| Background:Blepharoplasty has become one of the most well-known plastic surgery procedures in Asia now.However,behind the surge of demand in blepharoplasty,the aesthetic and technical shortcomings among plastic surgeons can not be ignored.Under the influence of western culture,many beauty seekers blindly pursue wide and deep appearance of double eyelid,while some surgeons do not give reasonable suggestions to beauty seekers,but cater to the extreme needs of them,and even hit the slogan of"European-style eyelid" for marketing,which leads to more and more patients suffering from complex upper eyelid deformity after surgeries.The reason for the deformity is that the operator removed excessive upper eyelid soft tissues and designed a high fold during the operation,resulting in extensive high adhesion of upper eyelid tissue,which leading to the failure of the relative motion between the palpebral plate and aponeurosis of upper eyelid and the upper eyelid skin,when the patient try to opened his/her eyes.At the same time,deformities such as severe depression of upper eyelid,multiple eyelid and ptosis can also be accompanied.Although this kind of deformity is common,due to its difficulty and high risk in repairing and different patients with various upper eyelid conditions,the number of the reconstructive surgeries and the related overall studies is small.Objective:By analyzing the similarities and differences of upper eyelid anatomical structures in different patients,the appropriate reconstruction methods were studied and summarized,namely choosing which tissue would be selected to reconstruct the upper eyelid "sliding system".Finally,the repair ideas and treatment strategies of such complex deformities were summarized,based on the results of postoperative follow-up and analysis.Methods:A retrospective study was conducted on the patients who underwent reconstructive surgeries of complex upper eyelid deformity after incisional double blepharoplasty in 14 departments of Plastic Surgery Hospital,CAMS,PUMC from February 2019 to December 2020.Patients were divided into 3 groups according to the method used to reconstruct the "sliding system".The relationship between the anatomical conditions of upper eyelid and the surgical methods in the 3 groups was studied,as well as the rationality of the corresponding surgical procedures,and the strategies for the reconstructive surgery were summarized.The effectiveness of the strategy in this paper was confirmed by the satisfaction of both doctors and patients after the operation.Results:A total of 40 patients(76 deformities)were followed up for 4-28 months.No postoperative complications,such as hematoma,infection,etc.,were found in all the patients.86.8%of the surgeries were considered to have good results,and 98.7%of postoperative results were evaluated by both sides as beneficial.Conclusions:The core idea of the reconstructive surgery is to completely release the adhesions and rebuild the "sliding system" with autologous adipose tissue.In the second step of reconstruction,the preaponeurotic fat flap transfer,free fat graft and free dermal-fat flap are selected for reconstruction according to the anatomical conditions of the upper eyelid exposed after releasing the adhesion.More effective and reliable operation results can be obtained,by utilizing the strategy and reconstruction methods introduced in this paper. |
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