许素琪 李高峰 张杨 丁卫 张博

[摘要]目的：探讨外切口骨膜上下双层平面剥离形成腔隙，用眶脂肪填充矫治泪沟型睑袋的效果。方法：2016年1月-2018年1月治疗伴有下睑皮肤松弛的泪沟型睑袋患者63例，126眼，其中Ⅱ型泪沟85眼，Ⅲ型泪沟41眼。经皮肤入路，在眼轮匝肌深面分离至眶骨弓状缘，切开弓状缘内侧骨膜，在骨膜下剥离至中外侧时，透过骨膜，转至骨膜上剥离，形成骨膜下和骨膜上双层面腔隙。将眶脂肪下拉，内侧置于骨质上平面，外侧置于骨膜上平面。结果：术后6个月评价：Ⅲ型泪沟中6眼转变为Ⅰ型，所有Ⅱ型及其余Ⅲ型泪沟均消失，所有患者的睑袋及下睑皮肤松弛得到明显改善，未出现后期睑外翻、下睑凹陷等并发症。56例满意（满意率为88.9%），7例基本满意，无不满意者。结论：外切口骨膜上下双层平面剥离形成腔隙，用眶脂肪填充对于下睑皮肤明显松弛的泪沟型睑袋患者有良好的改善效果。

[关键词]睑袋;泪沟;下睑皮肤松弛;睑袋整复术;双层面剥离

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）04-0005-03

Application of External Incision Periosteal Double-layer Dissection in Lacrimal Groove Blepharoplasty

XU Su-qi，LI Gao-feng，ZHANG Yang，DING Wei，ZHANG Bo

（Department of Plastic and Cosmetic Surgery，Hunan Provincial Peoples Hospital，the First Affiliated Hospital of Hunan Normal University，Changsha 410005，Hunan，China）

Abstract： Objective  To investigate the application effect of orbital fat filling by external incision periosteal double-layer plane peeling in lacrimal groove blepharoplasty. Methods  63 patients， 126 eyes， which have baggy and tear trough deformity with obvious skin laxity received the lower blepharoplasty from January 2016 to January 2018. 85 and 41 eyes were of Hirmand type Ⅱ and Ⅲ respectively. Blunt dissection was performed under the orbicularis oculi muscle to expose the periosteum of the arcus marginalis through the transcutaneous approach， and the periosteum was incised medially. The periosteum was dissected medially in the subperiosteal plane to the medial， and then in the supraperiosteal plane laterally. The orbital septum fat was tiled down and fixed in the sub- and supra-periosteal planes on the medial and lateral sides respectively. Results  Postoperative evaluation at 6 months： 6 eyes of Hirmand type Ⅲ reverted to type Ⅰ. In the rest cases， the lower eyelid pouch and tear trough depression disappeared and the dermatochalasis improved significantly. No complications such as ectropion or hollowing of the lower eyelid were observed. 56 patients （88.9%） were satisfied， 7 patients were partially satisfied， and no one was dissatisfied. Conclusion  Double-layered dissection of periosteum and orbital septum fat redistribution through transcutaneous approach is suitable for patients with baggy and tear trough deformities， and obvious dermatochalasis in the lower eyelid.

Key words： baggy deformity; lacrimal groove; lower eyelid skin relaxation; blepharoplasty; double-layer dissection

瞼袋，又称下睑袋，是衰老的特征之一，睑袋常常伴有泪沟。以往经典的睑袋整复术比较注重睑袋的去除，刑新等[1]发现54岁以后，约有80%以上的个体存在泪沟问题，说明在行睑袋整复术时应注重处理泪沟。眶脂下置术[2-3]的主要意义就在于矫正睑袋的同时进行泪沟处理，是一个里程碑式的进展，在此基础上也衍生出了许多改良术式，其中关于眶脂肪填充腔隙的剥离有不同方法。2016年1月-2018年1月，通过外切口经皮肤入路采用骨膜上和骨膜下双层面剥离形成腔隙，用眶脂肪填充来治疗伴有下睑皮肤松弛的泪沟型睑袋，获得了良好的效果。……