RU2139021C1 - Method of cosmetic blepharoplasty of lower eyelids - Google Patents

Abstract

FIELD: plastic ophthalmology. SUBSTANCE: method includes bow-shaped incision of cutaneous-muscular layer at a distance of 1.5-2 mm from external angle of eye; obtuse separation through this access of cutaneous-muscular layer; horizontal sublash incision from top point of inclined incision in direction to internal angle of eye, along eyelid; separation and dissection of fatty hernias; dissection of skin excess in form of strip along sublash edge of cutaneous-muscular flap and in form of triangle at external angle of eye. EFFECT: higher cosmetic effect of operation. 3 cl, 4 dwg

Description

 The invention relates to medicine, more specifically to plastic ophthalmic surgery, in particular to cosmetic blepharoplasty and is intended for the surgical removal of excess skin folds and wrinkles of the lower eyelids with or without fatty hernias.

 Changes in tissues in the eyelids are often not an age-related pathology, as they occur at any age. Any edema of the eyelid tissues that occurs with diseases helps to stretch the skin, weaken its bonds with the underlying structures and the appearance of sagging and wrinkles. This clinical picture progresses with the development of age-related degenerative changes in the skin of the face itself. The direction of the wrinkles is almost always parallel to the direction of the fibers of the circular muscle of the eye. Wrinkles and skin folds of the eyelids, as well as fatty hernias, can usually be removed only by surgery, since conservative methods of treatment are effective only up to 40 - 45 years.

 The decisive stage in blepharoplasty of the lower eyelids is excision of the excess skin, since too radical excision of the tissues of the lower eyelids can lead to an inversion of the eyelid, which is very difficult to eliminate.

 Known, for example, the method of cosmetic blepharoplasty of the lower eyelids, which consists in the following. (M.V. Zaykova. Plastic ophthalmosurgery. M: Medicine, 1980, p. 97).

 Previously, by capturing the skin with tweezers, determine the width of the flap to be excised. One incision is carried out retreating from the ciliary edge by 1.5 - 2 mm, the other - in an arcuate shape - departing from the original by 4 - 7 mm. The skin flap is carefully separated from the circular muscle, at the outer corner of the eye produce a wedge-shaped excision of the skin. The edges of the wound are separated and sutured with thin hair sutures.

 The disadvantage of this method is its limited use only to eliminate wrinkles, as well as an increased risk of postoperative complications in the form of compartments and hemorrhages. To remove fatty hernias, this method is not suitable.

 The closest to the claimed method of the prototype, is a method of cosmetic blepharoplasty of the lower eyelids, which is as follows (D. Andreeva. Elimination of excess skin folds and wrinkles of the upper and lower eyelids. In the book. Handbook of medical cosmetics. L .: Medicine, 1978 , pp. 98 - 99).

 Previously, a marker is applied to the eyelids drawing a cut line. The incision is carried out 1.5 - 2 mm below the ciliary edge along the furrow from the inner to the outer corner of the galase.

Then the incision is continued at an angle of 145 - 150 ^o to the direction of one of the wrinkles. Next, the skin of the eyelid of the circular muscle is exfoliated with blunt scissors to the lower edge of the orbit. To stop bleeding, hemostasis is performed by crushing the wound with gauze rollers. To remove fatty hernias, a strip of circular muscle is excised and its fibers are disconnected above the places of the swelling fat. Fatty hernias are taken with tweezers and cut at the base from all three pockets (nasal, median and temporal). After this, the exfoliated skin is tightened, the outer guide corner is incised and the first guide suture is applied with fishing line. Excess skin is excised towards the outer corner of the eye and impose nodal sutures.

The disadvantages of this method are:
- high invasiveness of the method, since only a skin flap is detached (without an adjacent muscle), which leads to bleeding during surgery and postoperative complications in the form of edema and hemorrhage;
- insufficient cosmetic effect of the operation due to the frequent formation of easy folding of thin skin of the eyelids in the postoperative period (secondary wrinkling like a free skin flap).

 An object of the invention is the creation of a less traumatic method of cosmetic blepharoplasty of the lower eyelids, providing the maximum cosmetic effect.

 The technical task is achieved by the proposed method, which consists in the following.

 After processing the surgical field and local anesthesia, an oblique arcuate skin incision is made with the capture of the muscle layer of the lower one in the direction of one of the wrinkles 12 - 20 mm long. Through the incision obtained with blunt scissors, the musculoskeletal layer is separated to the lower edge of the orbit. Then, starting from the inclined incision, a horizontal incision is made of the musculoskeletal layer, retreating 1.5 - 2 mm from the eyelash growth line, along in its lower eyelid towards the inner corner of the eye to the projection level of the lacrimal opening. Next, a strip of circular muscle is excised, fatty hernias in the nasal, median and temporal zones are isolated and excised. Spend hemostasis. Then a strip of excess skin is excised along the upper edge of the musculoskeletal flap towards the inner corner of the eye and at the outer corner of the eye in the form of a triangle. Repeated hemostasis is performed. The wound of the musculoskeletal layer is adapted with an 8 - 0 silk-wrap seam. A similar operation is performed on the paired lower eyelid.

 In FIG. 1 - 4 depict the main stages of the operation.

FIG. 1 - oblique arcuate incision and separation of the skin-muscle layer;
FIG. 2 - horizontal section of the musculoskeletal layer;
FIG. 3 - excision of excess skin along the upper edge of the musculoskeletal layer in the form of a triangle - at the outer corner of the eye;
FIG. 4 - draped seam with silk 8 - 0.

The determining essential distinguishing features of the proposed method in comparison with the prototype are:
- Blepharoplasty begins with an inclined skin incision with the capture of part of the underlying muscle layer in the direction of one of the wrinkles, which allows optimal access for blunt separation of the musculoskeletal layer.

 - After separation of the skin-muscle layer, through an oblique incision, a horizontal section of the skin-muscle layer is carried out along the ciliary edge towards the inner corner of the eye, which ensures better exit to the capsules of fatty hernias, eliminates trauma and stretching of the skin, and also reduces postoperative complications in the form of edema and hemorrhage, accelerate tissue healing.

 In the prototype, first, a horizontal skin incision is made parallel to the ciliary edge from the inner to the outer corner of the eye, and then blunt skin is separated from the underlying circular muscle from the underlying circular muscle.

 - The excess skin is excised in the form of a strip along the upper edge of the musculoskeletal layer and in the form of a triangle at the outer corner of the eye, which allows to increase the cosmetic effect of the operation due to more accurate correction of the uniform distribution of the skin along the ciliary edge and at the outer corner of the eye.

 The invention is illustrated by the following specific examples of the operation.

Example 1
Patient K., born in 1954, was in the clinic with a diagnosis of wrinkles and fatty hernias of the lower eyelids of both eyes.

 From the anamnesis: overhanging of the skin of the eyelids of both eyes appeared about 10 years ago.

 Preoperative examination: wrinkles of the II-III century, the skin of the eyelids is thin, mobile. The degree of excess skin when looking up is 2 mm, when looking directly - 3 mm. The tone of the external ligaments of the eyelids is nominal, the location of the lubricants is horizontal. Lymphostasis II Art. Fatty hernias: lateral - I st., Median - I st., Medial - II st. Prolapse II Art. with an average pressure on the eyeball. The location of the lacrimal glands is normal. The lacrimal opening device is normal.

 We performed the operation to eliminate excess skin folds and remove fatty hernias of the lower eyelids of the claimed method.

 Right lower eyelid. After treating the surgical field and local anesthesia with a 2% lidocaine solution, an oblique arcuate cut of the musculoskeletal layer 12 mm high was made towards one of the wrinkles. Through the resulting incision with blunt-pointed scissors, the skin-muscle layer was separated to the lower edge of the orbit. Next, the excess skin to be excised was determined. For this, with open eyes and looking up, the patients neatly straightened the musculocutaneous flap. The excess skin in this case will be that part of it that is located above the line of the skin subcutaneous incision. The musculoskeletal flap was folded back, a strip of the circular muscle of the eye was excised, the muscle exfoliated above the bulging sites of the fat hernias, and they were carefully removed from all three pockets: nasal, median, and temporal. To stop bleeding, hemostasis was performed by laying gauze swabs under the musculoskeletal flap and pressing them on top with a finger. Then, a strip of skin 1 mm wide along the upper edge of the wound and a skin triangle with a base of 1 mm and a width of 2 mm at the outer corner of the eye were excised. Repeated hemostasis. 3 interrupted sutures were applied to the skin wound and a continuous 8–0 silk stitching seam. A similar operation was performed on the lower left eyelid.

 The nearest postoperative examination in a day. Found: moderate swelling of the eyelids, the sutures are clean, the edges of the wounds adapted. After 5 days, the stitches were removed. The cosmetic result of the operation is good.

 6 months after surgery: postoperative scars are not visible, the achieved cosmetic result was stable.

Example 2
Patient T., born in 1956, was in the clinic with a diagnosis of wrinkles and fatty hernias of the lower eyelids.

 From the anamnesis: wrinkles and fatty hernias appeared about 5 years ago.

 Preoperative examination: wrinkles of the lower eyelids II-III degree. The skin of the eyelids is thin, mobile. The degree of excess skin when viewed directly is 1 mm. The tone of the external folds is normal; the arrangement of the ligaments is horizontal. Lymphostasis II degree. Fatty hernias: nasal - 1st century, median - 2nd century, temporal - 3rd century The location of the lacrimal glands and the lacrimal opening apparatus are normal.

 Spent the operation to eliminate excess skin and remove fatty hernias of the lower eyelids by the claimed method similar to example 1.

 Right lower eyelid. After processing the surgical field and local anesthesia, an oblique arcuate incision was made in the skin-muscle layer in the direction of one of the wrinkles 20 mm high. Through the incision, a blunt separation of the skin-muscle layer was carried out to the lower edge of the orbit. Then, a horizontal skin incision was made along the ciliary edge towards the inner corner of the eye. The musculocutaneous flap was thrown back and a strip of circular muscle was excised. Circular hernias were isolated and excised: nasal - 0.2 g., Median - 0.3 g., Temporal - 0.2 g. A strip of excess musculocutaneous flap was cut out with a width of 1.5 mm along the upper edge of the wound and a skin triangle with a base of 2 mm and a height of 3 mm at the outer corner of the eye. Held hemostasis. 3 fillet sutures were applied to the skin wound and a continuous 8 - 0 silk suture was sewn, a similar operation was performed on the lower left eyelid.

 The immediate postoperative result (in a day) was good: the sutures are clean, the edges of the wounds are adapted.

 6 months after the operation during the examination, it was found that there are no wrinkles of the skin on the lower eyelids, the sub-suture is not noticeable.

Using the proposed method will allow, in comparison with the prototype:
- reduce the invasiveness of the operation:
- reduce postoperative complications in the form of edema and hemorrhages;
- increase the cosmetic effect of the operation due to a more accurate comparison of the edges of the musculocutaneous flap and the exclusion of tension and wrinkling of the skin.

Claims (3)

 1. The method of cosmetic blepharoplasty of the lower eyelids, including a horizontal skin incision along the ciliary edge and inclined to the horizontal axial line of the eye in the direction of one of the wrinkles, blunt skin separation to the lower edge of the orbit, excision of the circular muscle, isolation and excision of fatty hernias in the nasal, median and temporal zones, excision of the excess skin of the upper edge of the skin flap and the application of the external suture, characterized in that first carry out an inclined arcuate skin incision with the capture of the muscle layer, then separating the skin-muscle layer followed by a horizontal cut of the skin along the ciliary edge towards the inner corner of the eye, then excess skin is excised in the form of a strip along the upper edge of the muscular-skin flap and in the form of a triangle at the outer corner of the eye.  2. The method according to claim 1, characterized in that the inclined incision of the musculoskeletal layer is carried out, retreating 1.5-2.0 mm from the outer corner of the eye with a length of 12-20 mm.  3. The method according to claim 1, characterized in that the horizontal incision along the ciliary edge and excision of the excess musculocutaneous flap is carried out towards the inner corner of the eye.

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