RU2190376C1 - Method for applying esthetic blepharoplasty - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making intraconjunctival linear incision to access fat hernia areas. The fat hernias are selected and removed. Hemostasis is carried out and continuous suture is put in over the conjunctiva. Patient's fat tissue obtained produced after removing the fat hernias is introduced under the tissue defect in the area of lacrimal sulcus. The fat tissue is injected in portions in the top down direction between the skin and fat. After the surgical operation being over, lower eyelid skin is subjected to chemical peeling by means of 35% trichloroacetic acid solution. EFFECT: improved cosmetic effectiveness of the operation. 4 cl

Description

 The invention relates to medicine, more specifically to plastic ophthalmic surgery, in particular to aesthetic blepharoplasty.

 There are various methods of aesthetic blepharoplasty to eliminate various defects of the soft tissues of the eyelids (RF Patent N 2139022, CL A 61 F 9/007, 1999; RF Patent N 2153867, CL A 61 F 9/007, 2000). However, the known methods do not provide a complete correction of a pronounced defect of the lacrimal groove, which is a deeply sunken fold originating from the lacrimal opening and descending to the lower edge of the orbit.

 Currently, various materials are used to correct defects in soft tissues of the face, in particular tissues of the orbit, such as alloplant for facial contouring, monolithic silicone, silicone gel capsules, sponge silicone, carbon felt (RF Patent N 2054911, class A 61 F 9 / 007, 1996). Implants from these materials are inserted into specific areas of the face to compensate for the lost volume of soft tissues. The implants are fixed either in close proximity to other subdermal structures, or by sutures to adjacent strong tissues.

 Known, for example, is a method for eliminating wrinkles and wrinkles in the area of an over-nose, including subdermal administration of a biocompatible polymer material under the folds (RF Patent N 2121311, class A 61 B 17/322).

The disadvantages of this method are:
- low efficiency of the method, since the polymer material migrates into the surrounding tissue and does not provide the duration and stability of the cosmetic effect;
- postoperative complications in the form of non-specific inflammatory processes and allergic reactions.

 Closest to the claimed method, the prototype is a method for cosmetic blepharoplasty of the lower eyelids, including a figured skin incision with a capture of the muscle layer, separation of the skin-muscle flap from the circular muscle of the eye to the lower edge of the orbit, isolation and excision of fatty hernias, excision of excess skin and adaptation of the skin wound external surgical suture (RF Patent N 2139021, class A 61 F 9/007, 1999).

 The known method is highly effective in eliminating folds and sagging of the skin of the lower eyelids, but does not eliminate a pronounced defect of the lacrimal groove.

 An object of the invention is to increase the cosmetic effect of the operation and expand the functionality of the method.

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

 After processing the surgical field and marking the lacrimal groove, local anesthesia of the lower eyelid is performed. Next, an intra-conjunctival linear incision is performed with a microcauter 1.2-1.5 cm long and provides access to fat hernias. Fatty hernias are then isolated and dissected in the nasal, median and temporal zones. Spend hemostasis. Impose a continuous suture on the conjunctiva biosorb 10-0. Further, under the tissue defect in the region of the lacrimal groove, the patient’s adipose tissue obtained after removal of fatty hernias is injected. For this, a special curved needle containing the patient’s adipose tissue is injected into the base of the groove and the latter is subdermally performed before the furrow begins. In this case, the skin exfoliates from subcutaneous fatty tissue, the fibrous bridge connecting the skin to the muscle is cut off, and the subcutaneous cavity forms under the lacrimal groove defect. Then, the needle is gradually removed from the formed cavity while the patient is filled with the last adipose tissue using a rod having a smaller diameter than the diameter of the needle made of a polymer material and located inside the needle. Adipose tissue is introduced portionwise from top to bottom between the skin and fiber, followed by palpation of the implant until it takes its final shape. A similar operation is performed on the paired lower eyelid.

 At the end of the operation, the skin of the lower eyelids is peeled, for which they are pre-wiped with acetone and then twice treated with a 35% solution of trichloroacetic acid. The acid solution is applied using a brush without any pressure and left to contact the skin for 2-3 hours, after which the skin of the eyelids is treated with petroleum jelly.

The defining differences of the proposed method in comparison with the prototype are the following:
- provide intra-conjunctival access to fatty hernias, which can dramatically reduce the invasiveness of the operation and increase the cosmetic effect due to the absence of external scars;
- in addition to blepharoplasty, lipocorrection of the lacrimal groove defect is made by injecting under the patient’s last adipose tissue obtained after excision of fatty hernias of the eyelids, while the introduction is carried out subdermally to the level of stationary adipose tissue in the direction from top to bottom and portionwise, which allows to expand the functionality of the method and increase cosmetic effect of the operation;
- additionally, the skin of the lower eyelids is subjected to peeling, which allows to increase the cosmetic effect of the operation; peeling is carried out mainly with a 35% TCA solution for 2-3 hours, with the decay of horn particles on the surface mature stratum corneum, which reduces its thickness, blocks hyperkeratos and limits the development of various types of dermatoses.

 The removed adipose tissue (fatty hernia of the eyelids) is the optimal material for implantation in order to eliminate the lacrimal groove defect, since it does not cause allergic complications, maintains the necessary shape and makes up for the deficit of adipose tissue under the lacrimal groove.

 Aesthetic blepharoplasty, including the removal of fatty hernias, lipocorrection of a pronounced defect of the lacrimal groove and peeling of the skin of the lower eyelids, allows to obtain a qualitatively new, synergistic effect of facial rejuvenation due to the fact that blepharoplasty eliminates sagging of the eyelid skin and ensures the straightening of small wrinkles and skin folds, subdermal intrinsic biofeedback the patient’s adipose tissue under the tear groove defect provides volumetric filling and straightening of the deep cavity under the furrow, which fails straighten using blepharoplasty, and peeling eliminates roughness of the skin, peeling, age spots. Thus, blepharoplasty of the eyelids, subdermal injection of adipose tissue under the defect of the lacrimal groove and subsequent peeling of the skin of the lower eyelids are mutually complementary and reinforce each other, providing the maximum cosmetic effect.

 Search and analysis of sources of known scientific, technical and patent information showed that the claimed technical solution meets the criteria of the invention of "novelty and inventive step", since a similar method that matches the distinguishing features of the proposed method was not found.

 The invention is illustrated by the following example of a clinical embodiment of the method.

 Example.

 Patient A., born in 1948, was in the clinic with a diagnosis of fatty hernias, sagging skin of the lower eyelids, soft tissue defect of the lacrimal groove.

 From the anamnesis: sagging of the skin of the eyelids of both eyes and a defect of the lacrimal groove appeared about 7 years ago.

 Preoperative examination: wrinkles of the 1st century, the skin of the eyelids is thin, mobile. The tone of the external ligaments of the eyelids is normal, the location of the ligaments is horizontal. Lymphostasis II Art. Fatty hernias: nasal - 1st century, median - 1st century, temporal - 2nd century Prolapse II Art. with an average pressure on the eyeball. Soft tissue defect of the lacrimal groove.

 We performed the operation to remove fatty hernias and lipocorrection of the lacrimal groove defect by the claimed method.

 Right lower eyelid. After treating the surgical field and anesthesia with injections of 2% ultracaine solution in the lower conjunctival fornix and in the area of fat hernias, retreating 7 mm from the edge of the eyelid, we made a linear incision of the conjunctiva 1.5 cm long using a microcautery. Next, submucous tissue was cut at the level of the conjunctival incision and fatty bags (hernias) from the muscle bed were bluntly separated with scissors. Fatty hernias from three pockets were removed: nasal, median and temporal. To stop bleeding, hemostasis was performed by laying a hemostatic sponge in the lower arch of the conjunctiva. A continuous suture of 10-0 was applied to the conjunctiva. A similar operation was performed on the lower left eyelid.

 The second stage carried out lipocorrection of the lacrimal groove defect on the right lower eyelid, for which purpose a special curved needle was injected into the groove base with a special curved needle 1 mm in diameter and 5 cm long, with a smaller stem inserted inside and stuffed with fatty tissue of the patient. Subdermal injection of the needle was carried out at the level of stationary adipose tissue before the onset of the furrow 7 mm from the lacrimal opening. Then the needle was moved in the opposite direction (from top to bottom), portionwise squeezing the patient's adipose tissue from the needle. A similar operation was performed on the lower left eyelid.

 In the third stage, the skin of the lower eyelids was treated with acetone, and then twice with a 35% TCA solution and left to contact the skin for 2 hours, followed by lubrication of the skin with petroleum jelly.

 The nearest postoperative examination in a day. Found: moderate swelling and redness of the eyelids. After a month: the cosmetic result of the operation is good, the defect of the lacrimal groove is eliminated.

 6 months after surgery: the sagging skin of the lower eyelids was eliminated, the achieved cosmetic result was high and stable.

 The inventive method in a clinical setting operated on 17 patients, in all cases a high and stable cosmetic result was obtained.

Using the proposed method will allow, in comparison with the prototype:
- to increase the cosmetic effect of the operation due to the simultaneous correction of pronounced sagging skin due to the swelling of fatty hernias of the lower eyelids and the elimination of the defect of the lacrimal groove, not amenable to straightening in a known manner;
- to expand the functionality of the method due to additional lipocorrection of the defect of the lacrimal groove of the patient's own biocompatible adipose tissue and chemical peeling of the skin of the lower eyelids;
- reduce the invasiveness of the operation due to intra-conjunctival access to fatty hernias and the absence of external skin incisions during lipocorrection of the lacrimal groove;
- to ensure the duration and stability of the cosmetic effect.

Claims (4)

 1. The method of aesthetic blepharoplasty, including access and excision of fatty hernias, characterized in that the dissection of fatty hernias is carried out through the intrajunctival access, lipocorrection of the lacrimal groove is additionally carried out, for which, using a curved needle, the skin is separated from the subcutaneous fat under the lacrimal groove, and the formed cavity is filled with the obtained adipose tissue of the patient, followed by chemical peeling of the eyelid skin.  2. The method according to claim 1, characterized in that the filling of the cavity under the lacrimal groove is carried out injection from top to bottom as the needle moves back from the subdermal space.  3. The method according to claim 1, characterized in that they use a curved needle with a diameter of 0.8-1.0 mm, filled with adipose tissue of the patient, and with a smaller diameter rod inserted into it made of polymer material.  4. The method according to claim 1, characterized in that the peeling is carried out using a 35% solution of trichloroacetic acid for 2-3 hours