2022年9月19日
目の下のクマ（くま）、たるみに対する結膜面アプローチによる下眼瞼形成術の治療成績-6

結語1．目の下のたるみは大量の下眼窩脂肪がこれを支える支持組織の加齢による弛緩により前方脱出がその主な原因であり、その治療はこの過剰脂肪を除去する”脱脂”が主体をなす。 2． 目の下のクマ（くま）は、目の下の色素を強調する下眼瞼皮膚の下垂を引き起こす解剖学的構造の不具合が原因であり、その治療は”脱脂”のみならず、下眼瞼皮膚を挙上させるべく、下眼瞼構造の改変が必要である。 3． 目の下のクマ（くま）は、下眼瞼皮膚の下垂や過剰脂肪の存在だけではなく、皮膚自体の色素沈着が原因となる場合もある。 4． 従来まで中高年層以降や症状の強い症例目の下のたるみ症例は、皮膚切開を用いた下眼瞼形成術でなければ改善しないとされていた。だが、皮膚切開を用いない経結膜的下眼瞼形成術で、こういった症例でも十分良好な結果がえられることがわかった。 5．経結膜的下眼瞼形成術に伴う合併症について調べたところ、下眼瞼の凹み、しわの発生率はそれぞれ5%, 8%だった。しかし、そのほとんどが一時的な症状であり、治療後3ヶ月以内に自然治癒した。 6．他院で行われた再治療症例では、目の下のクマ（くま）、たるみ症状の再発や治療後に発生したしわ等の改善を目的に、新たに経結膜的下眼瞼形成術を行った。その結果、すべての症例で症状の著しい改善が得られた。 7．中高年層に行った多くの経結膜的下眼瞼形成術の治療結果を検証したところ、目の下のクマ（くま）、たるみが解消されたのみでなく、上眼瞼の凹みや眼瞼下垂症状が改善されることがわかった。 8．今回検証した経結膜的下眼瞼形成術はもちろんのこと、美容外科手術は緊急性を要しない、いわゆる”elective surgery(随意意志による手術）”なので、 安全性を最優先にした 後遺症が生じない手術を第一選択とすべきである。

銀座CUVOクリニック目の下のたるみ治療
銀座CUVOクリニック目の下のくま治療

Treatment Result of Lower eyelid Blepharoplasty Using Conjunctival Approach
Takayuki Kubo M.D Ph.D
Ginza Cuvo Clinic

In our country, surgical treatment for lower eyelid symptoms such as eye bag or darkness of skin color was carried out using skin incision method. The main reason why skin incision approach was commonly utilized is that we believed lower eyelid symptoms were derived from skin condition itself rather than defective anatomical structure of lower eyelid.In addition to that, the fact that skin incision approach is easier than conjunctival one has also made skin incision approach more popular in this treatment. However, most patients are reluctant to undergo skin incision approach because they are afraid of suffering side effect such as residual scar or ectropion. Since aesthetic surgery is so-called elective surgery, which is far different from  imminent surgery for life-saving, sequelae related to aesthetic surgery  has to be avoided absolutely.In our clinic, we essentially utilized conjunctival approach for lower eyelid blepharoplasty and succeeded in obtaining good results in most cases. As this approach is recognized as a good method, customers began to visit to our clinic from all over Japan. We will manifest the effectiveness of the lower eyelid blepharoplasty with conjunctival approach by analyzing the results accumulated in my clinic.

Therefore, we developed new procedure based on transconjunctival lower blepharoplasty to resolve those symptoms. 1044 patient(female 936, male 108 average age 41.2 year old, Range19-75, SD 9.88) underwent this procedure during one year(from 2007/4/1 until 2008/3/31). 200 patients were followed up after the surgery and subjective satisfaction rate was evaluated. The data showed that 28% was excellent, 56% was good, 13% was fair, 3% was poor. Majority of the satisfied patients said that they felt very happy being free from an inferiority complex incurred by lower eyelid symptoms. 

Until now, it was believed that conventional incisional blepharoplasty was the only one method to improve relatively older generation with server symptom. However, modified transconjunctival lower blepharoplasty was proved to have satisfactory result for sever cases. In addition to that, not only lower eyelid symptoms, but also upper eyelid symptoms such as sunken eyes or blepharoptosis were also improved.

文献

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