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Bags under the eyes usually refer to the signs of sagging and edema of the lower eyelid skin, such as sagging of the lower eyelid skin, degenerative changes of the orbital septum fascia, swelling of the orbital septum fat, etc., which mostly occur in middle-aged and elderly people over 40 years old. The deformity of eyelid bag can be corrected by blepharoplasty.

First-hand preoperative preparation

Because bags under the eyes mostly appear in middle-aged and elderly patients, it is necessary to check the cardiopulmonary function before operation, and at the same time rule out hypertension and abnormal coagulation mechanism. Patients taking aspirin should stop taking aspirin two weeks before operation.

At the same time, the doctor should explain to the patient that the bags under the eyes cannot be completely removed; Surgical scar will be left in a short time after external incision, and it will become less obvious after half a year. There may be slight eversion after operation, and it takes 2 ~ 3 months to recover gradually.

Second, the operation mode

Eyebag plastic surgery is a highly technical operation in facial surgery. Generally, under local anesthesia, it is divided into two ways: internal cutting and external cutting.

Internal incision blepharoplasty

1. The biggest advantage of internal incision is that there are no surgical traces from the appearance, and the disadvantage is that it can only remove excess raised fat, but it is impossible to remove excess wrinkled skin under the eye bags. In most cases, the lower eyelid is more relaxed after operation. Suitable for young patients with good skin elasticity, but no or slight relaxation of lower eyelid skin.

2. The operation method is to make a transverse incision of about 0.2 ~ 3 mm.5 mm in the center of the lower eyelid, cut the conjunctiva and subconjunctival tissue, separate them obliquely in the direction of the lower orbital margin with a small bending scissors, and pull down the lower eyelid with a retractor, so that a thin orbital septum can be seen. When the orbital septum is opened, the fat in the center will automatically swell out from the incision. After separating the capsule, gently lift the adipose tissue and take it out after electrocoagulation to stop bleeding. The medial adipose tissue was removed from the same incision, and the lateral cellulite was not required to be removed deliberately because of its deep position.

External incision of blepharoplasty

1. The method of skin incision at the edge of the lower eyelid can not only remove excess fat, but more importantly, plastic surgery can also be performed at the same time to remove excess skin of the lower eyelid and reshape the flat appearance of the lower eyelid. The disadvantage is that for a period of time after operation, the surgical marks on the suture edge are obvious and need to be covered up.

2. Apply lidocaine to the lower eyelid for infiltration anesthesia, mark the incision line at 1 ~ 2 mm below the eyeliner of the eyelid margin, cut the skin of the lower eyelid margin, and alternately separate the orbicularis oculi muscle downward with a sharp and blunt scalpel to form a myocutaneous flap. You can see the thin orbital septum protruding from the muscle space. Open the orbital septum near the lower edge of the orbit, separate the swollen orbital septum fat, and remove the excess fat that causes the bulge after thorough hemostasis. Avoid excessive stretching of adipose tissue, so as not to cause local depression deformity after operation. Generally speaking, it is not necessary to hang the orbicularis oculi muscle outward and upward. When standing, the lower eyelid skin and orbicularis oculi muscle are obviously relaxed, and the orbital septum fat is obviously swollen. The orbicularis oculi muscle can be tightened outward and fixed on the periosteum of orbital bone.

Ask the patient to open his eyes to the top of his head, open his mouth if necessary, flatten the lower eyelid flap to cover the wound, record the excess loose skin to be removed, and remove it from the outside. Avoid cutting off too much lower eyelid skin, otherwise it will cause the lower eyelid margin to be shortened and everted, which will lead to serious consequences.

Generally speaking, the orbital septum and orbicularis oculi muscle do not need to be sutured. Trim part of orbicularis oculi muscle at the edge of myocutaneous flap to make it fit the incision, and sew the incision with 5-0 silk thread.