浅表肌腱膜系统多重悬吊的全颜面除皱术

目的探索一种操作简单、安全、效果持久的全颜面除皱术式，以利于推广应用。方法采用浅表肌腱膜系统(superficial musclo-aponeurotic system，SMAS)多重悬吊法进行全颜面除皱术，首先进行广泛皮下组织分离；接着应用1号丝线折叠缝合切口前1～2cm的SMAS，缝合间距1cm，折叠量约1～2cm，将颈阔肌后缘略做分离，向后上与胸锁乳突肌筋膜缝合；再用4-0可吸收线将眼轮匝肌及口角、鼻翼附近的SMAS分区向外上悬吊缝合。结果两年来临床应用此法为48例进行手术，术后随访6～16个月，无面神经损伤、血肿等严重并发症，受术者对手术效果均满意。并发症包括：颞部秃发3例，暂时性不对称2例，耳后瘢痕增生2例。结论本法克服了单纯皮下分离除皱时疗效不持久的缺点，避免分离SMAS造成的面神经损伤。实践证明，SMAS多重悬吊的全颜面除皱术是一种操作简单、安全、效果持久的除皱术式。     

头皮分层切开和帽状腱膜覆盖减张缝合法预防额颞部除皱术后脱发

目的：探讨额颞部除皱术治疗额颞部皮肤老化的缝合方法及临床效果。方法：设计头皮分层切开和帽状腱膜覆盖减张缝合法，头皮的皮肤和皮下组织与帽状腱膜的切开不在同一水平，将形成的后叶帽状腱膜瓣和前叶帽状腱膜深面减张缝合。结果：在过去的5年中，此缝合方法应用于56例额颞部或全颜面除皱术。术后随访证实此缝合方法能长时间地去除额纹，上提眉毛，并可预防术后出现永久性脱发和凹陷性瘢痕。结论：头皮分层切开和帽状腱膜覆盖减张缝合法能有效地维持手术效果，并预防术后出现脱发和凹陷性瘢痕。     

个体化全面部分区域除皱术

目的:探讨分区域个体化设计除皱术的手术效果。方法:由于患者皮肤松弛和皱纹出现的轻重程度不同以及患者对除皱的要求各异,对患者行分区域个体化设计除皱术。在进行不同区域除皱术的同时还可根据患者意愿行上下眼袋整形术、隆鼻术、隆颏术,颊脂肪垫和颏脂肪切除术等作为面部除皱术的辅助手术。结果:作者总结了自1990年以来施行除皱术145例,其中全面部颈部除皱术25例,全面部52例,颞面颈部除皱术10例,额颞部除皱术32例,单纯颞部除皱术26例,术后效果满意。结论:个体化全面部分区域除皱术安全有效,能满足不同人群的需要,值得推广。     

内窥镜下额颞部除皱术

目的：探讨内窥镜下额、颞部除皱术的临床应用效果。方法：从2003年到2004年，施行内窥镜下额、颞部除皱术28例。采用额部小切口，在帽状腱膜下和骨膜下平面剥离，用缝线和螺钉固定后推的头皮和额部皮肤。结果：28例患者术后效果满意，且脱发、感觉减退和出血等手术并发症少。结论：内窥镜下额、颞部除皱术同传统面部除皱手术相比具有很多优点，可以推广使用。     

除皱术中外耳的处理

在除皱术中通过合适的手术设计和方法，既取得满意的除皱效果，又能防止术后外耳畸形。方法 术前合理设计耳前、耳后切口，术中皮下有限剥离，SMAS下广泛剥离，将颊部松垂组织上提缝合固定的张力放在SMAS层，既有效矫正颊部软组织松垂，又能使耳前耳后切口无张力缝合。结果 1995年至1999年共施行除皱术40例无并发症发生，术后效果满意。结论 除皱术中同时对处耳处理，能取得更加完美的手术效果。     

除皱术中外耳的处理

目的　在除皱术中通过合适的手术设计和方法，既取得满意的除皱效果，又能防止术后外耳畸形。方法　术前合理设计耳前、耳后切口，术中皮下有限剥离，SMAS下广泛剥离，将颊部松垂组织上提缝合固定的张力放在SMAS层，既有效矫正颊部软组织松垂，又能使耳前耳后切口无张力缝合。结果　1995年至1999年共施行除皱术40例无并发症发生，术后效果满意。结论　除皱术中同时对外耳处理，能取得更加完美的手术效果。     

不同颞部除皱术式对秃发影响的比较

目的：比较不同除皱术式对秃发的影响，从而选择一种对秃发影响较小的手术方式，以利在临床中广泛采用。方法：将11例患者分为A和B两组，分别在同一受术者的两侧术区采用不同的除皱术式。将颞浅筋膜浅层除皱术和颞浅筋膜深层除皱术分别与多层次除皱术比较，观察手术效果和对秃发的影响。结果：11例患者均获得良好的手术疗效。A组和B组患者的左侧术区均出现范围大小不等的秃发、头皮结痂等现象。而A组和B组患者的右侧术区均无片状秃发和结痂现象的出现。结论：颞浅筋膜浅层除皱术、颞浅筋膜深层除皱术、多层次除皱术三者比较，经颞浅筋膜浅层分离的除皱术式对秃发的影响最大。而多层次除皱术式对秃发影响最小。     

颜面部手术皮内缝合的美学价值

本文就颜面部手术皮内缝合的美学价值进行了临床搪塞，结果：皮内缝合效果良好，适用于面部任何部位的直线切口或弧度较小曲线切口，受到患者的欢迎，操作要点，切口平整对位，创缘协调一致，减少组织张力，缝线畅通无阻，两端固定良好，本文还就面部皱纹与切口的关系，组织学变化，切口与术后瘢痕的关系，皮内缝合的优缺点进行了讨论。     

除皱术解剖学研究及临床应用

目的 以解剖学研究为基础寻找一种操作简单、安全、效果持久的除皱术式。方法 对6具新鲜尸体进行头面颈部逐层解剖，观察鼻唇沟旁脂肪分布特点及皮肤限制韧带分布，结合临床观察对其功能进行评价。结果面部老化时皮肤、皮下组织、SMAS均出现松弛，但松弛程度不同，各层组织需分别提升；鼻唇沟旁脂肪组织肥厚，有较大活动度，皮下分离不必超过咬肌前缘；面部老化后皮肤限制韧带变得松弛，只需双重折叠缝合面部SMAS便可矫正其松弛。临床应用局限性皮下分离，结合SMAS双重折叠缝合，进行100例除皱术，效果满意，无严重并发症。结论 局限性皮下分离，结合SMAS双重折叠缝合的除皱术是一种简单、安全、效果持久的除皱术式。     

颈阔肌肌瓣在面颈部除皱术中的应用

目的为解决颏颈部老化提供一种新的更有效的方法。方法采用多层次除皱法，耳前分离一舌形SMAS筋膜瓣转移至耳后，缝合固定于乳突区筋膜表面，颈阔肌采用T形瓣法，将两瓣向后上方悬吊固定于乳突区，修剪多余的皮肤。结果临床应用12例，随访6个月至1年，术后效果均满意，无一例出现面神经损伤及术后并发症。结论在面颈部除皱术中，采用改良的SMAS筋膜瓣法加强下颌缘上提作用的同时结合颈阔肌肌瓣悬吊法，使颈部除皱效果大大改善，亦增强了面部除皱术的效果。     

The third suture in MACS-lifting: making midface-lifting simple and safe.

BACKGROUND: The minimal access cranial suspension (MACS)-lift is a short scar rhytidectomy with vertical purse string suture suspension of the facial tissues. It exists in a simple and extended version. The simple MACS-lift achieves a vertical lifting of neck and lower half of the face with two purse string sutures. The action of a third, malar suture gives additional correction of the middle third of the face, and results in the extended MACS-lift. OBJECTIVE: To draw attention to the power and advantages of the 'third' malar suture in the extended MACS-lift in achieving volumetric restoration of the midface, softening of the nasolabial fold and enhancing support of the lower eyelid. METHODS: The core principle of this technique is the use of strong purse string sutures in a pure antigravitational direction for correction of the ageing neck and lower two-thirds of the face. In a simple MACS-lift the neck is corrected by a first narrow vertical purse-string suture. The volume of jowls and cheeks is repositioned in a cranial direction with a second, slightly oblique purse string suture. To achieve better control over the midface an extended MACS-lift is performed by adding a third malar vertical purse string suture between the paracanthal area and the malar fat pad. RESULTS: 557 MACS-lift procedures have been performed by the two senior authors, of which 183 were simple and 374 extended. A retrospective review of this technique revealed high patient satisfaction, only one major complication and a minor complication rate of 6%. Both versions of the technique deliver a vertical vector correction of sagged facial features. The third suture restores the volume of the midface and malar mound and provides strong support of the lower eyelid. CONCLUSIONS: The third suture in the MACS-lift short scar rhytidectomy produces a natural midface lifting through a short scar, with adequate softening of the nasolabial fold and good support of the lower eyelid.     

腹腔镜前列腺癌根治术中不同吻合方法对手术的影响分析

目的：总结两种不同的尿道膀胱颈吻合方法对腹腔镜前列腺癌根治术的影响．方法：2009年1月~2010年3月我科对52例早期局灶性前列腺癌实施经腹膜外腹腔镜前列腺癌根治术,手术采用经腹膜外入路。患者随机分成两组。一组20例采用问断缝合方法。另一组32例采用连续缝合方法。首先将两根15cm长3-0可吸收肠线末端打结固定。予膀胱颈6点处将两针自膀胱浆膜层向黏膜层穿出．线结位于浆膜层外并拉紧,两针分别向9点、3点方向与尿道吻合,最后在12点处将两线打结．完成吻合．结果：52例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。间断缝合组：尿道膀胱吻合用时25～41min,平均32．6min;出现短时间吻合口漏2例,分别为2天和3天;连续缝合组：尿道膀胱吻合用时11～27min,平均17．7min;出现短时间吻合口漏1例,2天后好转。结论：连续缝合方法可缩短手术时间,减少漏尿发生率。     

Long-Term Results of Suture Suspension Platysmaplasty for Neck Rejuvenation: A 13-Year Follow-up Evaluation

Background Neck rejuvenation has been one of the most important components in treatment for the aging face because the neck frequently is the first feature to show signs of aging. Several techniques have been described, but assessment of the long-term effects, although limited, has shown frequent recurrence of neck ptosis and the need for reoperation. The suture suspension technique was introduced 13 years ago. This article presents the long-term results for this technique, illustrating the different neck types, their classification, and their outcomes. Methods For this study, 100 patients who underwent neck rejuvenation using the suture suspension platysmaplasty technique were randomly selected. They represented the four patient groups examined: 5-year group (47 patients), 7-year group (28 patients), 10-year group (19 patients), and 13-year group (6 patients). The key anatomic points for each patient were evaluated preoperatively and postoperatively by five independent observers who analyzed the outcomes with a simplified scoring system (1 to 10 for each anatomic point). The scoring system was used for all the patient age groups and applied to all six key anatomic points of the neck: cervicomental angle depth, mandibular border definition, mandibular angle definition, labiomandibular fold prominence (jowling), mental prominence, and neck width. Patient satisfaction surveys were offered to all patients included in the study. Results All the patient groups showed significant aesthetic improvement (in terms of their scores) for all the anatomic points (1–6) evaluated. Specifically, the long-term effect of the procedure was the most impressive for the cervicomental angle (with improvement ranging from 82% to 95% for the four groups of patients). The least degree of improvement was noted for the labiomandibular fold (with improvement ranging from 12% to 53% for the four groups of patients). The remaining anatomic variables showed an overall improvement ranging from 61% to 85%. Conclusion The suture suspension technique is a safe, reproducible technique that allows for a staged rejuvenation of the neck. As an alternative for the early rhytidectomy candidate, it produces excellent patient satisfaction outcomes with long-term corrections for the majority of patients. As compared with previously described platysmaplasty techniques, suture suspension platysmaplasty has the benefit of endurance. This article documents that the corrections can last at least 13 years with virtually unchanged aesthetic results.     

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。     

个性化处理SMAS层的面部年轻化手术

目的:总结并探讨各种通过SMAS个性化处理达到面部年轻化的除皱手术方法.方法:回顾研究56例面部老化患者的治疗过程,根据患者自身老化程度,行相应区域的SMAS广泛剥离,并以不同方式个性化处理SMAS层,达到对面部软组织年轻化重塑的手术方法和术后效果.结果:术后随访6月～2年,面部软组织均获得显著的年轻化效果,术后56例患者均较满意.结论:根据患者自身的老化程度,以不同方式个性化处理 SMAS层的面部年轻化手术,是安全有效的软组织提升方法,可达到除皱术更为持久的年轻化效果.     

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.     

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。     

肿胀麻醉在中面部和颈部除皱术中的应用体会

目的:探讨在中面部和颈部除皱术中应用肿胀麻醉的作用。方法:本组103例患者,均有不同程度的面颈部皮肤松弛。在静脉全麻和局部肿胀麻醉下进行手术。术中仔细止血,放置负压引流,加压包扎。结果:所有患者术后无血肿形成。有6例患者在眼周、口角、颊部、颈部形成不同程度的瘀斑,5～12天后瘀斑消失。术后随访6～12个月,除皱效果良好。结论:在面颈部除皱手术中应用肿胀麻醉能明显减少术中出血,加快手术速度,是减少术后血肿形成必要的措施。     

Purse-string platysmaplasty: the third dimension for neck contouring

Techniques and concepts for treatment of the aging neck have been evolving since the late 1960s and rely on two-dimensional anterior approximation with lateral imbrication of the platysma with or without submental fat reduction, However, the medial approximation can sometimes give a "boxy" appearance to the anterior neck, especially if anterior shifting of the platysma recurs after platysmaplasty with laxity redeveloping in this midline location. The "purse-string" platysmaplasty (PSP) is a new concept in neck contouring that facilitates an enhanced definition for the cervicomandibular transition to better simulate the well-defined contour of this transition that is present in youth. It aids in the contouring of difficult poorly defined necks and in male patients. The PSP adds a "third dimension" to neck recontouring by invaginating the platysma with a plication suture and pexing the platysma, without incising it, to deeper neck fascia with a technique that adds support and definition to the neck contour. The PSP can be performed in patients undergoing a full rhytidectomy as well as in individuals having isolated neck rejuvenation. The PSP is especially helpful in rejuvenating the male lower face and neck because of the relatively heavier deeper structures of the male neck and the need to enhance definition along the jawline.