服務項目 》Baggy Eyelid
Aging sign usually begins around eyes. Patients presented with lateral hooding on upper eyelid or baggy eyelid on lower eyelid visit plastic clinics for correction. Upper blepharoplasty to correct aging signs on upper eyelids is introduced in another section.
In this section, method to correct lower eyelid ( lower blepharoplasty) is presented.
Before presenting lower blepharoplasty, baggy eyelid should be differentiated with smile roll. Smile roll is a bulge just below eyelashes. It is accentuated when smiling. It is caused by muscle contraction and is a sign of young. Smile roll do not have to be treated. On the contrary, smile roll should be augmented in some aged patients.
Baggy eyelid is caused by fat protrusion. Baggy eyelid is usually associated with a depression below. The depression is named as "tear trough" or "nasojugal fold".
There are two ways of treating fat in baggy eyelid; one is fat excision, the other is fat transposition. The latter is quite suitable for baggy eyelid patients with tear trough. There are two ways of making incision; one is external incision ( skin incision, below left picture) , the other is internal incision ( transconjunctival incision, below right ). The latter is quite suitable for younger patients with baggy eyelid, because there is no redundant lower eyelid skin to be excised.
There is four methods of combination for baggy eyelid surgery. (1) external incision with fat excision. (2) external incision with fat transposition. (3) transconjunctival incision with fat excision. (4) transconjunctival incision with fat transposition.
Below left showed a case after fat excision through external incision.
Fat transposition:
The drawback of excision of orbital fat to treat baggy eyelid is that the procedure does not treat tear trough. So that baggy eyelid is corrected partially. The concept of fat transposition is that orbital fat (the cause of baggy eyelid) is preserved and pulled down to fill the depression (tear trough). So that the procedure corrects the bulge (baggy eyelid) and depression (tear trough) . The postoperative curve between lower eyelid and cheek is smooth. Below show the procedure of fat transposition.
Below picture shows the comparison between young eyelid, baggy eyelid and the appearance of excessive fat removal. To rejuvenate lower eyelid, fat is removed only when fat is really excessive. Otherwise, eyelid fat should be preserved and used to fill up the tear trough.
One of the benefit of fat transposition is that smile roll will be accentuated after surgery because fat is pulled down. Eyelid with smile roll looks younger that eyelid without smile roll. Below right is picture after surgery. Arrow pointed to smile roll.
Below case showed the result after fat excision lower blepharoplasty performed by another surgeon. Baggy eyelid was not corrected because tear trough was not treated.
Below show two cases of fat transposition lower blepharoplasty by external skin incision.
Below show the before (left) and after (right) pictures of three cases underwent fat transposition lower blepharoplasty. For younger cases, transconjunctival incision would not leave scar. Recovery is quicker than skin incision.
上方圖例：左圖是手術前，右圖是手術後。
本診所改良脂肪固定方式，手術後外表看不到縫縫，瘀青腫脹少，恢復快。
我們稱之為「無縫線眼袋內開脂肪移位術』。
如下圖。
另一個例子。
其他眼內開案例介紹
Treatment of tear trough:
It is recommented to treat baggy eyelid and tear trough by fat transposition. For cases presented with obvious tear trough, but no baggy eyelid, filler or fat injection into tear trough is recommended.
Below showed before (left) and after (right) pictures of a case underwent hyaluronic acid injetion into tear trough.
Hyaluronic acid injection filled up the depression on tear trough. But it should be emphasized that bulge of baggy eyelid existed after filler injection.
Below showed the case after hyaluronic acid injection. Marked area is baggy eyelid.
For case with baggy eyelid and midcheek groove, baggy eyelid treatment following by fillers (such as hyaluroinic acid or fat injection) into midcheek groove is the best way to rejuvenate eyelid and cheek. Below left is before picture. Follwowing by picture after baggy eyelid surgery (fat transposition, internal incision). Marking on third picture is the location of midcheek groove. Last picture is the result after fat injection. Cheek is fuller than before.
From the left picture to the right one: Before -> After baggy eyelid surgery -> Location of fat injection -> After fat injection
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病人同時有上眼皮下垂及眼袋問題時，同時手術上眼皮及眼袋，可以在一次的恢復時間，得到最好的術後效果。
♦上圖病例：有上眼皮下垂及眼袋問題，做完上下眼皮整形後（右圖是術後八個月的照片），人看起來最少年輕十歲。
♦上圖病例：有上眼皮下垂及嚴重的眼袋問題，做完上下眼皮整形後（右圖是術後二年的照片），人變漂亮年輕。
♦上圖病例：有上眼皮凹陷及眼袋問題，做完上眼皮補脂，拿掉下垂上眼皮及眼袋手術後（右圖是半年後照片），得到病人滿意結果。
♦上圖病例：有嚴重眼袋及凸眼及上眼皮有多重眼皮等問題，做完眼袋手術及上眼皮補脂後，眼袋及凸眼問題得到明顯改善。右圖為術後八個月的照片。
♦上圖病例：上眼皮較泡，同時有眼袋問題，做完上眼皮整形（抽脂及拿掉下垂上眼皮）及眼袋手術後（右圖為術後二年半的照片），病人非常滿意術後結果。
♦上圖病例：較年輕（23歲）但上眼皮較泡同時有眼袋問題，做完割雙眼皮手術（含上眼皮抽脂）及眼袋手術（右圖為術後四個月的照片），術後眼睛變得有精神。 -
下眼凹陷有些是先天的，在外表看起來會有淚溝得深而且長，但眼袋不太。
這看狀況的處理最好是用玻尿酸或是用自體脂肪。下圖顯示的是凹陷的範圍。
下面是用玻尿酸施打在下眼凹陷的案例。
很多人打在眼周的玻尿酸可以留存數年以上，所以眼周玻尿酸可以說是簡單又經濟。
某些人的下眼凹陷是因為眼袋手術是脂肪拿太多所造成。
如下例，處理的方式也是用玻尿酸填補。下例是用玻尿酸填補。
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1. 藥物：口服藥：傷口痛才需要吃止痛藥，一次一粒。間隔時間4-6小時一粒。眼藥水：消炎用。術後一天最多可以滴四次，眼藥水使用不可超過一週。如果使用中眼睛有紅腫不適時，請停止使用眼藥水並與醫師聯絡。2. 術後一週內洗臉請輕輕擦拭，由內下往外上。
3. 手術後可以多冰敷減少眼皮水腫及傷口疼痛，72小時之後，改用溫敷改善瘀青現象。
＊冰熱敷時間以敷三十分鐘，休息三十分鐘為原則。
4. 眼皮周圍多少會有瘀青現象，一至兩週會慢慢退去。
5. 依預約時間回診。 -
1. 藥物：傷口痛才需要吃止痛藥，一次一粒。間隔時間4-6小時一粒。
藥膏：早晚兩次塗抹於傷口。
2. 術後一週內傷口勿碰水，保持乾燥。
3. 手術後可以多冰敷來減少眼皮水腫及傷口疼痛，72小時之後，改用溫敷改善瘀青現象。
＊冰熱敷時間以敷三十分鐘，休息三十分鐘為原則。
4. 有拉眼皮的病人術後洗臉頰，須由內下方往外向上方洗。
5. 眼皮周圍多少會有瘀青現象，一至兩週會慢慢退去。
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Q：1.下眼皮外開手術時,是否可順道拉起下垂皮膚？
2.手術後一星期傷口復原照片如何？
3.多久後開刀之傷口疤痕完全復原？
A：1.眼袋手術如果是採外開方式，除了處理脂肪外，可以將下眼皮鬆弛的皮膚一併拿掉。
2.手術後一週傷口已癒合，外觀上水腫已明顯改善，有些人會有瘀青現象，在術後二週內瘀青才會完全消掉。
3.疤痕一般約需二至三個月會變得看不出來。
Q：除眼袋的方式哪一種最好（恢復快，功效好）呢？
A：除眼袋手術的好幾種方法中，經結膜（內開）除眼袋脂肪是恢復最快的方法，水腫幾天就消很多，瘀青的機會較少，但功效未必最好。我們會依不同形態的眼袋，採取不同的手術方式，譬如說，不做脂肪保留去填補淚溝，只是把脂肪拿掉時，術後效果會不完全。眼皮如已鬆弛的話，外開（可以切眼皮）會較好。
Q : 你好，我今年25歲，請問我只有一眼有眼袋的問題，為什麼會只有一眼呢？有可能是什麼原因形成的呢？
A : 人的左右兩側常常是不對稱的，只是程度上有人明顯，有人不明顯。
Q : 我有先天性鼻過敏，眼袋黑眼圈，當時醫生建議我去眼袋，可是一直沒勇氣，現在先生都建議我可以試試看，請問去除手術後會不會很快就恢復或更嚴重？
A : 去除眼袋後要好多年後眼皮會慢慢鬆弛，眼袋會再慢慢跑出來。鍾醫師開業二十年來再開的例子不多。
Q : 我有鼻子過敏，造成黑眼圈，眼袋下垂，一半也是由於遺傳，請問可以抽眼袋嗎？動完手術會不會又恢復？可以永久持續嗎？
A : 眼袋是脂肪的問題，手術時是處理脂肪，術後的結果會維持數年以上的時間。
黑眼圈是美容科的棘手問題，沒有辨法靠手術解決，但有淚溝的病人（眼袋下方的凹溝）會讓黑眼圈看起來更深，在做完眼袋手術，淚溝會同時改善，黑眼圈看起來也會改善。
如果你有其他問題，可以寄到 service@LRclinic.com.tw 我們會儘快答覆你。有關手術費用的問題，因為採取的手術方式得看過診後才可以得知，請不要透過網路詢價。
