Four-layer reposition combined with periorbital fixed-point suspension to reconstruct the aesthetic structure of lower eyelid subunits
10.3760/cma.j.cn114453-20221021-00331
- VernacularTitle:四层次重置联合眶周定点悬吊重建下睑亚单位美学结构
- Author:
Zhongfeng ZHANG
1
;
Meiping YU
;
Lili CAO
;
Jianyong SU
Author Information
1. 浙江省荣军医院美容整形外科，嘉兴 314000
- Keywords:
Eyelids;
Lower eyelid subunit;
Orbital septum flap;
Orbital septum fat flap;
Musculocutaneous flap;
Skin flap;
Fixed-point suspension
- From:
Chinese Journal of Plastic Surgery
2023;39(8):879-887
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbitum septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue, to reconstruct the aesthetic structure of lower eyelid subunits.Methods:The clinical data of patients admitted to the Department of Beauty and Plastic Surgery of Zhejiang Rongjun Hospital for midface rejuvenation via lower eyelid margin approach surgery from June 2019 to August 2021 were retrospectively analyzed. The layer above the orbital septal, maxillary space, and zygomatic space were dissected to form a musculocutaneous flap. The septal fat flap was released and fixed, then the orbital septum flap was dissected and to make a net-like fixation in horizontal and vertical arrangement around the orbit. The mid and lateral suspension points and suspension tissues were determined and marked by pushing up the facial soft tissues in the sitting position, followed by fixation. Then, the abondant part of the musculocutaneous flap and the lower eyelid margin skin were trimmed to form a flap. Post-operative follow-up was performed by patient self-assessment (very satisfied, satisfied, dissatisfied, very dissatisfied). One attending plastic surgeon who was not involved in the surgery evaluated the results of the reconstruction of the aesthetic structures of the lower lid subunits, including laughing hill, lower eyelid fold, inferior sulcus of the lower tarsal plate, and eyelid-cheek junction based on global aesthetic improvement scale (IGAIS) (-1 to 3, the higher the score the more significant the improvement).Results:A total of 96 patients were included, including 7 males and 89 females, aged 38-83 years, with an average age of 53 years. In all patients, the swelling subsided 1 week after surgery, with no complication such as hematoma, lower eyelid retraction, blepharon separation, lower eyelid ectropion, etc. There was no malar lateral soft tissue accumulation and suspension point sunken deformity. 6-12 months postoperative follow-up showed that all patients had expected benefit outcomes in the reconstruction of laughing hill, lower eyelid fold, and inferior sulcus of lower tarsal plate. Yet, fat bulgings at the eyelid-cheek junction were moderately visible in 2 cases, and it is slightly visible in 3 cases. The rest of the patients had good curvilinear continuity in the eyelid-cheek junction area. Patient self-assessment showed that 76 were very satisfied, 16 were satisfied, and 4 were dissatisfied. IGAIS score showed 96 patients scored 2.43±0.35, with 76 scored 3, 16 scored 2 and 4 scored 1.Conclusion:Four-layer reposition of skin flap, musculocutaneous flap, orbital septum flap, and orbital septum fat flap via lower eyelid margin approach, combined with periorbital fixed-point suspension of the midfacial soft tissue can effectively reconstruct the aesthetic structure of the lower eyelid subunits, including the laughing hill, lower eyelid fold, inferior sulcus of inferior tarsal plate and eyelid-cheek junction.
