| Background:Upper eyelid skin laxity is an external manifestation of the degenerative changes of human facial skin.Currently,the commonly used surgical methods to correct upper eyelid skin laxity in clinical practice are mainly upper eyelid or lower eyebrow incision for upper eyelid laxity correction.When the degree of upper eyelid laxity is relatively heavy,upper eyelid or lower eyebrow incision combined with double eyelid surgery is usually used to correct upper eyelid skin laxity.The author observed that both the upper brow incision and the lower brow incision could improve the morphology of the double eyelid in different degrees.We want to evaluate this part in clinical itself has heavy eyelid but caused by the upper eyelid relaxation eyelid shape when the postoperative effect of poor patients usually only with a doctor or the patient's subjective satisfaction,has long been a lack of specific data or scientific way to assess changes in the form of double eyelid surgery or sagging upper eyelid correction.Therefore,we raise the question: is the superior eyebrow incision or the inferior eyebrow incision blepharoplasty better for the improvement of double eyelid morphology? Can we objectively evaluate the immediate improvement and long-term maintenance of double eyelid morphology after upper and lower eyebrow incision blepharoplasty with specific data? Objective:By reviewing our department between January 2015 and September 2019 on the eyebrow incision or eyebrow incision under eyelid relaxation diorthosis on clinical cases and eyebrow or incision under the eyebrow combined with double eyelid surgery correcting sagging upper eyelid in clinical case,analysis on the eyebrow incision and correction eyebrow incision under the upper eyelid relaxation on the influence of heavy eyelid shape,line for clinicians brow incision for reference to correct the upper eyelid relaxation.Methods:A retrospective analysis was performed on 551 patients who underwent eyebrow incision to correct upper eyelid laxity from January 2015 to September 2019.Mild-tomoderate patients with upper eyelid relaxation application on simple eyebrow or eyebrow incision under correction,patients with severe upper eyelid relaxation on the application of eyebrow correction or incision under the eyebrow combined with double eyelid surgery,only about 30% of the patients with postoperative 6 and 12 months of follow-up,including 50 cases on the eyebrow incision orthotics,63 regular diorthosis under the eyebrow incision,23 cases on the eyebrow incision combined diorthosis double eyelid surgery,29 cases under the eyebrow incision combined diorthosis double eyelid surgery,all are performed by the same performer,all patients were followed up photos are taken by the same person and ensure the resolution and pixel.Standardized photographs of all patients were measured and calculated using FastStone Capture Version 9.0 software "the ratio of the vertical distance between the double eyelid fold line and the horizontal line in the center of the pupil to the iris radius",abbreviated as "FPc/Ir".Main way for the heavy eyelid fold line to take three points,respectively,the iris medial,central,and lateral vertical line and the double eyelid line intersection point,measuring the distance with the pupil central level,for the DM,DC,DL,the average of the distance(DM + DC + DL)/ 3 of which is the ratio of radius of the iris “I”,so it is concluded that formula "FPc/Ir = + DC + DL(DM)/ 3 I",FPc/Ir value quantifiable patients heavy eyelid line into the middle of the pupil is horizontal distance,to a certain extent reflects the width and the form of heavy eyelid.The change of FPc/Ir value in patients was compared by measuring and calculating the "ratio of the distance between the double fold line of the eyelid to the horizontal line of the central pupil and the iris radius" of the patients before,immediately after and 6 months after the operation,and then the change of FPc/Ir value was used to quantify the change of the width of the double eyelid.The data results of FPc/Ir values were compared to compare the difference of the effect of upper eyelid blepharoplasty on the morphology of double eyelid between the upper brow incision and the lower brow incision,and the difference of the effect of the upper eyelid blepharoplasty combined with the lower brow incision and the upper eyelid blepharoplasty.The obtained data were statistically analyzed using SPSS 21.0 software.Results:(1)For patients with mild to moderate upper eyelid relaxation,the average FPc/Ir of patients with supra-brow incision correction was 0.793 before surgery,1.063 immediately after surgery,and 0.903 6 months after surgery.The mean FPc/Ir of patients with subbrow incision correction was 0.821 before surgery,1.11 immediately after surgery,and 1.065 6 months after surgery.Immediately after the operation,the FPc/Ir values were all increased and were greater than "1",indicating that the morphology of the double eyelid was restored.Compared with the operation,the improved FPc/Ir values of the upper eyebrow incision and the lower eyebrow incision were 0.27 ± 0.10 and 0.29 ± 0.14,respectively.6 months postoperatively,applied the eyebrow incision orthodontic patients with upper eyelid relaxation of FPc/Ir value compared with the preoperative increase the value of 0.11 ± 0.03,sagging upper eyelid and eyebrow incision under correction value compared with the preoperative patients FPc/Ir increase the value of 0.24 ± 0.08,compared the two was statistically significant,the data show that after 6 months both width of double eyelid surgery patients are reduced,,but under the eyebrow incision for double eyelid shape maintain degree is better and change is not big.(2)For patients with severe upper eyelid relaxation,the average FPc/Ir value of patients treated with suprabrow incision combined with blepharoplasty was 0.491 before surgery,1.003 immediately after surgery,and 0.849 6 months after surgery.The average FPc/Ir was 0.459,1.055 immediately after the operation,and 0.939 6 months after the operation.Immediately after the operation,the improved FPc/Ir values of upper eyelid relaxation were 0.51 ± 0.13 and 0.6 ± 0.07,respectively.6 months postoperatively,the eyebrow incision on joint double eyelid surgery patients with correct sagging upper eyelid in FPc/Ir value compared with the preoperative increase the value of 0.36 ± 0.11,and under the eyebrow incision joint double eyelid surgery patients with correct sagging upper eyelid in FPc/Ir value compared with the preoperative increase the value of 0.48 ± 0.05,compared the two was statistically significant,indicating that after 6 months under the eyebrow incision joint heavy eyelid surgery in patients with heavy eyelid shape maintain degree is better.Conclusion:(1)For patients with mild to moderate upper eyelid slack and simple upper or lower eyebrow incision correction,both the upper and lower eyebrow incisions can improve the shape of the heavy eyelid immediately after the operation.The shape of the double eyelid of the patient is still good,and the correction of the double eyelid shape of the patient who underwent the correction of the upper eyebrow incision is lower than the immediate improvement after surgery.(2)For severe upper eyelid relaxation line eyebrow on or under the eyebrow incision combined with double eyelid surgery of the upper eyelid relaxation of patients,postoperative eyelid relaxation and reproduce on immediate can obviously improve heavy eyelid shape,after 6 months under the eyebrow incision and eyebrow incision joint correction double eyelid surgery in patients with upper eyelid relaxation compared preoperative is still very good,but the line under the eyebrow incision in patients with heavy eyelid shape maintain degree is better.(3)By quantifying the change of “the ratio of the distance between the fold line of the double eyelid to the horizontal line in the center of pupil and the iris radius”,not only the influence on the morphology of the double eyelid can be evaluated,but also the effect of the upper eyelid relaxation correction can be evaluated,which provides an effective evaluation method for clinicians to evaluate the effect of the upper eyelid relaxation. |
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