Method of blepharoplasty of lower eyelids
(57) Abstract:The method can be used in medicine, namely in plastic surgery. Technical goal: improve the cosmetic effect of the operation and the reduction of postoperative complications. An incision of the skin of the lower eyelid. The incision is carried out using a continuous laser power of 2.8 to 3.0 W and the diameter of the light spot of 0.2 mm, with directional cooling air. Using laser surgical apparatus "LST-20/01" with simultaneous directional cooling of the surgical field by air. Then usepreview the skin over the circular muscle of the eye. Isolated and excised using laser fat herniation. While conducting laser hemostasis. Using continuous laser radiation. Then on the circular muscle of the eye causing laser network samples in a pulse mode: the capacity of 2.3-2.5 W, the diameter of the light spot of 0.2-0.3 mm, exposure of 0.03 C. Determine the excess skin and examine them. On cutaneous wound impose one of the external surgical sutures. The method allows to reduce the invasiveness of the surgery to reduce postoperative complications and improve the cosmetic effect of the operation. 3 C.p. f-to blepharoplasty, intended for surgical removal of excess skin of the lower eyelid fat herniation or without them, with the weakening of tissue turgor lower eyelids.The weakening of tissue turgor in the lower eyelid is observed at any age. Any swelling of the tissues of the eyelids, resulting in diseases that contribute to the stretching of the skin, weakening its ties with the underlying structures and the emergence of otpisani and wrinkles. This clinical picture is progressing with advanced age-related degenerative changes in the skin of the face and the circular muscle of the eye. The excess skin of the lower eyelid and fat herniation can be eliminated, as a rule, only surgically, as conservative treatment methods are effective only up to 40-45 years.The defining stage blepharoplasty lower eyelids is the excision of excess skin, as too radical excision of tissue of the lower eyelid can lead to ectropion, to resolve which is very difficult.Known, for example, the method of blepharoplasty lower eyelids, which are as follows (M. C. Zaikova. Plastic ophthalmic surgery. M.: Medicine, 1980, S. 97).Previously, by capturing the skin with tweezers, determine the width of the flap, subject to excision. Single incision PR is m The skin flap is carefully usepreview from circular muscles at the outer corner of the eye to produce a wedge-shaped excision of the skin. The wound edges usepreview and sew the hair thin seams.The disadvantage of this method is the limitation of its use as a way of prednazanchen only to eliminate excess skin of the lower eyelid and does not provide for the strengthening of subcutaneous structures, as well as an increased risk of postoperative complications such as edema and hemorrhages.The most nearest to declare the prototype of the method is cosmetic blepharoplasty lower eyelids, which are as follows (A. N. Andreeva "Elimination of redundant skin folds and wrinkles of the upper and lower eyelids". In kN. Handbook of medical cosmetics. HP: Medicine, 1978, S. 98-99.).Pre-marker applied on the eyelids picture of the section line. The incision is performed on 1.5-2 mm below the ciliary edge along the grooves from the inner to outer corner of the eye.The incision continues angle 145-150oto the direction of one of the wrinkles. Next, prepare the chin skin ages of circular muscle, blunt scissors to the lower edge of the orbit. To stop bleeding perform hemostasis of the wound down Marley wybuchowego fat. Fat herniation grab the tweezers and cut at the base with all three pockets (nasal, median and temporal). Then debonded skin tighten, at the outer corner netscout scissors and put the first guide seam line. The excess skin excised towards the outer corner of the eye and impose nodal joints.The disadvantages of this method are:
- high invasiveness of the method associated with a large area of ofseparate skin flap, which often leads to bleeding during surgery and the postoperative complications such as edema and hemorrhage;
- inadequate cosmetic surgery because of frequent education easy folding thin skin of the eyelids in the postoperative period (secondary puckering like a free skin flap);
the inefficiency of the operations of weakness and looseness of the circular muscles of the eye.An object of the invention is to improve the cosmetic effect of the operation and the reduction of postoperative complications.This object is achieved by the proposed method lies in the following.After marking the cut line, processing operating on the external corner of the eye, reached 1.5-2 mm from the ciliary margin. The incision is carried out using a continuous laser radiation (laser beam) power (output manipulator) 2,8-3,0 W and the diameter of the light spot of 0.2 mm in a continuous mode, with directional cooling air. Using laser surgical apparatus "LSI - 20/01" (sealed waveguide CO2laser with RF excitation with a wavelength of 10.6 microns). Then blunt-pointed scissors usepreview the skin over the circular muscle of the eye and throw back the skin flap. Further isolated and excised using laser fat herniation in nasal, median and temporal areas and at the same time
- conduct laser hemostasis (coagulation) stump hernias. Using continuous laser mode: power 2,8-3,0 W, the diameter of the light spot of 0.2 mm, Then in the "box" formed after ofseparate skin flap, on the circular muscle of the eye causing laser network coagulates in a pulse mode: the capacity of 2.3-2.5 W, the diameter of the light spot of 0.2-0.3 mm, pulse duration (exposure time) of 0.03 C. During application of the laser coagulates the observed contraction of the muscle fibers and seal the muscle structure. While the coagulates are located in the circular muscle of the eye. Then the skin flap is laid in place, visually determine the excess skin is excised and their. On cutaneous wound impose one of the external surgical sutures of nonabsorbable material intradermally. A similar operation is performed on the pair lower eyelid.In Fig. 1-3 shows the main steps involved are:
Fig. 1 - paramilitary incision and separation of the skin flap;
Fig. 2 - applying coagulates on Nude circular muscle;
Fig. 3 - intradermal suture of non-absorbable material.Defining the essential distinguishing features of the proposed method in comparison with the prototype
1. Skin incision and excision of fat herniation is carried out using a continuous laser radiation, which reduces post-operative complications such as bruising and bleeding, provides simultaneous holding of data manipulation and hemostasis (coagulation), increases the cosmetic effect of the operation by eliminating ligature swelling under the skin. The parameters of laser irradiation were selected for surgical laser apparatus "LST-20/01, namely: for skin incision and excision of fat herniation (with simultaneous hemostasis) use continuous radiation power radiation with a capacity of 2.3-2.5 W with a diameter of a light spot of 0.2-0.3 mm and the exposure time of 0.03 sec. When the power values of CW laser radiation less than 2.8 W 2,3 W, respectively, the laser effect is insufficient, and at high power values than 3.0 and 2.5 W, respectively, possible thermal hyperparasitemia tissues. When the value of the diameter of a light spot smaller than 0.2 mm, there is a high energy density per unit area, and when the diameter of the light spot more than 0.3 mm and the laser will be uneven. Exposure pulse laser irradiation can vary from 0.03 to 0.06 with and depends on the state of the circular muscles of the eye, the radiation power and the diameter of the light spot.2. In Nude after ofseparate skin flap circular muscle of the eye causing network coagulates by using pulsed laser radiation, which allows you to densify, strengthen muscular structure, and increase the turgor of tissues of the lower eyelid.The invention is illustrated by the following specific examples of the operation.Example 1.Patient C., 1952 birth, was in the clinic with complaints about relaxing and hanging down of the tissues around the eyelids, reduced skin turgor, wrinkles and fat herniation lower eyelids of both eyes.From the anamnesis: the wrinkles of the skin of lowered expectations. The degree of excess skin while looking up to 2 mm, when looking straight - 3 mm Tone exterior ligaments age normal, the location of the horizontal ligaments. Lymphostasis II tbsp. Fat herniation: lateral - I senior, mid - Art. I, medial - II degree Prolapse II century at an average pressure on the eyeball. The location of the lacrimal glands are normal. Slezootvodyashih device OK.Had surgery removing excess skin folds and removal of fat herniation of the lower eyelid by the claimed method.The right lower eyelid. After processing the surgical field and local anesthesia with 2% lidocaine solution produced paramilitary skin incision with a triangular bending down in 135ofor the outer corner of the eye. The skin incision was performed using the laser in continuous mode: the power of 2.8 W, the diameter of the light spot of 0.2 mm, Then blunt-pointed scissors made the separation of the skin flap. The flap is pulled back. Has taken away millimetre (stratified) muscle over the places bulging fat herniation and gently removed them from all three pockets: nasal, median and temporal laser in continuous mode: the power of 2.8 W, a spot diameter of 0.2 mm with simultaneous hemostasis. On the circular muscle (in the "Lodge", obrazovanie: power of 2.3 W, the spot diameter of 0.3 mm, the pulse width of 0.03 sec. Skin flap was put into place, istekli excess skin and skin wound adapted intradermal suture using an atraumatic needle with nylon thread 8-0 ethilon. A similar operation was conducted on the left lower eyelid.Nearest postoperative examination through the day. Found: moderate swelling of eyelids, clean seams, edges of wounds adapted. After 5 days the stitches are removed. Cosmetic operation result is good.6 months after surgery: postoperative scars inconspicuous, skin turgor lower eyelids rose made cosmetic result was stable.Example 2.Patient K. , 1956 birth, was in the clinic with a diagnosis of blepharochalasis, fat herniation lower eyelids.From the anamnesis: wrinkles and fat herniation appeared about 5 years ago.Preoperative examination: wrinkles of the lower eyelids II-III degree. The weakness of the circular muscles of the eye. The degree of excess skin when looking straight - 4 mm. Tone outer folds of the eyelids normal; the location of the horizontal ligaments. Lymphostasis of the II degree. Fat herniation: nasal - I senior, mid - Art. II, temporal - III century the Location of the tear glands and slezootvodyashih partsboobs analogously to example 1.The right lower eyelid. After marking the outline of the section, processing operating margins and local anesthesia produced paramilitary skin incision with a triangular bending down 145o, some distance from the ciliary edge of 2 mm Incision was made using a continuous laser mode: power 3.0 W, the diameter of the light spot of 0.2 mm Skin flap was useprofile from the circular muscles of the eyes and pulled back. Identified and isikli using CW laser radiation in the same mode fat herniation: nasal 0.2 g, mid - 0.3 g, temporal - 0.2 g with simultaneous coagulation stump hernias and hemostasis. In Nude after ofseparate skin flap circular muscle caused three rows coagulates by using pulsed laser radiation mode: power of 2.5 W, the diameter of the light spot of 0.2 mm, exposure of 0.03 sec. Skin flap was put into place, istekli the excess skin, and the skin wound was adapted intradermal suture nylon thread 8-0. A similar operation was conducted on the lower left eyelid.Nearest postoperative outcome (the next day) was good: clean seams, edges of wounds adapted, edema and hemorrhages were observed.6 months after surgery when the inspection is established, the Use of the proposed method will allow for a comparison with prototype:
- to reduce the invasiveness of the surgery due to the exclusion of stages ofseparate skin to the edge of the orbit and excision of circular muscle strips;
to reduce postoperative complications such as edema and hemorrhage due to a manipulation associated with the skin incision and excision of fat herniation with a laser, which provides simultaneous hemostasis;
to improve the cosmetic effect of surgery by strengthening the subcutaneous muscle structure and increased skin turgor. 1. Method of blepharoplasty of the lower eyelid, including shaped skin incision, separation of the skin flap from the circular muscles of the eye, highlighting, and cutting fat herniation, hemostasis, excision of excess skin and adapting cutaneous wounds surgical outer seam, characterized in that the skin incision, excision fat herniation and hemostasis is performed using continuous radiation, and naked after ofseparate skin flap circular muscle cause network coagulates by using pulsed laser radiation.2. The method according to p. 1, characterized in that the exposure laser radiation is performed using a laser surgical apparatus "LST-20/01" with simultaneous directional cooling of the surgical field of vozdukhoobespecheniya 10.6 microns, with a capacity of 2.8 to 3.0 W and the diameter of the light spot of 0.2 mm4. The method according to p. 1, characterized in that the pulse laser irradiation is performed with the capacity of 2.3 - 2.5 W, the diameter of the light spot of 0.2 - 0.3 mm and the exposure time of 0.03 sec.
SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.
EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.
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