Evidence-Based Medicine: A Graded Approach to Lower Lid Blepharoplasty

被引:41
|
作者
Hashem, Ahmed M.
Couto, Rafael A.
Waltzman, Joshua T.
Drake, Richard L.
Zins, James E. [1 ]
机构
[1] Cleveland Clin, Dept Plast Surg, 9500 Euclid Ave,Suite A 60, Cleveland, OH 44195 USA
关键词
TRADITIONAL LOWER BLEPHAROPLASTY; ORBICULARIS RETAINING LIGAMENT; LOWER EYELID MALPOSITION; LATERAL CANTHAL TENDON; TEAR TROUGH DEFORMITY; SURGICAL ANATOMY; CLINICAL-APPLICATION; ADDITIONAL SUPPORT; FRESH CADAVERS; NERVE BRANCHES;
D O I
10.1097/PRS.0000000000002849
中图分类号
R61 [外科手术学];
学科分类号
摘要
Modern lower lid blepharoplasty requires a thorough understanding of periorbital anatomy, age-related changes of the lid-cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion. The patient with isolated lower lid bags may be treated by transconjunctival fat resection alone. Additional mild skin laxity can be improved with skin pinch or skin-only undermining. Skin resurfacing using chemical peeling or laser can further address fine lines. In these patients with an abnormality of the lid-cheek junction, release of the medial orbicularis oculi muscle and variable amounts of the orbicularis retaining ligament is essential. This is combined with orbital fat resection or repositioning through a transconjunctival or transcutaneous skin-muscle flap. The transcutaneous approach most often necessitates lateral canthal tightening to optimize lid margin control. Generally, the degree of laxity dictates whether a canthopexy or a canthoplasty is most appropriate. Lateral canthal procedures can be applied to patients displaying clinical signs predictive of lid malposition and to those presenting with varying degrees of established lid descent.
引用
收藏
页码:139E / 150E
页数:12
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