广泛多层次剥离复合除皱术

目的矫正鼻唇沟过深、颌下线中断等面中下部老化表现.方法行面中下部超过鼻唇沟的广泛皮下及SMAS下剥离,将掀起的SMAS瓣,依耳轮脚及耳垂下极水平分成三份,分别向上、后、乳突方向悬吊,对松弛的眼轮匝肌进行紧缩和悬吊,将颧脂肪垫向外上方向牵拉固定于颧骨体表面筋膜,去除部分过度增厚的颧脂肪垫.结果12例面中部老化明显者,手术后随访5个月至3年,效果良好,无面瘫、血肿等并发症.结论该术式对鼻唇沟面中下部老化表现矫正十分安全有效.     

广泛多层次剥离复合除皱术

目的；矫正鼻唇沟过程，颌下线中断等面中下部老化表现。方法：行面中下部超过鼻唇沟的广泛皮下及SMAS下剥离，将欣起的SMAS瓣，依耳轮脚及耳鼻下极水平分成三份，分别向上、后、乳突方向悬吊，对松弛的眼轮匝肌进行紧缩和悬吊，将颧脂肪垫向外上方向牵拉固定于颧骨体表面筋膜，去除部分过度增厚的颧脂肪垫。结果：12例面中部老化明显者，手术后随访5个月至3年，效果良好，无面瘫、血肿等并发症。结论：该术式对鼻唇沟面中下部老化表现矫正十分安全有效。     

颧颊部解剖学研究与"佛手"式颧颊纤维脂肪垫连续悬吊术矫正面中下部老化松垂

目的 研究确定人颧颊部皮下组织层次中脂肪组织层形态结构及其固定形式;探索面中下部年轻化手术方法.方法 ①尸体标本颧颊部被覆软组织结构解剖学研究;②以PTFE线作为悬吊材料,采用"佛手"式颧颊纤维脂肪垫连续悬吊,矫正面中下部老化性松垂形态.结果 解剖学研究显示,面中下部皮下组织层中存在不同于脂肪组织的脂肪与纤维的混合结构组织层-纤维脂肪垫层.其分布于颧颊部的皮下脂肪层和SMAS层之间,分隔了SMAS层与皮肤的联系.该层与皮肤以规律密集的"篱笆"样短小纤维韧带致密连结,与SMAS层及深部组织间以簇状粗大"真性韧带"及"幕墙"样纤维韧带疏松连结.牵动纤维脂肪垫结构,可带动其上皮肤同步移动从而影响面中下部形态,而牵动SMAS层则不能有效地移动表层皮肤.临床应用"佛手"式颧颊纤维脂肪垫悬吊术矫正老年面中下部松垂172例,其中27例随访1年,11例随访2年,效果满意.结论 颧颊部皮下组织中存在纤维脂肪垫层,该层又可分为两部分,即颧纤维脂肪垫和颊纤维脂肪垫.该纤维脂肪垫层是形成面中下部衰老形态的主要结构层次.也是影响SMAS层上提面中部效果的主要原因.以PTFE线"佛手"式连续悬吊颧颊纤维脂肪垫上提手术,可同时均匀上提面中下部、睑外侧部软组织,从而有效地改善面中下部老化松垂的形态.用1-0 PTFE线进行悬吊可以减少"切割"现象,延长手术效果的维持时间.     

颧颊部解剖学研究与“佛手”式颧颊纤维脂肪垫连续悬吊术矫正面中下部老化松垂

目的研究确定人颧颊部皮下组织层次中脂肪组织层形态结构及其固定形式；探索面中下部年轻化手术方法。方法①尸体标本颧颊部被覆软组织结构解剖学研究；②以盯FE线作为悬吊材料，采用“佛手”式颧颊纤维脂肪垫连续悬吊，矫正面中下部老化性松垂形态。结果解剖学研究显示，面中下部皮下组织层中存在不同于脂肪组织的脂肪与纤维的混合结构组织层一纤维脂肪垫层。其分布于颧颊部的皮下脂肪层和SMAS层之间，分隔了SMAS层与皮肤的联系。该层与皮肤以规律密集的“篱笆”样短小纤维韧带致密连结，与SMAS层及深部组织间以簇状粗大“真性韧带”及“幕墙”样纤维韧带疏松连结。牵动纤维脂肪垫结构，可带动其上皮肤同步移动从而影响面中下部形态，而牵动SMAS层则不能有效地移动表层皮肤。临床应用“佛手”式颧颊纤维脂肪垫悬吊术矫正老年面中下部松垂172例，其中27例随访1年，11例随访2年，效果满意。结论颧颊部皮下组织中存在纤维脂肪垫层，该层又可分为两部分，即颧纤维脂肪垫和颊纤维脂肪垫。该纤维脂肪垫层是形成面中下部衰老形态的主要结构层次。也是影响SMAS层上提面中部效果的主要原因。以PTFE线“佛手”式连续悬吊颧颊纤维脂肪垫上提手术，可同时均匀上提面中下部、睑外侧部软组织，从而有效地改善面中下部老化松垂的形态。用1-0PTFE线进行悬吊可以减少“切割”现象，延长手术效果的维持时间。     

颧脂肪垫悬吊联合皮瓣递进减张法行面中下部除皱术

目的：探索一种有效而安全的面中下部除皱方法。方法：采用发际缘-耳前-耳垂下-耳后切口,在SMAS筋膜浅层广泛分离面部皮瓣。范围：由切口向前至外眦、颧骨、近鼻唇沟,向下至下颌缘下2横指,显露颧脂肪垫,用缝线将颧脂肪垫向后上方、后方悬吊拉紧,将皮瓣通过递进减张法向切口方向舒平拉紧,剪除多余皮肤,缝合伤口,面部适当加压包扎。结果：随访6个月～2年,16例术后面中下部再年轻化效果明显,未发生皮肤坏死、面神经损伤、皮下血肿等并发症,切口瘢痕隐蔽。结论：该方法对面中下部除皱效果显著、确切,而且具有简便、安全等优点。     

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。     

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.     

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。     

眉部和下睑缘切口对颧脂肪垫及眼轮匝肌悬吊的中面部年轻化效果分析

目的探讨眉部和下睑缘切口对颧脂肪垫及眼轮匝肌悬吊的中面部年轻化效果。方法以72例进行面中部整形者为观察对象,应用眉部和下睑缘切口对颧脂肪垫及眼轮匝肌悬吊法进行手术。分析术后1周、3个月、6个月和1 a的治疗效果,观察有无外眦变形、下睑外翻或退缩、瘢痕增生等并发症。结果患者均未出现外眦变形、下睑外翻和面神经损伤并发症。4例患者下睑外眦切口末端有少许猫耳,3~6个月后自行消失。2例术后1周时出现双侧鼻唇沟不对称,采用脂肪填充后被矫正。3例患者术后外眦水肿较明显,经射频治疗后逐渐恢复。3例患者早期诉眼部干涩,3个月后症状消失。其余患者效果满意,中面部老化状态得到良好矫正,且无其他并发症和继发畸形出现。结论眉部和下睑缘切口对颧脂肪垫和眼轮匝肌悬吊处理效果满意,手术切口小且无面神经损伤,有效提高中面部的年轻化美容效果。     

颧脂肪垫的解剖学研究与老化分析

目的 通过对颧脂肪垫的解剖学研究,探讨面中部老化机制.方法 选取10具甲醛固定后的成人尸头标本20侧,应用显微手术器械在10倍解剖显微镜下逐层解剖,仔细观察面中部纤维,区分不同区域皮肤与皮下脂肪层的结合方式,对其进行标记,注意其位置及范围,观察脂肪垫的范围、形状、位置,记录支持结构的解剖学位置并照相保存.结果 ①颧脂肪垫近似一个三角形,底部沿下睑眼轮匝肌支持韧带上层呈一弧线;内侧界为鼻唇沟和口下颌沟;外侧界从颧大肌在颧骨表面的止点区到达口角外下方或下颌缘.②颧脂肪垫系由较韧的纤维结缔组织组成的网状结构,其间有较大的脂肪颗粒;沿鼻唇沟水平方向牵拉,使颧脂肪垫纤维更加紧密,垂直方向牵拉,使颧脂肪垫纤维变得疏松,纤维之间距离增大.③在面部皮肤层和颧脂肪垫之间存在4个连接紧密的区域,从内向外分为Ⅰ区、Ⅱ区、Ⅲ区和Ⅳ区,Ⅰ、Ⅱ、Ⅲ区为与鼻唇沟平行的长条形,Ⅳ区为不规则的 四边形.④颧脂肪垫与深层组织固定的结构有6条韧带:眼轮匝肌支持韧带上、下层、颧弓韧带、颧骨皮韧带、颧骨下皮韧带、颈阔肌皮肤前韧带、颊上颌韧带.结论 颧脂肪垫与皮肤连接紧密,而与深层组织只有6条韧带相连接,随着时间的推移,颧脂肪垫支持韧带的松弛导致颧脂肪垫随着皮肤的老化下垂而下移,从而形成特征性的衰老面容.     

微笑的解剖学基础与面中下部年轻化

目的 从解剖学角度研究微笑产生的机制,研究微笑状态下面中下部老化特征的变化.方法 对10具（20侧）成人新鲜尸头行甲醛溶液固定后,在10倍解剖显微镜下对鼻唇沟区域进行形态学观测,并根据50例门诊医师和患者的照片观察,对静态与微笑时面中下部老化特征的变化进行对比.结果 （1）鼻唇沟是面中部多脂肪区与无脂肪区的分界,外侧为颧脂肪垫.（2）鼻唇沟是7种表情肌在皮肤上止点形成的连线区域.（3）微笑时,使鼻唇沟脊深度加深、延长,颊沟加深、延长,颊纹加深、延长.（4）微笑时,颧脂肪垫上移,泪槽畸形：64％消失、36％变浅,形态得到改善;眶颊联合：水平部100％消失,垂直部74％变浅,26％无变化,外观得到改善;颊中沟：78％消失,22％变浅得到改善;口下颌沟：Ⅲ度100％消失,Ⅱ度100％消失,Ⅰ度74％消失,26％变浅,外形得到改善.下颌缘流畅：18％得到改观,82％无变化.结论 肌肉收缩产生微笑,鼻唇沟是微笑的起点;微笑可以使颧脂肪垫上移,能掩盖一部分面中下部老化特征,使人显现年轻化效果.     

Surgical anatomy of the midface as applied to facial rejuvenation

Distinct anatomic structures provide attachments and support for the soft tissues of the central third of the face. Over time, laxity of these structures and descent of the malar fat pad contribute to the characteristic changes seen in the aging face. Mobilization of the midface soft tissues to allow reelevation of the malar fat pad is an effective method of rejuvenating the midface. A focused anatomic dissection of 8 fresh cadaver heads was performed to evaluate 4 soft-tissue structures that control mobilization of the malar fat pad. Specifically, the orbicularis retaining ligaments, the lateral orbital thickening, prezygomatic space, and zygomatic cutaneous ligaments were evaluated. The anatomic relationship of these structures explains the visible effect of aging in the central third of the face. In addition, it correlates with the outcomes of surgical rejuvenation as demonstrated in clinical cases. Effective repositioning of the malar fat pad was found to be reliably obtained by release of the lateral orbital thickening and the orbital retaining ligaments. Suspension of the malar soft tissue is in a cephalad direction after release of these structures recreates a youthful facial architecture. Motor nerve injury is less likely to occur with this technique than with traditional lateral facelift approaches. The conclusion reached is that ptosis of the malar fat pad can be corrected safely and effectively utilizing either the lower lid blepharoplasty approach or temporal prehairline incision. These findings were consistent with clinical data from facial rejuvenation procedures.     

Facial Rejuvenation with SMASectomy and FAME Using Vertical Vectors

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.     

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。     

Clinical analysis of malar fat pad re-elevation

Primary suture suspension of the malar fat pad has been described as a safe and simple component of global facial rejuvenation. This review evaluates the efficacy and indications for re-elevation of the malar fat pad elevation. A retrospective review of the medical records of patients who underwent malar fat pad elevation was performed between 1994 and 2000. Of 472 procedures, 14 involved re-elevation of the malar fat pad. These cases were examined for complications, risks, and results. Secondary midface elevation was performed using a subcutaneous approach to the malar fat pad through a pre-hairline incision and vertical suspension of the malar fat pad to the temporoparietal fascia. The indications for re-elevation of the malar fat pad included nasolabial asymmetry, malar fat pad malposition, and malar fat pad asymmetry. Primary elevation of the malar fat was performed in 472 patients. Fourteen of these patients had suboptimal results that necessitated re-elevation of their malar fat pads. Their average age was 57.5 years. Of the 14 malar fat pad elevations, 12 included SMAS procedures, nine were combined with platysmal plication/submental lipectomy, six with forehead lift, and three with eyelid procedures. The average interval between original malar fat pad elevation and the re-elevation was 40 months. Average follow-up was 15 months. Complications were seen in five patients, with the most significant being persistent eye irritation. Two patients had some minimal scar hypertrophy, which was self-limiting. Minor preauricular skin slough developed in one patient. Restoration of the youthful position of the deep structures in patients with a previous mid-facelift was successfully achieved by re-elevating the malar fat pad in a vertical direction. Re-elevation of the malar fat pad demonstrated effective and reliable long-term results. It is appropriate in the small number of patients who require revision or improvement of midface rejuvenation using the malar fat pad suspension technique.     

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.     

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。     

Midfacial effects of the deep-plane facelift

Rejuvenation of the midface is a challenge in facial plastic surgery. To this end, several techniques have been developed to address the changes seen in the midface with aging. Specifically, ptosis of the malar fat pad and deepening of the nasolabial fold contribute to the aesthetic changes that characterize midfacial aging. The history of modern facelifts and deep-plane facelift techniques to correct the nasolabial fold are presented.     

面中下部年轻化的综合治疗

目的:总结对面中下部衰老应用多部位联合手术进行综合性治疗的效果和经验。方法:于2008年6月～2013年4月,对于32例鼻唇沟加深患者采用颧袋脂肪抽吸术、自体浅表颗粒脂肪移植、联合眶隔脂肪释放的睑颊沟填充术的综合手术方法。结果:本组共32例患者,术后均随访3～24个月,鼻唇沟变浅,睑颊沟不明显,面中下部老化得到明显改善,效果满意。结论:针对以鼻唇沟加深为主要表现的面中下部衰老患者,应用多部位联合治疗,通过周围脂肪组织异位,局部脂肪容量变化,合理提升下垂组织,达到面中下部年轻化的美容目的。