改良的中下面部三维综合除皱术在面部年轻化中的应用

目的：探索应用改进的综合方法对中下面部进行三维除皱术,以恢复年轻时的面部立体轮廓形态。方法：局部麻醉下进行中下面部三维除皱术,术中应用了改进的筋膜悬吊、面颊部软组织折叠,下颌部超声去脂、面部局部吸脂、脂肪充填等手术方法;其中将传统的筋膜悬吊改进为多层次的分段提紧和选择性的连续提紧方法。结果：2006年1月～2009年10月间,采用此法完成手术56例,不仅提高了除皱效果,还减少了愈合后瘢痕的形成。结论：通过以上手术方法不仅术后除皱效果良好,而且使面部轮廓形态得到了显著改善,三维面部年轻化的概念也得到了体现。     

上提折叠面中部软组织的面部三维除皱术

目的：在面部除皱中为了使患者恢复年轻时的面部轮廓，达到三维除皱效果，延长有效时间，从理论及实际观察中探讨面中份老年化及面部轮廓改变形成的原因，并通过相应手术方法进行矫正。方法：全麻下进行全面部除皱术，术中在皮下、SMAS筋膜及骨膜下广泛分离，在面颊部，颧弓下定一关键点，并在此上提折叠面颊部皮下软组织及移位折叠SMASA筋膜，下垂脂肪上提复位。结果：从2002年2月至2003年5月，完成手术12例，术后患者面部轮廓改善明显，除皱效果满意。结论：本手术方法旨在通过折叠上提面颊部皮下软组织及移位折叠SMAS筋膜，使面部松弛软组织向上和外侧方向牵拉同时使软组织向前方隆起，从而重塑年轻时的面部轮廓达到三维除皱效果。     

除皱术中利用去毛囊筋膜脂肪复合组织游离移植填充颞部凹陷

目的：探索去毛囊筋膜脂肪复合组织填充颞部凹陷的效果,并进行初步评价。方法：在额颞部除皱同时,根据颞部凹陷程度制备相应大小的去毛囊筋膜脂肪复合组织块游离移植填充颞部凹陷。结果：随访3月～4年,该法除可获得远期丰满外形外,同时改善了面部轮廓。结论：除皱术中利用去毛囊筋膜脂肪复合组织游离移植填充颞部凹陷,在面部提紧的同时改善了面部轮廓,术后效果满意。     

颧颊脂肪垫悬吊在面部除皱术中的应用

目的:通过在面部除皱术中做颧颊脂肪垫提升悬吊,探索一种简便的面部提升除皱的方法.方法:在面部除皱术中,把颧颊脂肪垫向上提升悬吊在颞部颞深筋膜上,自2007年以来,已为26例患者做了这种手术.结果:26例中,24例对术后面部的改善感到满意,2例不满意,所有患者均未出现并发症. 结论:在面部除皱术中,颧颊脂肪垫提升悬吊能有效地改善中面部组织松垂和老化,该法具有手术简便和术后恢复快的优点.     

面部年轻化结合面部轮廓塑形术

目的探索面部年轻化的同时对头面部轮廓形态不佳者进行塑形的手术方法。方法采用自体组织或人工材料填充或磨削过度发育的眉弓和颧骨。最后对面部软组织进行年轻化处理。结果本组患者15例。额颞部除皱术10例。全面除皱术5例。额颞部除皱术10例：其中采用内窥镜技术5例（1例眉弓磨削，1例眉弓磨削同时伴颞部Gore-Tex软组织补片填充。1例颞部Gore-Tex软组织补片填充，2例颞部自体真皮脂肪游离组织填充）；开放式除皱术5例（1例头顶颞部填充硅胶片同时眉弓及颞部填充Gore-Tex软组织补片，1例眉弓磨削，2例颞部填充Gore-Tex软组织补片，1例颞部自体脂肪颗粒填充）。全面部除皱术5例（1例颞部填充Gore-Tex软组织补片，2例颧骨颧弓磨削，2例颧骨及上颌骨填充Medpor），均采用内窥镜额颞部上提结合中下部多层次剥离除皱技术。无面神经损伤，无排斥反应。自体颗粒脂肪注射有1／3吸收。随访1个月至3年。形态均满意。结论颜面部软组织年轻化处理同时行骨骼的重新塑形，是获得年轻的头面部形态的有效手段。     

小切口面部除皱术联合自体脂肪面部填充应用在面部年轻化手术中的效果

探讨面部年轻化治疗中应用自体脂肪面部填充联合小切口面部除皱术的效果。方法 选取 2018年2月-2023年2月于本院行面部年轻化治疗的30例患者为研究对象，依据治疗方法不同分为单独组和 联合组，各15例。单独组采用小切口面部除皱术治疗，联合组采用自体脂肪面部填充联合小切口面部除皱 术治疗，比较两组面部定量指标、下颌缘、鼻唇沟形态评分、面部皮肤检测指标、临床疗效、美容满意度 及并发症发生情况。结果 联合组治疗后双侧颧点间距、瞳孔垂线和鼻唇沟交点到瞳孔点距离、瞳孔垂线 与口裂线和鼻底线在下颌轮廓交点弧度均小于单独组（P ＜0.05）；联合组治疗后下颌缘形态、鼻唇沟形 态评分均低于单独组（P＜0.05）；联合组治疗后弹性、水分评分高于单独组，斑点、油脂评分低于单独组 （P＜0.05）；联合组治疗优良率为93.33%，高于单独组的80.00%（P＜0.05）；联合组美容满意度评分均高 于单独组（P ＜0.05）；两组并发症发生率比较，差异无统计学意义（P ＞0.05）。结论 小切口面部除皱术 联合自体脂肪面部填充的面部年轻化治疗效果优于单独小切口面部除皱术，可改善面部定量指标和面部皮 肤检测指标，优化下颌缘、鼻唇沟形态，且不会增加不良反应发生风险，患者满意度较高。     

全面部多层次复合除皱术

目的：探讨应用多层次复合除皱法使面部年轻化手术的效果及价值。方法：进行多层次解剖分离,使松弛移位的组织复位,包括额部、颧弓部位的骨膜下分离,眼轮匝肌紧缩,额肌部分切除、SMAS-颈阔肌瓣的悬吊提紧等。结果：本组17例患者,均获得良好的手术效果,皮肤松垂得以复位,面部轮廓清晰,形态完美,效果满意。结论：多层次复合除皱技术,效果确切、可靠、安全、持久,是面部皮肤老化松弛的理想治疗方法。     

颗粒脂肪注射额面部除皱凹陷充填12例

颗粒脂肪注射额面部除皱凹陷充填１２例仵伟张新荣屈玉霞陈建萍周梅自１９９３年５月以来，我科为１２例行自体颗粒脂肪注射充填面部凹陷及除皱术，均获得了比较满意的效果。一般资料本组共１２例，年龄２６～４５岁，皆为女性。其中３例为前额除皱，４例为颞部凹陷充填和...     

骨膜下分离加颞深筋膜──骨膜三角瓣技术行面部除皱

１９９１年，Ｒｅｍｉｒｅｚ描述了扩大的骨膜下剥离面部除皱术，笔者按此法进行手术时，仍感下面部特别是下颌区上提不足，鼻面沟消除不明显，影响了整个面部除皱的综合美容效果。为了增加骨膜下除皱术面部上提的幅度，更有效地解决下面部松垂问题和消除加深的鼻面沟，笔者在Ｒｅｍｉｒｅｚ手术方法的基础上设计了耳前颞深筋膜—骨膜三角瓣技术，共为９例病人施行手术，均取得满意效果，无１例面神经损伤。通过实践，笔者认为，本手术方法造成面神经损伤的机会很小，且能更有效地提高面部上提的幅度，使全面除皱效果更为明显。     

面颈部除皱术的探讨

目的探讨SMAS瓣悬吊复合吸脂术及填充术在面颈部除皱术中的应用。方法采用额部冠状切口或微小切口，颞区发际后、耳前、耳垂、耳后切口，分别在皮下、SMAS瓣下剥离悬吊。辅以颊脂肪垫切除，面颈部吸脂和颞部填充术。结果本组623例患者，均获得良好的手术效果，皮肤松垂得以复位，面部轮廓清晰，面型完美，效果满意。结论SMAS瓣悬吊辅以面颈部吸脂、颊脂肪垫切除、颞部填充术，不仅使面部年轻化，同时改变了面部外形轮廓。     

Alternative management of the aging jawline and neck

The lower third of the face and neck have distinct changes that occur with aging. These changes can be globally and dramatically addressed with a traditional rhytidectomy. However, as the demographics of facial plastic surgery patients evolve, patients seek increasingly less invasive procedures that will result in faster recovery time and less postoperative morbidity. To accommodate this change, today's facial plastic surgeon must include less invasive procedures in the treatment strategies for the lower face and neck. Correct, patient-specific procedure selection and patient education can yield results similar to those of a traditional facelift. This article discusses options available for treatment of the lower face and neck.     

Three-Dimensional Mandible Reduction: Correction of Occlusal Class I in Skeletal Class III Cases

Background The human face is a three-dimensional structure. However, many studies on mandible reduction procedures are based on a two-dimensional concept, with a particular focus on one dimension: the width of the lower face. Many Korean individuals have class I occlusion with a skeletal class III pattern. When a conventional mandible reduction procedure is used on such individuals to reduce the width of the lower face, an unsatisfactory facial outcome may result because the changes in the other two dimensions of the lower face, vertical height and anteroposterior distance, are disregarded. This is true because the skeleton of the lower face is well developed in all three dimensions. Methods Bimaxillary surgery that reduces all three dimensions of the lower face was planned and conducted by the authors. This mandible reduction procedure reduced the protrusion of both the maxilla and the mandible and, at the same time, shortened the lower face height. The procedure consisted of a Le Fort I osteotomy for superior and/or posterior repositioning of the maxilla, followed by mandibular counterclockwise rotation and setback via a bilateral sagittal split osteotomy. Genioplasty was performed as necessary. Results With this procedure, the entire lower face volume is reduced, and the overall profile is improved. Conclusions Three-dimensional mandible reduction greatly enhances the aesthetic outcome by improving the skeletal characteristics of the face common in the Korean population so that the facial measurements more closely approach normal values.     

颜面下部轮廓美容重塑

目的 探讨颜面下部轮廓的美容重塑方法。方法 颜面下部轮廓由下颌骨、肌肉和面颊部的脂肪共同构成。通过下颌角切除和颏部假体充填(隆颏术)可以改变面部的骨骼结构，面部脂肪抽吸术则能够调整面部软组织形态。根据受术者的具体情况，单独和联合施行上述3种手术进行颜面下部轮廓的重塑。结果 731例颜面下部轮廓重塑者中，共行下颌角切除461例，隆颏术300例，面部吸脂89例，手术均在局部麻醉下进行，部分施行了联合手术。下颌角手术采用口内外联合切口微型电锯截骨术式，隆颏术经口内下唇系带旁切口行硅胶假体置入，面部采用肿胀麻醉行脂肪抽吸术。术后基本符合美学标准，达到术前预期要求，术者与受术者均比较满意。无严重并发症。结论 通过单独或联合施行下颌角切除、隆颏术、面颊部脂肪抽吸术进行颜面下部的轮廓美容重塑，可以取得良好的效果。     

Subperiosteal minimally invasive laser endoscopic rhytidectomy: The SMILE facelift

Current concepts of total facial rejuvenation involve a comprehensive integrated approach to achieve a balanced youthful appearance. Recently introduced endoscopic-assisted techniques allow us to rejuvenate the face through small, remote incisions. Previously, we have considered only young patients with good skin turgor as candidates for minimally invasive procedures, but the advent of the resurfacing laser has allowed us to expand our indications for single stage minimal access rejuvenation. Full facial immediate laser resurfacing at the time of standard rhytidectomy has been avoided due to risk of flap necrosis. Subperiosteal minimally invasive endoscopic assisted techniques do not substantially interfere with facial blood supply. We can now perform endoscopic-assisted full facelifts combined with immediate laser resurfacing to reposition the tissues in a more youthful position and then tighten the skin envelope. Extended endoscopic-assisted subperiosteal forehead lift is performed through three to five scalp incisions; subperiosteal midface lift is performed through a crow's foot or intraoral incision. Cervicoplasty, if needed, is performed through a small submental incision. Full face laser resurfacing is done using a Coherent Ultrapulse laser. To date we have performed eleven subperiosteal minimally invasive laser endoscopic (SMILE) rhytidectomies. There has been no evidence of flap necrosis with this technique. Postoperative recovery has been no different from patients treated only by full face resurfacing, except perhaps for the slight increase in early facial edema. We believe the SMILE facelift is a viable alternative to standard techniques. The limitations of this procedure still need to be elucidated.     

Profiloplasty of the lower face by maxillary and mandibular anterior segmental osteotomies

Maxillary and mandibular anterior segmental osteotomies (ASO) are ways to correct disharmony in the lip (contour, lip seal, and profile) and occasional dentoalveolar malocclusion. We performed 23 maxillary setback ASO, three maxillary advancement ASO, 21 mandibular setback ASO, and six mandibular advancement ASO in 28 patients to improve their lower facial profile. Other combined operative procedures include nine LeFort 1 osteotomies, four bilateral mandibular ramus osteotomies, two genioplasties, four mandibular angle contouring procedures, two reduction malar plasties, two piriform augmentations with bone graft, and a facelift for correcting of long faces, asymmetric faces, severe malocclusions, microgenias, prominent mandibular angles, prominent malar eminences, piriform recessions, and an aging face. Twenty five patients were satisfied with the results. Two patients complained of an over-recessed lip region, and one of septal deviation. There were no other significant complications or relapses throughout the followup period (9–30 months). Maxillary and mandibular ASO are effective, selective, relatively safe, and simple methods for correcting lower facial profile disharmony to attain a satisfactory aesthetic facial contour.This paper was presented at the 60th annual meeting of American Society of Plastic and Reconstructive Surgery, Seattle, WA, USA, September 24, 1991     

Anatomic study of full facial and scalp allografts without cutaneous facial scars

Abstract

Conventional reconstructive procedures for face and scalp reconstruction fall short of aesthetic and functional goals because of the unique quality and quantity of facial and scalp soft tissue. The purpose of this cadaver study was to demonstrate the feasibility of a flap design for full face and scalp composite tissue allotransplantation, without cutaneous facial scars. Six fresh human cadavers were dissected with sagittal scalp and mucosal incisions for full face and scalp harvest without cutaneous facial incisions. Sub-galeal and sub-SMAS dissection allowed for inclusion of the external carotid and internal jugular systems. Time of facial-scalp flap harvesting, length of the arterial and venous pedicles, length of sensory nerves (that were included in the facial flaps) and approximate surface area of the flaps were measured. Three of six flaps were transferred to recipient cadavers and the time of transfer was recorded. As a proof of concept, the external carotid arteries of one of six cadavers was flushed to remove clots and perfused with a radio-opaque latex polymer, Microfil (Flow Tech Inc.), to study flap perfusion by X-ray imaging. In the donor cadaver, the mean harvesting time of the total facial-scalp flap was 105 ± 19 minutes. The mean length of the supraorbital, infraorbital, mental and great auricular nerves were 1.3 ± 0.2, 1.3 ± 0.1, 1.3 ± 0.1, and 4.8 ± 0.6 cm, respectively. The mean length of the external carotid artery and external jugular vein were 8.7 ± 0.3 and 9.2 ± 0.4 cm, respectively. The approximate area of the harvested flap was 1063 ± 60 cm². In preparation for full face and scalp allotransplantation in humans, this study has demonstrated the feasibility of a full face and scalp flap without visible facial incisions.     

Skin rejuvenation in facial surgery

The treatment of the aging face has evolved to increasingly incorporate minimally office-based procedures. The importance of recognizing and treating facial rhytids has always been recognized as important, but an increasing number of modalities have been developed for this purpose. Similarly, there has been an increase of emphasis in the recognition of dyschromias, solar keratoses, and other skin abnormalities. In this article, an overview of many of the minimally invasive office-based procedures that we favor in our practice will be briefly reviewed.     

Face transplantation surgical options and open problems in cadaveric models: A review article

Being first conceptualized in 2005–2006, total face transplantation is now a clinical reconstructive option in the treatment of patients with acquired facial deformity. The authors propose a review on the status of total face transplantation based on their clinical experience in dealing with traditional microsurgical head and neck reconstructions and on the basis of their published pre‐clinical research investigating technical aspects of the facial allotransplantation procedure in cadaveric models. The authors first discuss the harvesting options and propose two facial flaps which address different reconstructive needs. Next, the concept of donor–recipient anatomical compatibility is introduced, and the possible outcome of the chimeric face is studied, following the insetting of a fasciocutaneous facial allograft. Finally, the authors address the major technical challenges associated with transplanting the most complex osteomyocutaneous allograft. Significant improvement has been made in the field of vascularized composite tissue allotransplantation over the last 5–6 years. The results of the 13 face transplants performed worldwide are encouraging both functionally and aesthetically, when compared with traditional reconstructive procedures. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.     

Reconstruction following head and neck burns

Burn reconstruction of the head and neck must first start with special care to this anatomic area in the early acute phase, with appropriate early débridement and coverage with sheet grafts of medium thickness into unit facial orientation. Postoperative garment and mask splinting, will help lessen the hypertrophic scar formation that frequently follows facial burns and skin coverage. Carefully planned reconstruction of these areas is indicated, with priority given first to the neck, then to the periorbital area, and then to perioral areas. Principles of scalp, ear, nasal, and cheek reconstruction following burns of the face are carefully outlined. The unit concept of burn scar resurfacing of the face has been the mainstay of our treatment. We have emphasized skin coverage of the face from similar donor site areas. The emotional and psychological effects of facial scarring secondary to severe burns are crippling to patients. Although numerous reconstructive surgical procedures may lessen the deformity, ultimately burn patients realize that their burn scars are permanent and no surgeon can give them back their original facial appearance. These patients need strong and continued support and reassurance from their physicians and nursing professional staff to maintain their self-identity and confidence.     

Polyacrylamide Gel for Facial Wasting Rehabilitation: How Many Milliliters per Session?

Background

Facial lipoatrophy is most distressing for HIV patients in pharmacologic treatment. Nonabsorbable fillers are widely used to restore facial features in these patients. We evaluated the safety and aesthetic outcomes of two samples of HIV+ patients affected by facial wasting who received different filling protocols of the nonabsorbable filler Aquamid^® to restore facial wasting.

Methods

Thirty-one HIV+ patients affected by facial wasting received injections of the nonabsorbable filler Aquamid for facial wasting rehabilitation. Patients were randomly divided into two groups: A and B. In group A, the facial defect was corrected by injecting up to 8 ml of product in the first session; patients were retreated after every 8th week with touch-up procedures until full correction was observed. In group B, facial defects were corrected by injecting 2 ml of product per session; patients were retreated after every 8th week until full correction was observed.

Results

Patients of group A noted a great improvement after the first filling procedure. Patients in group B noted improvement of their face after four filling procedures on average. Local infection, foreign-body reaction, and migration of the product were not observed in either group during follow-up.

Conclusion

The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items.