Effect analysis of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel transplantation in suborbital rejuvenation
10.3760/cma.j.cn114453-20220709-00214
- VernacularTitle:经结膜入路下睑袋矫正术联合脂肪来源干细胞基质胶移植在眶下区年轻化中的效果分析
- Author:
Chuang WU
1
;
Zhi YAN
;
Ming YANG
;
Chen HE
Author Information
1. 武汉市第一医院整形外科，武汉 430022
- Keywords:
Stem cells;
Lower eyelid bag;
Tear trough;
Lower eyelid bag removal;
Stromal vascular fraction-gel
- From:
Chinese Journal of Plastic Surgery
2023;39(2):134-140
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of transconjunctival lower blepharoplasty combined with stromal vascular fraction-gel (SVF-gel) transplantation in suborbital rejuvenation.Methods:The clinical data of patients with suborbital rejuvenation who were admitted to the Department of Plastic Surgery, Wuhan No.1 Hospital from April 2019 to April 2021 were retrospectively analyzed. Hirmand classification of tear trough deformity was performed based on preoperative photographs. The expanded orbital septum fat was removed through the conjunctival approach, and the SVF-gel was extracted from the fat which was harvested from abdomen or thigh. The tear trough or suborbital depression was corrected by SVF-gel injection. The patients were followed up and the complications related to the operation were recorded. According to tear trough rating scale (TTRS), the depth of tear trough depression, the degree of pigmentation, the sagging degree of zygomatic fat pad and the degree of lower eyelid skin fold were scored before and after operation. The higher the total score indicates the greater severity of the lacrimal groove deformity. The morphology of the orbital-buccal junction was rated (0 to 3) according to the Barton aesthetic rating criteria. The aesthetic effects of lower eyelid bag and tear trough correction were comprehensively analyzed based on the satisfaction questionnaire (very satisfied, satisfied, dissatisfied 3 grades). SPSS 22.0 software was used for statistical analysis, and the normally distributed measurement data were represented by Mean±SD. Paired sample t-test was used to compare preoperative and postoperative TTRS scores, and P<0.05 was considered statistically significant. Results:A total of 92 patients with bilateral lower eyelid bag accompanied by tear trough or middle facial depression were included. There were 15 males and 77 females, aged (38.8±9.6) years (21-55 years). Preoperative Hirmand tear trough classification was performed as type Ⅱ in 37 cases, as type Ⅲ in 55 cases. All patients had conjunctival edema and lower eyelid swelling of different degrees 3 days after surgery, among which 35 patients had skin ecchymosis of different degrees, which recovered spontaneously 1 to 2 weeks after surgery, and no complications such as hematoma, diplopia, fat liquefaction, fat nodule and fat embolism occurred. Postoperative follow-up was conducted for 6 to 12 months. Comparison of preoperative and postoperative TTRS scores: compared with preoperative results, the TTRS scores of Hirmand type Ⅱ patients [(2.37±0.78) points vs. (4.83±0.98) points, t=36.54, P<0.001] and type Ⅲ patients [(2.61±0.60) points vs. (5.38±0.93) points, t=55.20, P<0.001] were significantly decreased after surgery, and the differences were statistically significant. Comparison of Barton aesthetic rating before and after surgery: for Hirmand type Ⅱ patients, preoperative rating was grade 1 in 7 cases, grade 2 in 19 cases, grade 3 in 11 cases, and postoperative improvement was grade 0 in 36 cases and grade 1 in 1 case; for Hirmand type Ⅲ patients, preoperative ratings were grade 2 in 20 cases, grade 3 in 35 cases, and postoperative improvement was grade 0 in 50 cases, grade 1 in 5 cases. Postoperative patient satisfaction survey: 85 cases (92.4%) were very satisfied, 5 cases (5.4%) were satisfied, 2 cases (2.2%) were dissatisfied. For the 2 patients who were not satisfied, one patient had no obvious improvement due to tear trough deformity, and was filled with SVF-gel for the second time 3 months later, achieving satisfactory results. One patient still had baggy eye on the outer side of the lower eyelid after surgery, which was corrected again 3 months later and achieved satisfactory results. Conclusion:For patients with lower eyelid bag with tear trough or suborbital depression without obvious skin relaxation, lower eyelid bag correction through conjunctival approach combined with SVF-gel transplantation can achieve the effect of rejuvenation of the suborbital region.
