改良颧脂肪垫悬吊中下面部除皱术

目的 改进中面部除皱的手术方法,对手术要点进行探讨.方法 对于颈部松垂不明显、颌下脂肪堆积不严重者,切口限制在颞部和耳前部,不延伸到耳后;皮下分离后,将颧脂肪垫用不可吸收线缝合悬吊于颞深筋膜,颊部SMAS向后上方向提升,折叠缝合,皮肤向上提升.结果 自2002年10月至2009年12月,应用该方法进行中面部除皱137例,随访1～3年,手术效果满意.1例患者术后右侧面神经颊支损伤,1个月后自然恢复,1例右侧耳前皮下局部感染,清创后愈合.无皮下血肿及皮肤坏死发生.结论 提升下垂的颧脂肪垫,重建中面部年轻凸出的曲线是中面部除皱的关键,术中将皮瓣向上提升可以有效减少手术瘢痕.     

高位SMAS联合颧脂肪垫及眼轮匝肌悬吊在面中部除皱术中的应用

目的探讨一种相对微创的面中部除皱技术,并分析高位SMAS联合颧脂肪垫及眼轮匝肌提升对面中部老化的改善情况。方法对121例患者实施高位SMAS联合颧脂肪垫及眼轮匝肌悬吊,于颞部发际缘设计切口,在颧弓以上范围沿SMAS浅层剥离,将下垂的颧脂肪垫、SMAS和眼轮匝肌悬吊于颞深筋膜,去除多余的皮肤组织,使下垂的面部组织维持长期的提升效果。结果本组121例患者术后随访6周至1年,均取得了面中部年轻化的效果;术后恢复时间较短,未发生面神经损伤、面部皮下血肿、切口感染等并发症;手术切口瘢痕较隐蔽。结论高位SMAS及颧脂肪垫和眼轮匝肌的复位,是面中部年轻化的关键。皮下层的安全剥离避免了面神经分支的损伤。该方法对面中部除皱效果较显著,皮下分离安全,且具有简便、效果持久等优点。     

颧脂肪垫悬吊技术辅以SMAS折叠的中面部除皱术

目的：出于中面部提升简单化的趋势,介绍一种颧脂肪垫提升和SMAS移位的除皱技术。以期改善颧下区域空虚、鼻唇沟加深等中面部老化的问题。方法：采用一种中面部年轻化方法,行颊部耳前SMAS折叠,同时将下垂的颧脂垫缝线悬吊于耳前筋膜,使老化中面部维持长期的提升效果。结果：2006～2010年,在52例面部除皱术中运用该技术,中面部提升效果维持时间长,恢复期短,无面神经损伤等严重并发症出现。结论：皮下层的安全剥离避免了面神经分支的损伤。颧脂肪垫悬吊技术辅以SMAS折叠术,避免了较长的恢复期和深层剥离可能导致的损伤。这种方法可作为独立的中面部手术在局麻下实施,操作简单、安全、效果持久。     

内镜辅助下颧、颊脂肪垫悬吊除皱术的临床应用

自从Owsley、Yousif提出颧脂肪垫（malarfatpad）的概念以来，中面部提升术取得了很大的进展。但是传统的颧、颊脂肪垫提升术需要颞部设计切口延续到耳前和耳屏前，耳前瘢痕明显，是很多医者和受术者双方的顾忌。我们对16例中上面部除皱者在内镜辅助下，应用微小切口，使耳部切口仅延续约1cm（耳屏上），即可完成颧脂肪垫（包括颧部脂肪垫和颊部脂肪垫）的悬吊，提升中面部，改善鼻唇沟加深、颊部组织下垂、眶下区变深等衰老、憔悴面容等表现。最近两年来，我们共已完成了16例，现报告如下。     

耳前小切口颧脂肪垫悬吊术在中面部提升中的应用

目的：探讨通过耳前小切口行颧脂肪垫悬吊术的安全性和促进中面部提升的美容效果。方法：本组就医者12例,面部皮肤弹性良好,均表现为眼角下垂、颊部组织下降、鼻唇沟过深。在内镜辅助下,应用PTFE线,经耳前小切口行颧脂肪垫悬吊术,提升中面部,改善鼻唇沟加深、颊部组织下降等衰老面容。结果：随访观察6～12个月,12例均获得较好的中面部提升效果。除1例发生皮下积血外,无严重并发症,就医者满意。结论：对于面部皮肤组织弹性良好者,耳前小切口颧脂肪垫悬吊术是一种安全、有效、切口隐蔽的中面部年轻化技巧。     

面中下部除皱术的进展

面中下部主要指眶下区,颧颊区,颏外侧部(下颌骨表面)及鼻唇沟部.其老化的主要表现为:眼轮匝肌松弛下垂,眼轮匝肌下脂肪突出,眶脂肪囊疝出,进而出现颧眶部"弦月征".颊脂肪垫松垂将会导致鼻唇沟加深,面部肌肉松弛及颈阔肌松垂,从而使颏颈颌部正常曲线中断(颌下线中断).面中下部除皱手术大致经历了以下各阶段的发展.     

中面部除皱术的进展

面部衰老是多种因素作用的结果，包括皮肤本身的老化，软组织的萎缩松弛、下垂，重力作用的长期影响以及骨组织的吸收、退缩等。而要使面部年轻化需要多方面的综合处理，包括改善皮肤质地的激光除皱、光子嫩肤、肉毒杆菌毒素注射除皱，还有骨移植、脂肪移植及提面术等，提面术主要是针对重力长期作用导致的组织松弛而进行的手术方法，手术方式经历了漫长的演变过程，仍有待进一步的发展完善。面部软组织老化表现为脂肪下垂、体积萎缩和皮肤松弛等几个方面，在面中部具体表现为下眼睑延长、颧脂肪垫下垂、颧颊沟加深、下颌缘脂肪堆积、鼻唇沟加深以及皮肤松垂。     

睑袋手术下睑缘切口入路中面部除皱术

面部除皱术的临床实践从单纯皮肤拉紧提升，到目前已有新入路、多部位及深层次分离提紧，使这一项手术更科学、更合理、更到位，远期效果有所提高。我们从2000年3月至2006年4月，设计经睑袋下睑缘切口手术入路行颧骨骨膜下或皮下上唇提肌浅面分离提升拉紧中面部除皱手术，共45例，因其入路近、提拉固定确实可靠，均取得较好除皱效果。     

经睑缘切口颧脂肪垫双向悬吊中面部提升术的临床疗效

探讨经睑缘切口颧脂肪垫双向悬吊中面部提升术在面部衰老患者中的应用效果。方法 选择 2020年6月-2022年6月秦皇岛市第一医院医学美容科收治的65例中面部衰老患者为研究对象，随机分为A组 （n =32）和B组（n =33）。A组予以经睑缘切口颧脂肪垫双向悬吊中面部提升术，B组予以颧脂肪垫单向悬 吊中面部提升术，比较两组鼻唇沟皱纹严重程度、面部整体美容效果及并发症发生情况。结果 两组术后 1周皱纹严重程度比较，差异无统计学意义（P＞0.05）；A组术后6个月2级占比高于B组，4级占比低于B组 （P ＜0.05）；A组术后6个月GAIS评分优于B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 通过经下睑缘切口颧脂肪垫双向悬吊中面部提升术能够获得更好的美容效果，术后瘢 痕隐蔽，创伤小，恢复快，安全可靠，能够有效提高中面部的年轻化美容效果。     

改良中面部除皱术在临床中的应用

目的探讨改良中面部除皱手术的方法，以及手术要点与优势。方法对43例面中部皮肤及软组织松弛的女性，采用颞部“w”形＋耳前倒“L”形切口，在皮下和SMAS筋膜之间分离组织间隙达到设计范围，并在耳前纵向解剖分离一“舌形”SMAS筋膜瓣，大小约2．5em×1．5cm；将筋膜瓣掀开，在SMAS筋膜前侧断缘，斜向上45。对位拉紧缝合，使口角上提，鼻唇沟变浅；再将预制的SMAS筋膜瓣向上提紧，缝合固定于颧弓处；下颌缘及部分颈部皮肤上提，去除颞部及耳前多余皮肤并缝合固定。结果本组共43例患者，术后随访3～18个月，鼻唇沟明显变浅，下颌缘及颈部形态清晰，效果满意。结论采用改良中面部除皱术能有效改善口角、鼻唇沟、下颊部及部分颈部的皮肤松弛，同时手术切口张力小，瘢痕不明显，位置隐蔽，且术后皮肤紧致、弹性好，表情自然，值得临床推广应用。     

The naso-labial fold: analysis and proposed techniques for correction]

The naso-labial fold is a permanent depression of the face which corresponds to the combined action of congenital and acquired factors such as cutaneous atrophy, bone resorption, muscular activity and skin ptosis. It is therefore not realistic to abandon any attempt to correct this complaint or to provide a universal solution to correct it; over the last four years, we have used EPTFE implants to fill the naso-labial fold: triangular, in one or two layers introduced via a gingival incision for the upper naso-labial part, with 2 mm large strips directly inserted through the skin for the lower labio-mental part. Tolerance and versatility were always remarkable; efficacy depends on the possible associated cutaneous ptosis: if major, a lifting procedure, more or less extensive, must be offered, which may also improve the projection of the malar area with an implant of the same material introduced via an oral or temporal approach. All other well known procedures (liposuction, fat grafts, collagen, etc.) may be employed but only as a complement to filling and traction procedures.     

The S-Lift Facelift Featuring the U-Suture and O-Suture Combined with Skin Resurfacing

BACKGROUND: A short-flap S-lift may be helpful for minor jowling or submental laxity in cases of early facial ptosis, revision facelifts, or where skin resurfacing is combined with neck lifting. OBJECTIVE: To develop a safe and effective method to lift the jowl either as a single procedure or combined with other rejuvenation methods. METHODS: After the induction of monitored anesthesia care the skin resurfacing is completed, if necessary, and the submental and lateral S-lift incisions are marked next to the tragus. The submental area is hydrodissected with modified tumescent solution. After a 15-minute waiting period, the submental area is debulked with small spatula cannulas using reduced pressure liposuction. Often the platysma bands are tied together with a running locked suture. The right cheek area is hydrodissected and debulked in a similar fashion. A 3-4 cm flap is elevated. If necessary, further blunt dissection is passed through the anterior mandible ligament and the nasolabial fold. Care is taken to keep the skin trabeculae intact. The SMAS is plicated with a U-shaped and O-shaped purse-string suture. Following this tightening of the subcutaneous tissue, the skin is closed with a double-layer closure. The face is dressed in two layers of tube gauze. Sutures are removed in 7-9 days. RESULTS: This S-lift gives a pleasing rejuvenation of the jowl and submental area. It is also possible to combine this procedure with other procedures such as corset platysmaplasty, skin resurfacing, fat augmentation, a browlift, or blepharoplasty. CONCLUSION: The S-lift provides a safe and effective method for rejuvenation of the early sagging face or for revision facelift.     

锯齿状缝线皮下置入面部提升术临床应用中的若干问题探讨

目的:对临床应用特制锯齿状缝线置于皮下的微创面部皮肤松弛提升术出现的问题及并发症进行探讨,并提出对策。方法:将两端具有细微的、向中央倾斜的聚丙烯锯齿状缝线,通过含有针蕊的穿刺导引针,置于皮下,治疗面部松弛者352例,观察临床效果,并对不成功病例进行分析,同时与国外资料进行对比,提出改进办法。结果:随访观察3个月至32个月,对352例求美者随访,根据术者和求美者的综合判断,其中显效132例,有效165例,效果较差39例,无效16例,总有效率84.37%,无效及疗效不佳者占15.63%,分析其原因为:1.锯齿状缝线齿的问题;2.手术技巧的问题;3.术前、术后与求美者沟通不够,导致疗效下降或无效。结论:锯齿状缝线皮下置入进行面部提升是一种简便有效的方法。但应对锯齿状缝线的倒刺进行有效的改善,手术方法进行改进,完善并加强与求美者沟通,以提高成功率。     

上睑下垂的分型及手术方法选择的临床分析

目的：探讨上睑下垂的分型及手术方法和疗效。方法：上睑下垂分轻、中、重3型。手术选择包括：①轻度下垂：可选择上睑提肌折叠缝合;②中度下垂：可选择上睑提肌部分切除缩短术;③重度下垂：可选择额肌筋膜瓣下移悬吊术。结果：本组60例,经6个月～5年的随访,外形满意,仅有1例眼眶弧度形态欠自然,经二次修整术后外形满意,无其他并发症。结论：上睑下垂,按分型程度选择适宜的手术方法和完善手术技巧是提高手术成功率的关键。     

Definition of the inframammary fold in breast reconstruction: a simplified option

Background:

Redefinition of the inframammary fold in post-mastectomy reconstruction is an essential element to achieve construction of a natural-looking breast, either using implants and autologous tissue. Over years many techniques have been described scheduling external surgical approach (through incisions being made directly on the fold) or internal surgical approach (through the scar of previous procedure for breast expander positioning) and using running sutures or suture with interrupted stitches.

Methods:

A modified technique for redefinition of the inframammary fold using an internal approach was performed in 130 breast reconstruction procedures. Cosmetic outcomes and stability over time were assesed.

Results:

No total collapse was observed. The outcomes were classified as very good 65.3% patients, satisfactory 23% and poor in 9.2%. The accumulative risk for definition loss of the reconstructed fold was 11% in eight years.

Conclusion:

The technique presented in this article is a modification of already reported techniques and is easy and fast to perform, it adds no external scars so ensuring at the same time, natural inframammary fold definition and good reproduction of ptosis in medium to large breasts.

Level of Evidence:

Level IV, therapeutic study.     

Current concepts in nonablative radiofrequency rejuvenation of the lower face and neck

With the multitude of treatment options and emerging technology available for rejuvenation of the lower face and neck, it is often difficult to determine which specific treatment would benefit an individual patient. Monopolar radiofrequency (MRF) nonablative skin rejuvenation is a promising new procedure that is utilized to tighten and contour nonsurgically mild to moderate laxity of the skin of the lower face and neck in patients without significant underlying structural ptosis. In these selected patients and others who wish to avoid surgical treatment modalities, MRF treatment offers a noninvasive method of tightening skin and soft tissue, causing softening of the nasolabial lines, tightening of the jowl, and improving the definition of the cervicomental angle, all without significant recovery time or complications. Further development of MRF technology and refinement of treatment protocols may allow even greater tightening of the skin and more dramatic modulation of underlying deeper structures, making the treatment more universally applicable for patients desiring facial rejuvenation.     

Botulinum Toxin A and Facial Lines: The Variable Concentration

Our improved understanding of the functional anatomy of the face and of the action of the botulinum toxin A leads us to determine a new injection procedure which consequently decreases the risk of eyebrow and eyelid ptosis, and increases the toxin injection's possibilities and efficiencies. Variable toxin injection concentrations adapted to each injected area are used. Thanks to the new procedure in the upper face, toxin A action is quite close to an endoscopic surgical action. In addition, interesting results are achievable on the nose, upper part of the nasolabial fold, jawline and neck regions. Lastly, a smoothing effect on the skin is obtained by the anticholinergic action of the toxin A on the dermal receptors.     

乳房重度下垂的直线切口法乳房成形术

目的 介绍应用直线切口法乳房成形术(Lejour法)治疗重度乳房下垂方法及效果.方法 按Lejour法设计手术切口.该类患者新乳头位置较正常人群可适当下移1～2 cm,新乳房下皱襞上移5～10 cm,通过适当下移新乳头位置及上移新乳房下皱襞达到缩短垂直切口距离.剥离乳腺组织,将下垂乳腺组织从乳腺深层固定于胸大肌第2、3肋水平.皮肤无张力缝合.结果 36例中乳房肥大者30例、体积基本正常者6例,经术后3个月至2年随访,无明显并发症,新乳房外形挺拔自然,患者满意.结论 本术式简便易行,远期效果好,可作为重度乳房下垂的术式之一.     

锯齿状缝线皮下埋置面部提升术--附168例临床应用观察

目的：应用特制的锯齿状缝线置于皮下，拉紧松弛组织，以研究一种微创面部皮肤松弛提升的术式。方法：将两端具有细微的、向中央倾斜的锯齿状缝线，通过含有针芯的穿刺导引针，置于皮下，治疗面部松弛者168例，观察临床效果。结果：随防观察，根据术者和求术者的综合判断，显示效果满意，总有效率92．26％。结论：此方法治疗面部皮肤松弛具有良好效果，且操作简便、安全、省时、创伤轻、痛苦小、费用低，值得推广应用。