内镜在除皱术中的应用进展

除皱术是面部年轻化的主要手段之一，已有百余年的历史。20世纪70年代以来，由于基础理论和手术技巧研究的进展，使除皱术有了长足的进步。20世纪90年代初，随着内镜技术在临床医学各科的普及，美国医师率先将其应用到面部除皱手术当中，开创了微创外科技术在美容整形外科的应用。由于其同传统手术相比具有切口小、创伤轻、术后恢复快、瘢痕小等优点，从一开始就得到热烈响应和迅速推广，并在短短十余年中获得了长足的进展。     

探讨多切口在除皱时的解剖学意义

目的　分析面部老年性改变的解剖学特征的分析 ,在除皱术中应用多切口 ,以充分矫正老年性变化带来的解剖学改变 ,达到自然、持久的年轻化效果。方法　行除皱术同时应用下睑缘切口、颏下切口或鼻翼缘切口以矫正面部老年性解剖学改变。结果　自 1999年来完成手术 18例 ,随访半年至一年 ,效果满意。结论　在除皱术中应用多切口可获自然、持久的术后效果 ,更有效地从面部解剖学角度使面部年轻。     

下颌角弧形截骨联合SMAS悬吊面部提升术

目的:探讨经除皱术耳前切口行下颌角弧形截骨并同时悬吊SMAS层提升面中部的手术方法。方法:回顾研究9例下颌角肥大的治疗过程,分析并总结采用耳前切口入路行下颌角弧形截骨,同时行SMAS层悬吊的面中部除皱术,对面部骨骼及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个月～2年,面部的骨骼及软组织均获得显著的年轻化效果,术后9例患者均较满意。结论:下颌角弧形截骨联合SMAS悬吊的面部提升术,在改变面部骨性轮廓的同时,最大限度的提升了面部松弛的软组织,是同时对面部骨骼和软组织年轻化重塑的理想方法。     

除皱术中多切口应用的探讨

目的通过分析面部老年化的解剖学特征,在除皱术中应用多切口充分矫正面部老年化所带来的解剖学的改变,以达到年轻化效果.方法行除皱术同时应用下睑缘切口、颏下切口或鼻翼缘切口以矫正面部老年化解剖学的改变.结果自1999年以来完成手术18例,随访半年至1年,效果满意.结论在除皱术中应用多切口可更有效地矫正面部老年化解剖学的改变,以获自然、持久的术后效果.     

除皱术中多切口应用的探讨

目的　通过分析面部老年化的解剖学特征 ,在除皱术中应用多切口充分矫正面部老年化所带来的解剖学的改变 ,以达到年轻化效果。方法　行除皱术同时应用下睑缘切口、颏下切口或鼻翼缘切口以矫正面部老年化解剖学的改变。结果　自 1999年以来完成手术 18例 ,随访半年至 1年 ,效果满意。结论　在除皱术中应用多切口可更有效地矫正面部老年化解剖学的改变 ,以获自然、持久的术后效果。     

面部年轻化手术体会

目的:总结面部年轻化手术的经验,基于求术者个性化差异行手术整复,以期获得良好的美容效果。方法:回顾2000年初～2006年2月对480例患者实施面部年轻化手术的情况。根据患者的要求及衰老表现分别进行了额部、额颞部、颞部、中面部、全面部年轻化手术和/或下睑成形术。①额部除皱术采用冠状切口、发际切口,或者直接在额部皱纹处做切口,进行帽状腱膜下和骨膜下分离,处理额肌、皱眉肌和降眉肌;②颞部年轻化手术采用颞区发际内切口,颞浅筋膜下分离,向外上方向悬吊眼轮匝肌;③中面部年轻化手术,手术切口起于耳轮角,沿耳屏环绕耳垂到耳后,行皮下和SMAS下分离,分别对皮肤和SMAS瓣进行不同方向的悬吊、固定;④下睑成形术采用传统的皮肤入路眼袋成形术手术切口;眼轮匝肌下分离到眶下缘,切开眶隔,重新固定眶脂肪和眶隔在眶下缘的位置;⑤全面部年轻化手术联合应用上述几种手术方式。结果:术后随访3￣24个月,手术效果满意,并发症少,达到了恢复年轻化面容的目的。结论:针对不同衰老表现,通过矫正容量变化,复位易位的组织,合理提升下垂组织,可达到恢复面部年轻化面容的目的。     

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.     

吸脂术在下面部年轻化手术中的应用

目的：探讨一种应用吸脂术的下面部年轻化整形美容手术方法。方法：临床79例患者在下面部年轻化手术中应用吸脂术，其中单纯下面部吸脂术45例，下面部除皱术结合吸脂术34例。结果：79例患者中随访68例，随访时间6个月至3年。单纯下面部吸脂术38例，效果满意32例，改善6例；除皱术结合下面部吸脂术30例，效果满意29例，改善1例；未出现皮肤坏死、面神经损伤等并发症。结论：下面部吸脂术具有面部年轻化的效果，且安全简便、恢复快，无切口瘢痕。在传统的面部除皱术中结合下面部吸脂术，可减少手术并发症，增加面部年轻化效果。吸脂术在下面部年轻化手术中是一种行之有效的方法，可广泛推广。     

埋线提升面部年轻化的研究进展

埋线提升是利用一种特制的锯齿状缝线,通过微创手术方法将线材埋置于皮肤与表浅肌肉筋膜系统组织层中,通过缝线的锯齿状"突"对组织的嵌入"锚"着提拉产生形变效应,改善面部、胸部、上臂、臀部等部位松弛的皮肤。随着整形美容外科微创技术的发展,埋线提升术被越来越多的应用于提升面部年轻化治疗,并取得了较好的效果。笔者将从面部衰老相关的解剖学研究、埋线提升的原理、面部年轻化手术的发展和线材的演变来阐述埋线提升面部年轻化的研究进展。     

鱼骨线联合颞部小切口除皱术在面部年轻化中的应用

目的观察鱼骨线联合颞部小切口除皱术在面部年轻化中的临床效果。方法自2016年10月至2018年4月,对41例面部皮肤松弛的患者应用鱼骨线联合颞部小切口除皱术。分别于术前和术后6个月进行标准拍照,由2名非手术医师采用盲法评估鼻唇沟、"木偶纹"及中面部皮肤松弛衰老的改善程度,并对患者的满意度进行分析。结果术后随访41例患者5～25个月,平均(12.95±6.29)个月。鼻唇沟、"木偶纹"、中面部皮肤松弛等衰老症状均得到明显改善,手术切口较隐蔽,术区无出血、感染、鱼骨线外露等并发症发生。患者满意度为92.7%,其中非常满意为24.4%;满意为68.3%;3例认为效果一般。术前、术后比较鼻唇沟改善程度(P=0.001)及中面部皮肤松弛衰老改善程度(P=0.010),其差异均具有统计学意义。"木偶纹"改善程度(P=0.271),其差异无统计学意义。结论应用鱼骨线联合颞部小切口除皱术对改善面部皮肤松弛效果较好,尤其适合鼻唇沟和中面部衰老的年轻化,且手术安全可靠,患者满意度较高。     

Male face-lift

Middle-aged men represent an emerging group expressing an interest in facial rejuvenation procedures. One must understand the complex differences in motivation, psychosocial factors, and aspects associated with anatomy and facial aging that are unique to men. To maximize postoperative results and increase patient satisfaction, the facial plastic surgeon must adjust perioperative management and surgical techniques when performing a male face-lift.     

The subperiosteal rhytidectomy: the third-generation face-lift.

The subperiosteal frontal rhytidectomy described by Tessier was the departure point for a new approach for facial rejuvenation. Psillakis described the subperiosteal face-lift "as an improved concept for correction of the aging face." However, this technique has a high incidence of frontal nerve injury and because of the limitations in the subperiosteal dissection, the facial soft tissues cannot be lifted reliably to the desired position. Other authors have repeated the Psillakis experience with the same frustrations and complication rate. In this report, I describe the evolution of the subperiosteal face-lift and the significant modifications that I have introduced, making this procedure safer and improving results in the degree of facial rejuvenation. My approach of subperiosteal rhytidectomy has been used in 34 patients with a minimal complication rate. This technique also addresses the rejuvenation of the central portion of the face and the restoration of tension of the facial mimetic musculature not obtained by current brow/face-lift procedures.     

Midface lifting: current standards

The most significant factor contributing to the overall change in the appearance of an individual's facial features over time is age. This process of gradual structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individual's lifetime. Here, we discuss how the approach to midface rejuvenation has evolved over time owing to our increased understanding of the aging process. In addition, we discuss specific techniques that we use that have helped us achieve more natural and lasting results.     

Submalar augmentation: a procedure to enhance rhytidectomy

The use of submalar augmentation in facial rejuvenation surgery satisfies the need for enhancement of the midface to obtain longer lasting and better results from rhytidectomy. Submalar augmentation is a new surgical technique that positions anatomically designed silicone implants over the midthird of the face. It provides the appearance of restoring midfacial soft tissue and reduces the depth of anterior facial folds. The enhanced underlying bone structure avoids exerting excessive tension on the skin during face-lift surgery, thus preventing distortion of midfacial architecture. Submalar augmentation is a procedure that has been used as a supplementary enhancement to rhytidectomy in 56 patients over six and one-half years. Only minimal complications have been reported, all of which have been satisfactorily resolved. To date, no implant has been rejected or permanently removed. In our experience, when performed in conjunction with rhytidectomy, submalar augmentation has greatly enhanced and prolonged the results of face-lift surgery, and has significantly increased patient satisfaction.     

Subperiosteal deep plane rhytidectomy: the composite midface lift

Techniques for facial rejuvenation have long involved specific remedies for each facial segment affected by the aging process. Traditional facial rejuvenation techniques have addressed the anterior neck and platysma complex as well as the acquired jaw deformity. These techniques often left the nasolabial complex and the "infraorbital hollow" un-addressed. Modern techniques, including the composite rhytidectomy, the subperiosteal midface lift, and the deep-plane and the triplane rhytidectomy, have contributed to redefining the challenge of correcting the problem of the orbicularis-malar soft tissue complex descent and as such focus on a particular segment of the facial rejuvenation. This evolution of the facelift demonstrates that one size does not fit all and that surgeons should consider their rejuvenations to be not a generic facelift but a midface, lower face, and neck lift. This concept has evolved into our appreciation of distinct surgical zones. This is especially important in males, and adjunctive techniques such as the ones we describe may add benefit and enhance the final result in male patients. As discussed, the male anatomy, because of its increased surface area and weight, is more difficult to gain leverage with in rejuvenation procedures. The author describes his preferred technique for facial rejuvenation in males, the subperiosteal deep plane rhytidectomy (SPDPR), which combines a deep plane rhytidectomy with a subperiosteal dissection. Although combining subperiosteal "release" of midfacial anatomy has been reviewed by other authors, the combination of subperiosteal release and deep-plane rhytidectomy has not been previously reported or advocated. The operative technique, complications, and results of this combined technique are reviewed. The procedure as described is used as an isolated procedure for midfacial descent as well as an incorporated technique when completing a "full" rhytidectomy.     

Rejuvenation of the aging neck

Patients seeking rejuvenation of the face are influenced by youthful faces commonly seen in the media and entertainment world. Although standards of beauty evolve over time, classical facial features such as symmetry, high cheek bones, and an angular jaw-neck line remain as ideals. As the human face ages, a relatively consistent series of anatomic events occurs. Although the rate of change varies from person to person, the process of facial aging is predictable. This process involves a loss of tone of the elastic fibers of the face, resulting in sagging of the skin and soft tissues of the face and neck. Additionally, aging of the lower face often includes ptosis of the soft tissues of the chin and banding or cording of the muscles of the anterior neck. Aesthetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues. To accurately treat facial aging, an individualized diagnosis and anatomically based problem list is compiled. This should include analysis of the skin quality, bone structure, amount and distribution of subcutaneous fat, and relationship of the superficial muscles to the overlying skin. After a detailed diagnosis is made, a surgical treatment plan is outlined to improve the face and restore a youthful appearance. This article describes the applied anatomy associated with facial aging and explains the author's specific techniques to obtain a natural postoperative appearance. Avoidance of common problems associated with aging face surgery is emphasized.     

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.     

Current techniques in midface lifting

Midface elevation is an evolving procedure.The current trends toward less manipulation of the midface soft tissues with less visible incisions and use of endoscopic and percutaneous techniques have allowed for the rejuvenation of the facial features of younger patients. The creation of a natural, unoperated, and youthful appearance to the midface are readily accomplished with these newer procedures. For patients with significant facial skin excess, the endoscopic and percutaneous or transblepharoplasty procedures can be combined with a traditional face or neck lift to restore a youthful facial and neck harmony and balance.     

The extended minimal incision approach to midface rejuvenation

Recent major advancements in comprehensive facial rejuvenation have focused on management of midfacial aging. Multiple techniques have been described to treat the aging midface; the mere nature of so many approaches is evidence that no one technique has prevailed. Although the nasolabial region remains a challenge to correct, the approach described herein provides comprehensive rejuvenation of the midface, lateral brow, and jawline. The technique is performed via a minimal incision brow-lift approach and has been performed (with minor modifications) by the senior author in more than 650 patients over the past 9 years. The technique has proven to be safe, reliable, and effective.