方法：选取2010-05/2015-05间我院实施下睑成形术的患者67例67眼，按照睑袋情况进行分型，并采取不同改进术式：A组：单纯脂肪膨出型12眼采用经结膜切口入路法； B组：皮肤或(和)轮匝肌松弛型19眼，采用经皮肤入路法，需在手术过程中切除下睑皮肤、眼轮匝肌； C组：皮肤肌层松弛合并眶脂膨出型13眼，采用经皮肤入路法， 术中切除眶隔脂肪、皮肤及眼轮匝肌； D组：混合型23眼，采用经皮肤入路法，需在手术中切除眶隔脂肪、皮肤及眼轮匝肌。

结果：术后5d拆线，术后随访3～6mo。四组患者手术效果优良率分别为100%、95%、100%及96%，差异无统计学意义(P>0.05)。患者下睑外观平坦，眶脂膨出消退，有1眼出现轻度睑外翻，2眼眶下缘凹陷以及4眼切口对合欠佳，术后2mo均自行恢复。未出现斜视复视、下睑退缩等严重并发症。四组患者术后并发症发生率分别为8%、11%、8%及13%，差异无统计学意义(P>0.05)。

结论：改进后的下睑成形术治疗不同类型睑袋术后效果满意。

METHODS:Sixty-seven patients(67 eyes)received the lower lid blepharoplasty from May 2010 to May 2015 in our hospital were selected. The patients were classified according to the type of eyelids. They received the different improved operations:12 eyes in group A with bulging fat adopted the trans-conjunctival approach; all the other patients adopted the trans-cutaneous approach. Nineteen eyes in group B with loosing orbicularis oculi muscle and/or loosing skin were required to remove the lower eyelid skin and orbicularis oculi muscle; 13 eyes in group C with loosing skin and bulging orbital fat and 23 eyes in group D with combined cases were both required to remove the orbital fat, skin and orbicularis oculi muscle.

RESULTS:After 5d of operation, the stitches were taken; the patients were visited for 3-6mo after treatment. The excellent rates of surgery in the four groups were 100%, 95%, 100% and 96%(P>0.05).The appearance of lower eyelid was flat; the bulging orbital fat was disappeared; the skin incision had no scar; there was 1 eye with mild ectropion, 2 eyes with sunken inferior orbital margin and 4 eyes with poor aligned incision, which were all recovered after 2mo of treatment. There were no serious complications like collapsed lower eyelid, strabismus, ambiopia, shrinks of lower eyelid, etc. The postoperative complication rates of the four groups were 8%, 11%, 8% and 13%, respectively(P>0.05).

CONCLUSION:The improved lower lid blepharoplasty has a favorable effect for different types of eyelids.