RU2231340C2 - Method for forming the fold of the upper palpebra - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with forming the fold of the upper mongoloid palpebra. One should mark and cut skin by forming both inferior and superior skin fragments. A part of orbicular muscle of eye is dissected up to orbital fascia to dissect it, also. Excessive fat should be removed. Inferior fragment should be leveled along a cartilage. Internal dermatotarsalaponeurotic suture is applied in 3 points, moreover, by leaving about 2-3 mm from internal side from the edge of inferior fragment. The first suture is applied in the center of incision, two other - at equal distance against the central one. Moreover, puncture in of every suture into inferior fragment should be conducted intradermally, then - into palpebral cartilage, and puncture out of every suture should be performed through levator's aponeurosis. Both puncture in and puncture out should be placed along vertical line. The method enables to prevent the development of a double fold in the superior mongoloid palpebra and, also, prevent its complete disappearance and obtain the fold of desired height.

EFFECT: higher efficiency of operation.

1 cl, 3 dwg, 2 ex

Description

The invention relates to medicine, namely to aesthetic surgery, in particular to the formation of skin folds of the upper Mongoloid eyelids. There is a known method of forming the folds of the upper eyelid (a.s. 556804, 1977), by which a low supraciliary incision is made 2-3 mm above the edge of the eyelid, the skin is peeled upward 1.5-2 cm above the intended line of the future fold, excised a strip of subcutaneous formations up to the cartilage covered with aponeurosis of the upper eyelid levator, and a continuous silk suture is applied between the dermis of the exfoliated skin along the fold line and the tendon stretching of the levator along the upper edge of the cartilage. The disadvantage of this method is the presence of a continuous internal non-absorbable suture, which can subsequently provoke complications from the levator of the upper eyelid. In addition, the incision of the skin of the upper eyelid does not coincide with the line of the future fold, which is unaesthetic.

There is also known a method of aesthetic correction of the upper eyelids (patent No. 2138230, class A 61 F 9/007, 1999), according to which the curved lines of the upcoming cuts limiting the excess skin are outlined, the lower one corresponding to the border of the future skin fold, an incision is made according to the intended lines, the bulging part of the circular muscle of the eye, fatty hernias are excised, and the proximal leaf of the tarsoorbital fascia is dissected with radial incisions up to 5 mm long with the formation of trapezoidal flaps, usually up to 5-6, then an intracutaneous suture is applied to the edges of the wound. The disadvantage of this method is that the dissection of the proximal leaf of the tarsoorbital fascia with radial incisions, with the formation of trapezoidal flaps, leads to excessive trauma to the muscles of the Mueller and levator. This leads to severe scarring of the levator and possible levator dysfunction, large edema and lengthening of the patient's rehabilitation time.

The closest in technical essence to the proposed technical solution is a method of forming a fold of the skin of the upper eyelid (patent No. 2170073 class. A 61 F 9/007, 2001), according to which marking the line of the future fold, skin incision, excision of part of the circular muscle of the eye and intraorbital fatty tissue, the imposition of internal muscle and external sutures on the edges of the skin wound, while the skin flap is excised to the orbital fascia, and the internal muscle sutures are imposed with the capture of the orbital fascia and aponeurosis of the levator of the eyelid. The skin incision is carried out, retreating 7-9 mm from the ciliary edge of the upper eyelid.

The disadvantage of this method is the inability to adjust the height of the folds, at the request of the patient, as well as the possible disappearance of the folds in the future. This is explained by the fact that there are no clear boundaries for fixing the flap of the eyelid skin to the orbital fascia and levator aponeurosis and, in addition, due to the lack of firm attachment of the eyelid skin, early eruption of suture material is possible, and, as a consequence, also a decrease in the fold size or its disappearance.

The technical task of the present invention is to develop a method of forming a fold of the upper eyelid, preventing its disappearance or the formation of a double fold, and the possibility of obtaining a fold of the desired height.

The problem is solved in that in the method of forming the folds of the upper eyelid, marking and incision of the skin are carried out with the formation of lower and upper skin flaps, a section of the circular muscle of the eye is excised to the orbital fascia, dissected, removed excess fat, straightened the lower flap along the cartilage and impose an internal dermatotarsal -palpebral suture at three points, while retreating from the inside from the edge of the lower flap and sew it with a fixed immersion suture in the center of the cut and at equal distance from it ayut seams laterally and medially, wherein each weld puncture the lower flap is carried out intradermally, then - in palpebral cartilage and vykoli each seam - in the levator aponeurosis, the puncture and vykoli each seam by a vertical line. The central seam can be located both in line with other seams, and above them.

The presence of new features, in comparison with analogues and prototype, indicates that this technical solution meets the criterion of "novelty."

Due to the fixation of the lower flap by the inner side at three points to the palpebral cartilage and to the levator aponeurosis, a stable fold of the upper eyelid is formed and its disappearance in the future is prevented, and a change in the distance between the injection and puncture of the central suture allows you to get a fold of a given value.

A method for fixing eyelid skin to palpebral cartilage is known (Sauos V.T., AM.J. Ophtalm., 1954, 38.4.556-559). However, due to the fact that the upper flap of the eyelid skin is sewn to the cartilage, which subsequently undergoes a significant change (sagging) in a natural way (unlike the lower flap of the eyelid skin), the fold of the upper eyelid skin formed by this method is unstable, shifting downward, which decreases or the effect of cosmetic surgery disappears altogether, so the effect achieved in the present invention is not achieved in this case.

Based on the foregoing, it follows that the proposed technical solution meets the criterion of "inventive step".

The method is illustrated by the drawing, Fig. 1, Fig. 2 and Fig. 3, where Fig. 1 shows the points of injection and puncture, Fig. 2 shows a fixed central suture, Fig. 3 shows a lower skin flap fixed to palpebral cartilage and aponeurosis. .

The method is carried out as follows.

Palpation of the upper edge of the cartilage of the upper eyelid and in its projection on the skin with a marker draw the line of the proposed incision. If there is an excess of skin of the upper eyelid, then a curly line is planned that limits the excess of skin. The bottom line corresponds to the projection of the future fold. Under local anesthesia, with an excess of skin, an incision is made along the intended contour, the skin, an area of the circular muscle of the eye is excised. In the absence of excess skin, the skin is mobilized up and down from the incision line, a section of the circular muscle of the eye is excised to the orbital fascia. Next, the orbital fascia is dissected and excess orbital fat is removed in the medial and midline sectors. In addition, if there is an excess of eyebrow fat, it is also removed. Hemostasis is performed. They retreat 2-3 mm from the inner edge of the inferior flap, straighten it along the cartilage and put on non-removable, submersible, internal sutures 6-0 prolene at three points: in the middle and at an equal distance from it laterally and medially (all three points can be located either on one horizontal lines, or the central point may be slightly higher than the other two points), with each seam injected into the lower flap intradermally, then into the palpebral cartilage, and each suture puncture through the levator aponeurosis, while the injection and puncture of each suture Lay in a vertical line. In this case, a fold is formed immediately and the eyelashes rotate. The lower flap is pulled up when the first suture is applied, preventing the appearance of the conjunctiva of the ciliary edge. A continuous suture of prolene 6-0 is applied to the skin wound along the border of the detachment.

A similar operation is carried out in the second century.

During the operation by this method, the internal congenital epicanthus disappears or significantly decreases due to the rotation of the lower skin flap inside.

Clinical example No. 1.

Patient N., born in 1979, a Buryat nationality, was treated at the Microsurgery RC with a diagnosis of Mongoloid eyelids. Preoperative examination: the skin of the eyelids is thick, inactive. The distance from the ciliary edge to the upper edge of the palpebral cartilage is 9 mm. Pronounced congenital internal epicanthus. Fatty hernias are well visualized in a calm state, increase with pressure on the eyeball. The lacrimal and tear-producing apparatus is normal. The patient removed fatty hernias and formed palpebral folds of the claimed method. The edge of the cartilage of the right upper eyelid was palpated, in its projection a marker marked the cut line (it is also the border of the future fold). Dissected the skin to the circular muscle of the eye. Mobilized the edges of the wound, excised part of the circular muscle of the eye. Next, the orbital fascia was dissected and excess intraorbital and eyebrow fat removed. Then, at the bottom of the wound, cartilage of the upper eyelid is visible, on the surface of which there is a tendon stretch of the muscle (levator), covered with aponeurosis. Hemostasis during the operation. They retreated from the inner edge of the lower flap 2-3 mm, straightened it along the cartilage and put on non-removable, immersed, internal sutures 6-0 proline at three points on the same line: in the middle and at an equal distance from it laterally and medially, with each stitch in the lower flap was performed intradermally, then into the palpebral cartilage, departing from its upper edge 3 mm, and the puncture of each suture through the aponeurosis of the levator, while the injection and puncture of each suture were placed in a vertical line. At the same time, a fold formed immediately and the eyelashes rotated. The lower flap was pulled up when the first suture was applied, preventing the appearance of the conjunctiva of the ciliary edge. A continuous suture of proline 6-0 was applied to the skin wound along the border of the detachment.

Similarly, the operation was performed on the upper left eyelid. The postoperative period was uneventful. Skin sutures were removed on the 3rd day. Primary healing. On examination after 6 months: the folds of the upper eyelid are pronounced, symmetrical, the height of the fold corresponds to the height of fixation of the central point of the lower skin flap to the palpebral cartilage, the epicanthus has significantly decreased, the scars are located in the folds, atrophic, a double fold has not formed. The result of the operation is rated as good.

Clinical example No. 2.

Patient Sh., Born in 1961, Korean, was treated in the Microsurgery Center with a diagnosis of Mongoloid eyelids, dermatochalasis of the upper eyelids. Preoperative examination: the patient has age-related changes in the upper eyelids in the form of excess skin, folds of the upper eyelids, pronounced fatty hernias are not expressed. The distance from the ciliary edge to the upper edge of the palpebral cartilage is 9 mm. The lacrimal and tear-producing apparatus is normal. Outlined a curly line that limits the excess skin on the upper right eyelid. The bottom line corresponds to the projection of the future fold. They made an incision along the intended contour, excised the skin, a section of the circular muscle of the eye. Next, the orbital fascia was dissected and excess intraorbital and eyebrow fat removed. Then, at the bottom of the wound, cartilage of the upper eyelid is visible, on the surface of which there is a tendon stretch of the muscle (levator), covered with aponeurosis. Hemostasis during the operation. They retreated from the inner edge of the lower flap 2-3 mm, straightened it along the cartilage and put on non-removable, immersed, internal sutures 6-0 prolene at three points: in the middle and at an equal distance from it laterally and medially, while the central suture is 1 mm higher than the two extreme sutures, with each suture injected into the lower flap intradermally, then into the palpebral cartilage, deviating from its upper edge 2 mm, and each suture puncture through the levator aponeurosis, with each suture and puncture placed vertically lines. In this case, a fold was immediately formed and the eyelashes rotated, and the height of the fold was higher than that of the patient according to Example 1. The lower flap was pulled up when the first suture was applied, preventing the appearance of the conjunctiva of the ciliary edge. A continuous suture of proline 6-0 was applied to the skin wound along the border of the detachment.

Similarly, the operation was performed on the upper left eyelid. The postoperative period was uneventful. Skin sutures were removed on the 3rd day. Primary healing. On examination after 9 months: the folds of the upper eyelid are pronounced, symmetrical, the height of the fold corresponds to the height of fixation of the central point of the lower skin flap to the palpebral cartilage, there is no double fold, dermatochalasis is not determined, the scars are located in the folds, atrophic. The result of the operation is rated as good.

Claims (2)

1. The method of forming the skin folds of the upper Mongoloid eyelid, according to which the incision line is cut and the skin is cut to form the upper and lower flaps, a section of the circular muscle of the eye is excised to the orbital fascia, it is dissected, excess orbital fat is removed, and internal and outer suture, characterized in that the inner suture is performed dermatotarsally aponeurotic and imposed at three points, while retreating from the inner side from the edge of the lower skin flap, straightening they are sutured along the cartilage and sutured with a fixed immersion suture in the center of the palpebral cartilage, at an equal distance from the central suture, the sutures are laterally and medially, with each suture injected intradermally, then through the palpebral cartilage, and poked out through the levator aponeurosis, with the injection and puncture carried out in a vertical line. 2. The method according to claim 1, characterized in that the lower flap is sewn, departing from the edge from the inside by 2-3 mm.

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