Abstract：
OBJECTIVE: This study characterizes the appearance changes associated with aging of the human lower eyelid, grounded in its anatomical basis. Tailored approaches to lower eyelid bag are performed by these anatomical manifestations.
METHODS: From January 2017 to January 2023, lower eyelid blepharoplasty was performed on 137 patients, aged 20 to 60 years. These patients were divided into 3 groups according to the periorbital aging appearance, primarily characterized by the presence and location of the \"bag\" bulge of the lower eyelid. We analyzed the corresponding changes in anatomical structures for each type, which included a weakened fibrous orbital support system, reduced muscle tone, and increased orbital fat. Patients were treated with tailored blepharoplasty techniques according to their classification. All patients in this study ranged in follow-up from 1 to 12 months. With patients\' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.
RESULTS: Our study identified 3 morphologies of the lower eyelid. Type 1 presents a \"bubble bag\" in the medial and inferior aspect of the lower eyelid. Type 2 features a double convexity contour, with separate fat pad herniations demarcated by fibrous connective tissue. Type 3 exhibits a single convexity with a uniform herniation of fat pads across the entire lower eyelid. We have delineated the anatomical changes associated with each morphology type. With an approach grounded in \"remodeling\" and \"recovery,\" the surgical treatment targets the fibrous support tissue to improve the outcomes of lower eyelid rejuvenation. No complications occurred. All postoperative results reached both surgeon\'s and patient\'s expectations.
CONCLUSIONS: Surgeons must recognize the pivotal role of fibrous connective tissues-including the arcuate expansion, fascia of the inferior oblique muscle, and the orbicularis retaining ligament-and endeavor to preserve or reinforce these structures during surgical procedures. An anatomically based surgical approach would more effectively and safely to resist the facial aging process.
METHODS: From January 2017 to January 2023, lower eyelid blepharoplasty was performed on 137 patients, aged 20 to 60 years. These patients were divided into 3 groups according to the periorbital aging appearance, primarily characterized by the presence and location of the \"bag\" bulge of the lower eyelid. We analyzed the corresponding changes in anatomical structures for each type, which included a weakened fibrous orbital support system, reduced muscle tone, and increased orbital fat. Patients were treated with tailored blepharoplasty techniques according to their classification. All patients in this study ranged in follow-up from 1 to 12 months. With patients\' permit, photographs and clinical information were taken to evaluate the preoperative and postoperative outcome.
RESULTS: Our study identified 3 morphologies of the lower eyelid. Type 1 presents a \"bubble bag\" in the medial and inferior aspect of the lower eyelid. Type 2 features a double convexity contour, with separate fat pad herniations demarcated by fibrous connective tissue. Type 3 exhibits a single convexity with a uniform herniation of fat pads across the entire lower eyelid. We have delineated the anatomical changes associated with each morphology type. With an approach grounded in \"remodeling\" and \"recovery,\" the surgical treatment targets the fibrous support tissue to improve the outcomes of lower eyelid rejuvenation. No complications occurred. All postoperative results reached both surgeon\'s and patient\'s expectations.
CONCLUSIONS: Surgeons must recognize the pivotal role of fibrous connective tissues-including the arcuate expansion, fascia of the inferior oblique muscle, and the orbicularis retaining ligament-and endeavor to preserve or reinforce these structures during surgical procedures. An anatomically based surgical approach would more effectively and safely to resist the facial aging process.
摘要：
目的：这项研究描述了与人类下眼睑老化相关的外观变化，扎根于其解剖学基础。通过这些解剖表现进行下眼睑袋的量身定制方法。
方法：从2017年1月至2023年1月，对137例患者进行了下眼睑眼睑成形术，20至60岁。这些患者根据眶周老化的外观分为3组，主要特征是下眼睑“袋”凸起的存在和位置。我们分析了每种类型的解剖结构的相应变化，其中包括一个弱化的纤维轨道支撑系统，肌肉张力降低，眼眶脂肪增加。根据患者的分类，采用量身定制的眼睑成形术技术进行治疗。这项研究中的所有患者的随访时间为1至12个月。有了病人的许可，照片和临床信息用于评估术前和术后结果。
结果：我们的研究确定了下眼睑的3种形态。类型1在下眼睑的内侧和下方面呈现“气泡袋”。类型2具有双凸轮廓，由纤维结缔组织划分的单独的脂肪垫突出。3型表现出单个凸面，整个下眼睑的脂肪垫均匀突出。我们已经描绘了与每种形态类型相关的解剖学变化。以“重塑”和“恢复”为基础的方法，“手术治疗的目标是纤维支持组织，以改善下眼睑恢复的结果。无并发症发生。所有术后结果均达到了外科医生和患者的期望。
结论：外科医生必须认识到纤维结缔组织的关键作用，包括弓形扩张，下斜肌筋膜，和保留韧带的口轮匝肌-并在手术过程中努力保持或加强这些结构。基于解剖学的手术方法将更有效和安全地抵抗面部老化过程。
方法：从2017年1月至2023年1月，对137例患者进行了下眼睑眼睑成形术，20至60岁。这些患者根据眶周老化的外观分为3组，主要特征是下眼睑“袋”凸起的存在和位置。我们分析了每种类型的解剖结构的相应变化，其中包括一个弱化的纤维轨道支撑系统，肌肉张力降低，眼眶脂肪增加。根据患者的分类，采用量身定制的眼睑成形术技术进行治疗。这项研究中的所有患者的随访时间为1至12个月。有了病人的许可，照片和临床信息用于评估术前和术后结果。
结果：我们的研究确定了下眼睑的3种形态。类型1在下眼睑的内侧和下方面呈现“气泡袋”。类型2具有双凸轮廓，由纤维结缔组织划分的单独的脂肪垫突出。3型表现出单个凸面，整个下眼睑的脂肪垫均匀突出。我们已经描绘了与每种形态类型相关的解剖学变化。以“重塑”和“恢复”为基础的方法，“手术治疗的目标是纤维支持组织，以改善下眼睑恢复的结果。无并发症发生。所有术后结果均达到了外科医生和患者的期望。
结论：外科医生必须认识到纤维结缔组织的关键作用，包括弓形扩张，下斜肌筋膜，和保留韧带的口轮匝肌-并在手术过程中努力保持或加强这些结构。基于解剖学的手术方法将更有效和安全地抵抗面部老化过程。
