inferior central pedicle can correct the laxity of the upper eyelid and improve the sunken upper eyelid. This operation can make full use of local tissue, and the effect is simple and lasting.
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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 The multiple malformation of upper eyelid,including the excessive width of fold line,sunken and/or multiple folded upper eyelid are the common complications after blepharoplasty.The aim of this study was to investigate the clinical effect of orbital septum fat redistribution on correcting these deformities.Methods From September 2015 to September 2017,38 patients with multiple malformations of upper eyelid were treated.The incision of upper eyelid and the excessive skin was designed and resected.After completely relieving the scar adhesion zones,we set the lateral orbital septum fat free and transposed it to the inner side of orbital septum or superior border of tarsus with suturing fixation.Then we routinely completed the double eyelid operation.Results Thirty-eight patients with multiple malformations of upper eyelid were treated successfully.The patients were followed up for 6 months to one year,and the results were totally satisfactory.The operation was not performed again.Conclusions The orbital septum fat redistribution can successfully correct the multi ple malformation of upper eyelid.It should become a regular procedure in blepharoplasty.
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Objective This study was intended to determine the role of microautologous fat transplantation (MAFT) in dealing with severe sunken upper eyelids.Methods The authors performed microautologous fat transplantation (MAFT) procedure,particularly in accurately delivering small fat parcels,to treat 238 patients with sunken upper eyelids with multiple folds.Results The average total injection volume of fat were 1.8 ml in right upper lid (from 1.1 to 2.4 ml) and 1.7 ml in left upper lid (from 1.1 to 2.4 ml) separately.Only 3 cases encountered prolonged swelling more than 2 weeks.There were no severe complications.All patients were satisfied with the final results and 2 patients asked for secondary enhancement procedure.Conclusions The therapeutic effects of MAFT and the long-term clinical results of patients with sunken upper eyelids with multiple folds indicate satisfactory outcomes.
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BACKGROUND: To date, many methods have been proposed to resolve the sunken eyelid. We treated our clinical cases of sunken upper eyelid based on whether there is a concurrent presence of the dermatochalasis or blepharoptosis and then performed the autologous fat grafting using either closed or open technique. METHODS: According to the classification of the patients, we used the following injection techniques: First, we solely performed the autologous fat grafting using the closed technique in the sunken upper eyelid only group, for which we did the injection using a micro-injector cannula on the suborbicularis plane. Second, we performed such procedures as skin excision, orbicularis oculi muscle strip excision and levator aponeurosis advancement to manage each symptom in the sunken upper eyelid with dermatochalasis or blepharoptosis group. Simultaneously, we also made a small window in the lateral portion of the orbital septum using the open technique with metzenbaum scissors. Thus, we performed the intraseptal injection of the autologous fat. RESULTS: During a period ranging from January of 2012 to April of 2014, we treated a total of 53 patients. The patients were followed up during a mean period of four months. Thus, we obtained satisfactory treatment outcomes without notable complications. CONCLUSIONS: In conclusion, our results indicate not only that surgeons should consider the fat grafting as one of eyelid-surgery procedures but also that they should perform it concurrently with blepharoplasty or blepharoptosis correction for the purposes of obtaining good treatment outcomes.