Curative Effect Evaluation And Analysis Of Tear Trough Deformity

Part 1:The surface anatomical measurements of tear trough deformityObjective:Using computer-aided photographic measurement method to measure and research the surface anatomy of tear trough deformity. In order to provide quantifiable data evaluation system on the basis of the Barton’s grading system.Methods:The candidates were selected from our department, between the ages of 20 to 30 years old, with or without tear trough deformity. There were a total of 200 cases, with 12 male and 188 female. According to the Barton’s grading system divided the candidates into four group (each group included 25 palpebral bag cases and 25 no palpebral bag cases). We used digital camera to take standard digital photos. For the qualified photos, we used Image Pro Plus 7 to analyze the linear and angle measurement index of the surface anatomy of tear trough. The data was analyzed by T-test and F-test.Results: ①The linear and angle measurement index between palpebral bag cases and no palpebral bag cases:there were no statistic differences in inner canthal distance, palpebral fissure length, lower eyelid length and inclination of palpebral fissure (P>0.05). The linear and angle measurement index between different Barton’s grades: there were no statistic differences in inner canthal distance, palpebral fissure length, lower eyelid length and inclination of palpebral fissure (p>0.05). ②The length and the height of the tear trough in Grade I were 14.74±1.73mm and 14.51±1.47mm respectively. The length and the height in Grade Ⅱ were 20.98±2.23mm and 18.38±0.85mm respectively. The length and the height in Grade III were 23.68±2.70mm and 19.18±0.87mm respectively. ③Between palpebral bag cases and no palpebral bag cases, there were statistically significant in the length of the tear trough in Grade Ⅲ (p<0.05).Conclusion:This study measured the tear trough area surface anatomy of the linear and angle measurement index, in combination with Barton’s grading system, to provide quantifiable reference data for the scheme and formulate the treatments of tear trough deformity.Part 2:The modified method for the treatment of tear trough deformity and the surface anatomical measurements in evaluation of curative effectObjective:The author performed the modified method of transconjunctival fat reposition with septal reset to correct tear trough deformity and used tear trough surface anatomical measurement indexs to evaluate the curative effect.Methods:For the patients with the tear trough deformity and without obvious laxity of the lower lid skin, the author performed the modified method of transconjunctival fat reposition with septal reset to correct tear trough deformity, and evaluated the curative effect by tear trough surface anatomical measurement indexs.Results:①Preoperative evaluation showed 34 cases included in grade Ⅰ with 30 cases (88.2%) improving grade I to grade 0, and 4 cases (11.8%) having no improvement. There were 44 cases preoperatively in grade Ⅱ, with 35 cases (79.5%) improving to grade 0,9 cases (20.5%) improving to grade Ⅰ. In preoperative grade Ⅲ cases, there were 24 cases initially, with 20 cases (83.3%) improving to grade 0,3 cases (12.5%) improving to grade Ⅰ, and 1 case (4.2%) improving to grade Ⅱ. ②Compared the postoperation with the preoperation, there were no statistic differences in the palpebral fissure length, lower eyelid length and inclination of palpebral fissure.③Compared the postoperation with the preoperation, there were statistically significant differences in the palpebral fissure length and height, lower eyelid length and height.Conclusion:The result of the method of transconjunctival fat reposition with septal reset is pleasing.Part 3:The transconjunctival Surgical Treatment of Tear Trough DeformityObjective:To used a statistical analysis to compare the results of the fat reposition technique, the septal reset technique and the modified techniques, in order to better correct tear trough deformities.Methods:From August 2010 to September 2015, a total of 136 patients, aged 20-46, underwent the orbital fat preserving and repositioning transconjunctival lower blepharoplasty in our department. Group 1 underwent intraorbital fat reposition. Group 2 underwent septal reset. Group 3 underwent fat reposition with septal reset. Postoperative effects were evaluated by Barton’s grading system, satisfaction surveys and the surface anatomical measurements of tear trough. The evaluation results were analyzed by T-test and rank-sum test.Results:①Based on the preoperative grades of postoperative scores:Compared with group 1 and group 2, there were no statistic differences in Grade Ⅰ (p>0.05), and were statistically significant in Grade Ⅱ and Grade Ⅲ (p<0.05). Compared with group 2 and group 3, there were no statistic differences in Grade Ⅰ (p>0.05), and were statistically significant in Grade Ⅱ and Grade Ⅲ (p<0.05).②Postoperative efficacy:Group 1 and group 2, group 1 and group 3 had statistically difference (p<0.05). Group 2 and group 3 had no statistical difference (p>0.05).Conclusion:For mild tear trough deformity, the therapeutic effect of three methods had no obvious difference. In patients with higher grade deformities, fat reposition with septal reset showed superior results to the others.Part 4:Curative effect analysis of injection filling treatment and surgical treatmentObjective:To use a statistical analysis to compare the results of fillers injection techniques and surgical techniques.Methods:From September 2013 to September 2015, a total of 144 patients, aged 20-45, underwent the treatments of tear trough deformity in our department. Group 1 underwent hyaluronic acid filler injection. Group 2 underwent autologous fat grafting. Group 3 underwent fat reposition with septal reset. Postoperative effects were evaluated by Barton’s grading system, satisfaction surveys. The evaluation results were analyzed by T-test and rank-sum test.Results: ①Based on the preoperative grades of postoperative scores:Compared with group 1 and group 2, follow-up visit at 6 months, there were statistically significant in Grade Ⅱ and Grade Ⅲ (<0.05). Follow-up visit at 12 months, there were statistically significant in Grade Ⅲ (<0.05). Compared with group 1 and group 3, follow-up visit at 6 months, there were no statistic differences in Grade Ⅰ and Grade Ⅱ (>0.05), and were statistically significant in Grade Ⅲ (<0.05). Follow-up visit at 12 months, there were statistically significant in Grade Ⅰ, Grade Ⅱ and Grade Ⅲ (<0.05). Compared with group 2 and group 3, follow-up visit at 6 and 12months, there were no statistic differences in Grade Ⅰ (>0.05), and were statistically significant in Grade Ⅱ and Grade Ⅲ (<0.05). ② Postoperative efficacy:Follow-up visit at 6 months, group 1, group 2 and group 3 had no statistical difference (p>0.05). Follow-up visit at 12 months, group 1 and group 2 had no statistical difference (p>0.05), group 1 and group 3, group 2 and group 3 had statistically difference (p<0.05).Conclusion:Injection filling treatment is more suitable for mild and moderate tear trough deformities. Surgical treatment has better advantage of higher grade deformities.