面部除皱术18例

总结面部除皱术１８例，对骨膜下除皱是否适用于东方人进行了讨论。认为东方人皮肤松弛的特点主要是因为年老，皮下脂肪减少，皮肤老化松弛而缺乏弹性，但皮下的肌肉系统与骨膜虽有松弛但往往很不明显，其皮肤的舒展度与肌肉骨膜系统的舒展度相差亦甚大。传统的额部除皱术，由于分离平面在帽状腱膜下，其额肌抵抗力影响了额部皱纹的舒展，就必须切除一块或三块额肌条和作部分皱眉肌及降眉肌切除，作者的手术实践也体会到，切除松弛皮肤３ｃｍ，ＳＭＡＳ仅能提紧２ｃｍ左右。如在骨膜下分离，由于受其舒展度限制，面部的肌肉系统又不能象额肌那样切除，切除的皮肤量就必然受到限制而影响除皱效果。作者仍主张分离平面在额部应选择在帽状腱膜下，颞区在颞浅筋膜上，面颊部在浅筋膜层。本文并对ＳＭＡＳ悬吊及术中有关注意事项也进行了讨论。     

射频手术机器辅助内窥镜骨膜下额颞部除皱术

目的探讨射频手术机器在内窥镜骨膜下额颞部除皱术中的应用。方法常规内窥镜骨膜下额颞部除皱术中,应用射频手术机器切割及凝固电极行骨膜下剥离,尤其是眶周和额颞移行区充分分离,仔细分离切割皱眉肌、降眉肌及部分额肌,松弛皮肤钛钉固定于颅骨外板。结果本组10例均获得满意效果。结论射频手术机器辅助内窥镜骨膜下额颞部除皱术,能准确分离切割额颞部肌肉,除皱效果确切、持久。     

面部小切口悬吊除皱术

目的　在小切口除皱基础上增加悬吊技术 ,探讨悬吊术的手术要点及并发症的发生原因和处理方法 ,以其达到最佳的除皱效果。方法　行额部、头顶部帽状腱膜下及颞部、颊部皮下小切口分离术区 ,切断且松解部分额肌、皱眉肌 ,利用Gore -Tex线拉紧松弛的皮肤达到悬吊除皱目的。结果　笔者为 96例患者行上半面部小切口悬吊除皱术 ,门诊随访 3 5例 ,大多数患者取得满意的除皱效果 ,无严重并发症发生。结论　面部小切口悬吊除皱术在小切口分离的基础上增加了悬吊的力量 ,比传统手术方法操作相对简单、组织损伤轻、并发症少、除皱效果确切、值得推广     

面部小切口悬吊除皱术

目的在小切口除皱基础上增加悬吊技术,探讨悬吊术的手术要点及并发症的发生原因和处理方法,以其达到最佳的除皱效果.方法行额部、头顶部帽状腱膜下及颞部、颊部皮下小切口分离术区,切断且松解部分额肌、皱眉肌,利用Gore-Tex线拉紧松弛的皮肤达到悬吊除皱目的.结果笔者为96例患者行上半面部小切口悬吊除皱术,门诊随访35例,大多数患者取得满意的除皱效果,无严重并发症发生.结论面部小切口悬吊除皱术在小切口分离的基础上增加了悬吊的力量,比传统手术方法操作相对简单、组织损伤轻、并发症少、除皱效果确切、值得推广.     

全面部复合除皱术30例分析

目的 探讨一种可以整体上提面中、上部,并解决睑袋、颧部皮肤软组织松弛、鱼尾纹、额纹、鼻唇沟过深的复合除皱术.方法 自2008年2月至2011年5月,共对30例患者施行全面部复合除皱术.额颞部选择发际缘切口与额部切口入路,颞部在颞深筋膜浅层剥离至颞肌前缘及眶外缘,额部在帽状腱膜下剥离至眶上缘及鼻根部,并在眉上1.0cm处及两侧眉峰间离断额肌、皱眉肌和降眉肌.联合应用耳前、耳后切口,行面中、下部超过鼻唇沟的广泛皮下及SMAS下剥离,分别向上、后、乳突3个方向悬吊,对松弛的眼轮匝肌进行悬吊,并将颧脂肪垫向外上方悬吊、固定于颧骨体表面.对于睑袋及颧部松弛严重者,辅以睑袋切口,在面中部骨膜下分离颧骨上分离至鼻唇沟外上1.5cm并悬吊.结果 本组30例患者,术后随访6～24个月,额纹、眉间纹、鱼尾纹、鼻唇沟过深、面中部组织松弛等问题均得以改善,无血肿、面瘫等并发症发生,效果满意.结论 全面部复合除皱术可从根本上改善老年患者面部组织松垂问题,效果持久,只要严格手术操作,避开重要血管、神经及其分支,可作为一种安全、可靠的面部年轻化手术的选择.     

面部小切口悬吊除皱术

目的 在小切口除皱基础上增加悬吊技术，探讨悬吊术的手术要点及并发症的发生原因和处理方法，以其达到最佳的除皱效果。方法 行额部、头顶部帽状腱膜下及颞部、颊部皮下小切口分离术区，切断且松解部分额肌、皱眉肌，利用Gore-Tex线拉紧松驰的头皮达到悬吊除皱目的。结果 笔者为96例患者行上半面部小切口悬吊除皱术，门诊随访35例，大多数患者取得满意的除皱效果，无严重并发症性。结论 面部小切口悬吊除皱术在小切口分离的基础上增加了悬吊的力量，比传统手术方法操作相对简单、组织损伤轻、并发症少、除皱效果确切、值得推广。     

面部除皱术18例

总结面部除皱术１８例，对骨膜下除皱是否适用于东方人进行了讨论，认为东方人皮肤松驰的特点主要是因为年老，皮下脂肪减少，皮肤老化松弛而缺乏弹性，但皮下的肌肉系统与骨膜虽有松弛但往往是不明显，其皮肤的舒展度与肌肉骨膜系统的舒展度相差亦甚大。     

内窥镜骨膜下额部除皱骨固定19例

目的 探讨额部除皱术有效的固定方法及眉的彻底游离对内窥镜骨膜下额部除皱的影响。方法 行骨膜下剥离，尤其是眶周和和额-颞移行区充分分离；上提眉周组织并无张力固位；头皮经颅骨外板隧道固定.结果 本组19例均获得满意效果。其中1例曾并发右面神经额支麻痹，3个月后完全恢复.结论 经颅骨外板隧道的切口固定使术后眉位置保持良好，且除皱效果持久。     

眼轮匝肌悬吊法眶周除皱术

目的 探索一种操作简单、安全、有效的眶周除皱术式.方法 在肿胀麻醉下,通过眉区切口入路,在眼轮匝肌眶部外侧深面向下剥离1 cm,将眼轮匝肌上提固定于颞深筋膜或额骨骨膜上;于内侧显露降眉肌和皱眉肌并离断之.然后,通过皮肤入路睑袋成形术切口,在行睑袋成形术的同时,在眼轮匝肌与其下脂肪组织间分离眼轮匝肌眶部外侧,形成眼轮匝肌肌皮瓣,向外上方提紧,固定于眶骨骨膜上.对于颧颊部丰满、鼻唇沟明显者,可同时悬吊固定颧脂肪垫.结果 65例中年女性,术后随访3～16个月,切口瘢痕不明显,静态时鱼尾纹、眉间纹消失,上睑松弛及眉下垂完全矫正,鼻唇沟纹明显减轻,95 %的受术者对手术效果满意.并发球结膜水肿者4例,经热敷治疗,1个月内均消退,无面神经损伤及其他并发症发生.结论 眼轮匝肌悬吊法采用新的切口入路,完全避开面神经,手术操作简单,安全,切口隐蔽,疗效可靠持久,创伤小,恢复迅速,是一种较好的眶周除皱手术方法.     

内镜额部除皱术结合传统切开法除皱的效果

目的探讨内镜除皱术与传统除皱术相结合的治疗方式及效果。方法仅存在额部皱纹、眉间纹及眉下垂者采用内镜额部除皱术,切除或切断皱眉肌、降眉肌和额肌,必要时结合额部皮瓣上提悬吊技术即可;如同时存在中下面部皮肤老化、松弛下垂,则内镜额部除皱术尚需结合传统切开法的中面部或中下面部除皱术,做浅表肌腱膜系统（sMAs）筋膜的折叠或切除缝合,以及多余皮肤的切除剪裁。结果104例采用额部内镜除皱术,均取得良好的除皱和眉提升效果。并发症较少而轻微,包括表情肌去除部位的轻度凹陷、额部皮肤麻木、发际线轻微后移、皱纹去除不彻底等。无面神经颞支损伤等严重并发症发生。其中84例存在中下面部皮肤松弛下垂,在做内镜额部除皱的同时行耳前切口的传统除皱术,明显改善中下面部的皮肤老化,并使面部上下的年轻化协调一致。结论内镜额部除皱术设计合理、操作安全、效果明确,是一项切口小、损伤轻的微创技术,符合整形外科的发展趋势。对于同时存在有中下面部皮肤松弛者,如能结合传统切开法除皱术,面部年轻化的整体效果可进一步优化。     

Three-Dimensional Analysis of Forehead Wrinkles

It is important to understand the anatomical characteristics of forehead wrinkles in order to perform a forehead lift. This study aimed to elucidate the mutual relationships among tissues composing the forehead using computer software that enables the stereoscopic observation of the tissues studied in arbitrary directions. The specimens were obtained from five cadavers and prepared in serial sagittal sections. Three-dimensional images were prepared by inputting the forehead wrinkle data obtained from serial sagittal sections. Consequently, the forehead skin was found to be fixed to the superficial galea aponeurotica through fibrous septa, suggesting that movement of the frontalis muscle would be transmitted to the skin, not through the fibrous septa alone, but from the superficial galea aponeurotica closely attached to the frontalis muscle through the fibrous septa. Since the forehead muscles exhibit a stereostructure where the corrugator supercilii muscle supports three superficial forehead muscles, including the frontalis muscle, the orbicularis oculi muscle, and procerus muscle on the periosteal side, it was presumed that a sufficient effect would not be attained unless the corrugator supercilii muscle was operated on concurrently in conjunction with these muscles during a procedure involving the superficial forehead muscles in a forehead lift. Based on the findings from the three-dimensional images obtained, effective tissue treatments could be achieved by performing (1) dissection between the superficial galea aponeurotica and the frontalis muscle, (2) dissection between the deep galea aponeurotica and the periosteum, and (3) a procedure incorporating the forehead muscles in order.     

Do forehead lifts lift or unfurl?

Forehead lifts are becoming increasingly more popular as an adjunct to facial rejuvenation. Considerable confusion exists as to how much the eyebrow should be elevated and how much scalp should be removed to achieve this goal. In an effort to evaluate this question, we have reviewed our recent forehead lift experience. These were done with forehead flap dissection down to glabella and supraorbital ridge, partial resection of corrugator supercilii, procerus, and frontalis muscles, and limited skin resection. We suggest that a natural-appearing, rejuvenating forehead lift should unfurl facial wrinkles without excessive eyebrow elevation. Technical maneuvers to obtain this goal are discussed.Presented in part at the Second Italian-American Congress of Plastic Surgery, Venice, Italy, September 1990     

Subperiosteal transblepharoplasty forehead lift

Contemporary options for correction of the aging upper one-third of the face include open techniques with a coronal or anterior hairline incision, endoscopic access to the forehead including muscle transection, brow lift through direct forehead skin excision and various forms of brow-pexies. Realizing the common need for aesthetic improvement in the upper eyelids and desiring minimal incisions for forehead rejuvenation, an approach through the blepharoplasty incision has been developed which addresses all of the components of the aging upper third of the face: A combined subperiosteal approach for forehead elevation and transection of corrugator and procerus muscles through the blepharoplasty incision is presented. The postoperative improvements in the position of the brow as well as improvement in the glabellar area rivals other approaches and allows simultaneous improvement in upper eyelid aesthetics.Presented at the Annual Meeting of The American Society for Aesthetic Plastic Surgery, Inc., March 1995 and at the 13th International Congress of The International Society of Aesthetic Plastic Surgery, September 1995     

Use of deep planes in surgery of rejuvenation of the face

Since 1976, anatomical studies intensively performed in France have demonstrated the surgical interest in using the superficial musculo-aponevrotic system in the face, and also a subperiosteal malar approach. The SMAS is mostly a surgical structure. It could be considered as a remnant of a primitive subcutaneous muscle which would have been located in the superficialis fascia; its stays outward the parotid gland. Muscular fibers have been found inside, uniting from-down the patysma muscle toward the periphery of the frontalis muscle at the top. Risorius muscle is included in this structure. Its surgical interest is that it allows to relieve skin tension during a face lift by a fibromuscular associated stretch. The modern way in face lifting should prevent the fixed appearance of a too tight skin-pull, when skin is redraped alone. Risks of facial nerve injury are minimal when the proper technique is used. It is possible, in the same way, during a blepharoplasty to stretch the orbicularis oculi muscle, like the muscular resuturing of an inguinal hernia repair. Each of this technique has its own different indications now well defined. The authors shows this experience after 150 cases of face lift operations and makes an analysis of the advantages and draw backs of using the SMAS in cases of rejuvenating face operations.     

Limited-incision face lift technique

Background: For the past 4 decades, the full subcutaneous face lift has been the procedure of choice for treatment of the facial effects of aging. Objective: We report the use of a less invasive procedure, the limited-incision face lift technique (LIFT), in a series of 1000 patients from January 1991 through January 2001. Methods: Each of the lift procedures was performed while the patient was under intravenous sedation and local field block infiltration; no narcotics were administered. Suction-assisted lipoplasty was used to defat the submental area and jowls, except in cases of prominent platysmal bands in the erect position, when open lipoplasty was performed. Undermining was carried medially 5 to 6 cm from the preauricular incision throughout the cheek and over the mandible to the submental area. The superficial musculoaponeurotic system (SMAS) was then developed distally; redundant SMAS tissue was resected at the apex of the closure and along its posterior border, followed by plication and closure. Results: Patients were pleased with the operative experience and surgical results. Complications included 6 cases of hematoma that required surgical drainage. There were also numerous small collections. In addition, development of skin ripples behind the ear lobule occurred in some patients early in the series but virtually disappeared as we gained experience in the procedure. The necessity for immediate neck lifts as an additional procedure occurred in 6 early patients but was eliminated by careful patient evaluation for neck skin laxity later in the series. Conclusions: The LIFT is an alternative to the traditional face lift. Advantages include limited incision and scar as well as excellent correction of nasolabial folds, cheek laxity, jowls, and redundant submental skin and fat. It is not indicated for patients with significant lower neck skin laxity. (Aesthetic Surg J 2001;21:216-226.)     

In Favor of the Subcutaneous Forehead Lift Using the Anterior Hairline Incision

We present our experience with 980 women who had subcutaneous forehead lifts using the anterior hairline incision, during the years 1989–1996. The dissection is easy and fast; the forehead wrinkles are smoothed by the separation of the septa between the frontalis and the skin. The access to the corrugator and the procerus muscles is easy, and the adjustment of the brows to the desired location can be accurate. We use this approach for 90% of women who are eligible for upper face rejuvenation. We have obtained a 96% satisfaction rate; only 1.8% of our patients had minor and reversible complications. The scar, which is supposed to be the main disadvantage of this procedure, is almost unnoticeable, and none of our patients has permanently changed her hairstyle due to this operation. Now, during the peak of interest in forehead lifts with limited scars using the endoscope, is the time to highlight this time-worn, safe, reproducible, and effective approach.     

Facial rejuvenation: A combined conventional and endoscopic assisted lift

This article describes our personal approach for facial rejuvenation combining conventional and endoscopic procedures. For a forehead lift we use an endoscopic assisted technique. However, for the face and neck we still prefer the conventional lift. Good candidates for subperiosteal endoscopic midface lifts without skin resection are young or middle-age patients with midface ptosis and pronounced nasolabial/nasoyugal folds, without significant skin excess. Ptosis of the temporo-malar or facial area is also a good indication for subcutaneous endoscopic assisted lift. Aesthetic improvement of the forehead is evaluated with objective data of preoperative and postoperative measurements. We find this minimally invasive technique less traumatic and time consuming. It allows a greater range of possibilities for individual needs because it limits the incision and dissection to the required areas and has a higher level of acceptance by the patients. It is also a good complement to a conventional face lift.