目的 将下眼袋和鱼尾纹同时解决，改善颞部和面中部皮肤老化，不增加额外瘢痕，改变采用传统面部除皱术时所产生的头皮瘢痕、脱发、创伤较大、恢复时间长的缺点。 方法 对2010年3月－2012年12月收治的23例患者利用眼袋切口将眼轮匝肌瓣固定于眶外侧缘的骨膜上，然后再通过颞部除皱切口皮下潜行分离，导针埋线悬吊固定于颞侧颅骨骨膜上，将松垂的皮肤及筋膜上移、提紧。 结果 对23例随访6个月～2年，瘢痕不明显，无脱发等并发症均取得医患双方满意的效果。 结论 此方法简单易行，可在门诊患者局麻下进行；创伤轻，恢复较快。颞部切口减张缝合，瘢痕轻微，可预防脱发。
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.