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Objective:To investigate the method and effect of correcting upper eyelid depression with released orbital diaphragmatic fat.Methods:From January 2017 to June 2020, there were 26 female patients with upper eyelid depression in this department of Hebei Chengde Stomatological Hospital. The patients aged 22-54 years, with average 43 years. An external mass orbital diaphragm fat release reverse folding repositioning with fat placement in the upper lid depression was performed in 26 patients. An incision about 4 mm long was made in the middle and lateral of the orbital diaphragm to ensure the integrity of the orbital diaphragm as far as possible. The photos of beauty seekers before and 6 months after operation were compared to observe the correction effect of upper eyelid depression and the shape of upper eyelid.Results:All 26 patients had one-stage healing of the surgical incision without infection, with inconspicuous incisional scarring. At 6 months postoperatively, 18 patients had satisfactory results; 1 patient had improved results due to insufficient fat; and 1 patient had poor results due to too little fat and poor filler placement, which was later improved by autologous fat grafting.Conclusions:External mass orbital fat release reverse folding repositioning for correction of upper eyelid depressions is a surgical procedure with obvious results, little trauma, and following the principle of anatomical recovery, which is worthy of clinical application.
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Objective:To explore the clinical effect of the middle facial rejuvenation by cutting off the tear trough ligament and the orbicularis retaining ligament complex, opening the soft tissue spaces, combined with the lower eyelid muscle flap lateral canthus periosteum suspension and the orbital septum fat release.Methods:The clinical data of 39 patients with pouch and lacrimal groove, eyelid buccal groove depression in the Department of Cosmetic Surgery, Chongqing Chengshang Medical Beauty Clinic from June 2018 to June 2019 were retrospectively analyzed, including 2 males and 37 females, aged 30-58 (39±7) years. Through the incision of lower eyelid margin, the tear trough ligament and the orbicularis retaining ligament were completely severed. Up on the periosteum blunt, the preseptal, premaxillary and the prezygomatic spaces were dissected, and thus the fat of orbital diaphragmatic was fully expanded, by moving down and fixing on the inside, midside and outside periosteum of the inferior edge of the orbital bone. The lower eyelid muscle flap was suspended on the lateral canthus periosteum at the same time.Results:The patients were followed up for 12 months, the pouch, lacrimal groove and eyelid buccal groove depression were solved, the ptosis tissue of middle face was restored well and the effect was lasting. 3 patients felt the external eye angle traction after operation, and the symptoms disappeared 3-4 weeks later. 1 patient had mild eyelid ball separation due to hematoma organization after operation, and symptoms disappeared 3 months after anti scar treatment.Conclusions:For patients with pouch, lacrimal groove depression, eyelid buccal groove depression and midface tissue ptosis, the operation can safely and effectively solve the above problems and achieve the purpose of rejuvenation of the middle face, which is worthy of clinical application.
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Objective:To compare the clinical efficacy of autologous fat injection and conjunctival pedicled orbital septal fat grafting for infraorbital margin depression in young people.Methods:Fourty young patients with lower eyelid pouch and infraorbital margin depression with age of 20 to 40 years and average age of 30.6 yaers in the First Affiliated Hospital of Nanchang University from September 2017 to September 2019 were enrolled. According to the surgical method, all patients were divided into 2 groups with 20 cases each. Group 1 underwent transconjunctival orbital septum fat reset. Group 2 underwent various autologous fat injection after proper amount of orbital septal fat being removed, including structural fat, fine-particle fat and nano-fat, performed in different parts and layers. The tear trough rating scale (TTRS) scores and patients＇ satisfaction at 1 year after operation between 2 groups were compared.Results:Compared with the preoperative TTRS scores, the differences in scores at 6 months and 1 year after surgery were statistically significant ( P<0.01). The scores between two groups were compared at 6 months and 1 year respectively after the operation, and the difference were both statistically significant ( P<0.01). 6 months after the operation, the TTRS scores including four items were carefully compared between the two groups. It showed that the reduction of tear groove depth ( P<0.05), pigmentation ( P<0.01) and wrinkle ( P<0.01) in group 2 were more obvious than those in group 1. The percentage of satisfaction in group 2 (95%) was higher than that in the group 1 (70%), and the difference was statistically significant ( P<0.01). Conclusions:For infraorbital margin depression of young people, after proper amount of orbital septal fat being removed, various free fats graft injection into different parts and layers could obtain better treatment results, reducing not only the depth of the tear groove, but also periorbital pigmentation and fine wrinkles.
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Objective:To evaluate the use of orbital fat flap combined with free fat for the treatment of the moderately or severe sunken upper eyelid and multiple folded upper eyelids.Methods:From March 2017 to March 2019, orbital fat release and replacement and free abdominal fat transfer graft were adopted to treat 20 patients (1 male, 19 females, aged 20-47 years, with an average age of 29 years) with sunken upper eyelids of multiple folds in Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Xiamen University Siming Branch.Results:Twenty cases were treated successfully. The swelling gradually disappeared at 3 month postoperatively. Patients were followed up for 3 months to 12 months with sustained aesthetic results; no complications occurred. Free fat graft survived well, and no obvious scar, sags, or crests were present in the upper eyelid.Conclusions:It is a reasonable method for correcting sunken upper eyelid and multiple folds with orbital fat flap and free fat. Survival rate of the free fat is quite high in sunken upper eyelid. It is worth spreading.
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Objective To study the effect and methods of orbital septum fat redistribution or autogenous orbital septum granular fat transplantation methods on upper eyelid depression.Methods Blepharoplasty incision was used to cut open musculus orbicularis oculi and septum orbitale horizontally,exposuring orbital fat,the conjunction was relieved between orbit fat envelope and septum orbitale,displaced orbital fat was extended and replaced to the depression region of upper eyelid,and the wound was routinely sutured.For orbital septum fat volume depletion,appropriate amount of granular fat was injected into depression region and put fat backward upto supraorbital margin.Then,resetting orbital septum and closing incision were conducted with suture technique of blepharoplasty.Results Of 48 cases (96 eyes),32 cases was followed-up for 6 to 42 months with mean of 11 months.All cases got ideal outcomes,with smooth and symmetry lid folds,depression of upper eyelid were fixed and no complication occurred.Conclusions Orbital septum fat redistribution or autogenous orbital septum granular fat transplantation can anatomically reduce the fat distribution of upper eyelid.This method is easy and effective to improve the appearance of eyelid.
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Objective To study the asymmetry of the soft tissue thickness of upper eyelids in Shanghai female undergraduates undergoing double eyelid surgery.Methods Data were collected in 565 female students from Shanghai universities.Before surgery,oblique sagittal view images of the upper eyelids by 3.0T MRI were obtained and the following parameters were measured: soft tissue thickness at upper tarsal plate margin and upper central tarsal plate,sub-eyebrow and intra-orbital septum fat pad areas,and whole upper eyelid soft tissue areas.The resected orbicularis and intra-orbital septum fat were weighed by a highly accurated electronic balance.The eyelid asymmetry index (EAI) was calculated.Results The MRI (U/U2) central tarsal plate soft tissue thickness were:4.46±0.90 in the right side and 3.78±1.01 in the left; the intra orbital septum fat areas were:172.33±49.29 in the right and 136.34±37.42 in the left; the whole tissue areas were: 697.13±146.99 in the right and 500.66±158.87 in the left (P＜0.01 for all).The weight of the resected orbicularis oculi muscle and intra orbital septum fat pad were (0.18±0.05) g and (0.17±0.06) g for the right side,and (0.15±0.04) g and (0.06±0.05) g for the left side (P＜0.01 for all),respec tively.The orbicularis EAI was 0.17±0.06,and the intra orbital septum fat EAI was 0.41 ±0.08.Conclusions The asymmetric phenomenon of the upper eyelids' soft tissue thickness is commonly found in the Shanghai female undergraduates,and the main manifestation is that orbicularis and intra orbital septum fat in right side are thicker than that in the left.
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Objective To explore the baggy eyelids anaplasty through posterior orbital septum fat displacement. Methods Orbital septum and posterior orbital septum fat were exposed through palpebral margin incision, internal orbital septum fat was released and sutured with arcuate expansion of capsulopalpebral fascia at the middle lower eyelid, which was taken as the function of tighting the flaccid lower eyelid at transverse direction. On such a basis, the muscle and skin were repaired and so did orbital septum and baggy eyelids.Results Ofthe 38 patients with this operation, baggy eyelids anaplasty was performed with satisfactory results.Conclusion The method of baggy eyelids plasty through posterior orbital septum fat displacement could reduce hemorrhage, prevent enophthalmos and decrease baggy eye palindromia, with better long-term effects.