ObjectiveTo evaluate an modified epicanthoplasty which can reduce epicanthic scar in blepharoplasty with mild to moderate epicanthus, by using upper eyelid rotation flap via blepharoplasty incision.MethodsA clinical data of 34 patients with mild and moderate epicanthus (trial group), who were treated with blepharoplasty and epicanthoplasty by using upper eyelid rotation flap, between July 2016 and October 2017, was retrospectively analyzed. And 38 patients who were treated with blepharoplasty and epicanthoplasty by using traditional " Z” plastic method were recruited as control group. There was no significant difference in age and degree of epicanthus between 2 groups (P>0.05). The lengths of palpebral fissure were measured at preoperation and at 6 days and 6 months after operation, and the length difference between pre- and post-operation was calculated to evaluate the improvement degree. The effectiveness was evaluated with reference to the scale of epicanthus orthopedics.ResultsAll incisions of 2 groups healed by first intention, and all patients were followed up 6 months. The epicanthi of 2 groups were significantly corrected. The inner canthus of trial group had no incision; and there were scars at inner canthus of control group, with obvious hyperplasia in 6 cases. The improvement degree of the length of palpebral fissure in trial group and control group were 3.63%±0.07%, 3.70%±0.05% and 4.64%±0.09%, 4.46%±0.10% at 6 days and 6 months after operation, respectively. There was no significant difference between 2 groups (t=0.005, P=0.996; t=0.287, P=0.871). The effectiveness was excellent in 20 cases, good in 12 cases, and poor in 2 cases in trial group, with an excellent and good rate of 94.12%; meanwhile, the effectiveness was excellent in 16 cases, good in 16 cases, and poor in 6 cases in control group, with an excellent and good rate of 84.21%. There was no significant difference between 2 groups (χ2=0.796, P=0.372).ConclusionThe modified epicanthoplasty by using upper eyelid rotation flap via blepharoplasty incision can significantly reduce epicanthic scar with simple operation and satisfactory effectiveness.
Objective To investigate effectiveness of transconjunctival lower eyelid blepharoplasty with “super released” orbital fat in correction of lower eyelid pouch protrusion and tear trough and palpebromalar groove depression. Methods A clinical data of 82 patients (164 sides) with lower eyelid pouch protrusion and tear trough and palpebromalar groove depression, who met the selection criteria between September 2021 and May 2022, was retrospectively analyzed. Of the included patients, 3 were males and 79 were females, with an average age of 34.5 years (range, 22-46 years). All patients had varying degrees of eyelid pouch protrusion and tear trough and palpebromalar groove depression. The deformities were graded by the Barton grading system as gradeⅠ in 64 sides, grade Ⅱ in 72 sides, and grade Ⅲ in 28 sides. The orbital fat transpositions were performed through the lower eyelid conjunctival approach. The membrane surrounding the orbital fat was completely released, allowing the orbital fat to fully herniate until the herniated orbital fat did not retract significantly in a resting and relaxed state, which is regarded as the “super released” standard. The released fat strip was spread into the anterior zygomatic space and the anterior maxillary space, and percutaneous fixed to the middle face. The suture that penetrates the skin was externally fixed by adhesive tape pasting without knotted. Results There were 3 sides with chemosis after operation, 1 side with facial skin numbness, 1 side with mild lower eyelid retraction at the early stage after operation, and 5 sides with slight pouch residue. No hematoma, infection, or diplopia occurred. All patients were followed up 4-8 months, with an average of 6.2 months. The eyelid pouch protrusion, tear trough, and palpebromalar groove depression were significantly corrected. At last follow-up, the deformity was graded by Barton grading system as grade 0 in 158 sides and grade Ⅰ in 6 sides, with a significant difference compared to the preoperative score (P<0.001). Patient’s self-evaluation satisfaction reached very satisfied in 67 cases (81.7%), satisfied in 10 cases (12.2%), generally satisfied in 4 cases (4.8%), and dissatisfied in 1 case (1.2%). Conclusion The “super released” orbital fat can effectively prevent the retraction of orbital fat, reduce the probability of residual or recurrence of eyelid pouches, and improve the correction effect.