Zusammenfassung
Die Behandlung der periorbitalen Region ist nach wie vor eine sehr anspruchsvolle Chirurgie. Neben der Operation selbst, spielt die richtige präoperative Diagnostik eine wichtige Rolle. Ein wichtiges Merkmal dabei ist die Unterscheidung zwischen positivem und negativem Vektor. Patienten mit einem negativen Vektor haben ein hohes Risiko, postoperativ eine Unterlidfehlstellung zu entwickeln. Aus diesem Grund sind wir dazu übergegangen, Patienten mit einem negativen Vektor und einem pathologischen Hertel-Wert routinemäßig nicht mit einer klassischen Unterlidkorrektur zu behandeln. Hier hat sich bei uns das subperiostale Midfacelift nach Hester als Standardverfahren durchgesetzt. Das wirksamste Mittel zur Behandlung von Tränensäcken bei negativem Vektor und Malar-Bags ist das subperiostale Midfacelift. Es verkürzt den Lid-Wangen-Abstand und verblendet die periorbitalen „retaining ligaments“. Außerdem verleiht es dem Unterlid Volumen und gibt einen stabilen Halt. Durch die Art des Verfahrens verwandelt es auch einen vorbestehenden negativen in einen neutralen oder sogar positiven Vektor. In erfahrenen Händen ist das Midfacelift das ideale Verfahren für die Behandlung von Malar-Bags und die ästhetische Korrektur der Unterlider bei negativem Vektor.
Abstract
Treatment of the periorbital region is still a very demanding surgical procedure. In addition to the operation itself the correct preoperative diagnostics play an important role. In this context an important feature is the differentiation between positive and negative vectors. Patients with a negative vector have a high risk of postoperatively developing a lower eyelid malposition. For this reason, patients with a negative vector and a pathological value with the Hertel exophthalmometer are no longer routinely treated with a classical lower eyelid correction. Instead the subperiosteal midface-lift according to Hester has become established as the standard procedure. The most effective means of treatment of lacrimal sacs with a negative vector and malar bags is a subperiosteal midface-lift. It reduces the eyelid-cheek distance and blends the periorbital retaining ligaments. Furthermore, it confers volume to the lower eyelid and provides a stable support. Due to the nature of the procedure a previously existing negative vector is transformed into a neutral or even positive vector. In experienced hands the midface-lift is the ideal procedure for treatment of malar bags and the aesthetic correction of lower eyelids with a negative vector.
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Richter, D.F., Wiedner, M. Midfacelift – Ästhetische Möglichkeiten für den Infraorbitalbereich. J Ästhet Chir 13, 18–25 (2020). https://doi.org/10.1007/s12631-020-00215-z
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DOI: https://doi.org/10.1007/s12631-020-00215-z