面部年轻化方式评述

面部年轻化治疗的理念已演变为预防为主,并早期联合治疗.治疗方式的选择从手术治疗逐渐向微创注射、光电技术发展和演变,手术治疗的指证变得更加严格.更多新技术、新材料的出现给面部年轻化带来了多种选择,但也面临着多种质疑与挑战,需要更多的研究来验证.未来科技创新会引领更新、更好的面部年轻化方式.     

Multimodality aesthetic skin rejuvenation

Patients requesting skin correction and rejuvenation are motivated by a number of clinical problems. Photo damage, abnormal pigmentation or vascularity, textural problems, rhytides, and laxity due to chronological aging are the primary complaints of the majority of patients. Advances in new technology in the past decade have provided the skin correction specialist with new options for treatment. Specialists with multiple technology options then face a new dilemma. What is the best treatment plan for individual patients when many options exist? Over the past five years we have developed an approach to our patients based on an individualized treatment plan consisting of a prescribed series of skin correction treatments utilizing the most specific rejuvenation techniques for each clinical problem. Multimodality aesthetic skin rejuvenation (MMASR) emphasizes the corrective process and utilization of the most appropriate technology for the patient's clinical skin problem as evidenced by the clinical examination. MMASR also takes into consideration patient bias, cost concerns, expectations of treatment, and feasibility of combining different technologies in the same treatment session. Combining skin rejuvenation techniques with surgical rejuvenation is also reviewed as an option for patients with both facial laxity and clinical skin problems.     

The ageing hand. A study to evaluate the chronological ageing process of the hand.

The rejuvenation of the hand has received increased attention recently. Although many different methods have been advocated, only little is known about the chronological ageing process of the Caucasian hand. A qualitative study was performed to evaluate ageing changes. One hundred and forty-three volunteers were enrolled. Standardised pictures of both hands were obtained and evaluated by one observer in regard to wrinkling pattern, visibility of subcutaneous structures and trophic changes. We found that both males and females showed a distinct progression of the wrinkling pattern. Dorsal veins and age spots increased with age whereas the wrinkle-wrinkle distance decreased. Contrary to common belief, significant joint thickening of the proximal interphalangeal (PIP) joint could not be confirmed. Hand ageing is a three-dimensional process that involves osseous and subcutaneous structures as well as the skin. Despite the increased interest in rejuvenation, a baseline study describing the chronological changes with ageing in the hand is still missing. Our findings will help to define the ageing process in Caucasians.     

Standardizing the Evaluation of Treatment Outcomes After Skin Rejuvenation: The Qualitative Scoring System

Current treatments to correct and reverse diseased or aged skin yield widely divergent results. Judging the outcome of such treatments is done in an arbitrary and subjective fashion that is often limited to a patient's feedback or the physician's opinion. This makes it difficult for inter-physician or physician-patient agreement as to the degree of improvement achieved. In an age where skin rejuvenation is being widely practiced, a tremendous void needs to be filled by a system that appropriately evaluates and scores treatment outcomes. Such a system will help physicians communicate better in lectures, help them to better assess the results of various treatment modalities, and facilitate patient-doctor communication. The objective of this paper is to present a standardized scoring system against which skin rejuvenation results can be judged. This system is based on a model of healthy skin that can be defined by practical criteria against which patients can be judged pre- and post-skin rejuvenation procedures. A gold standard for healthy skin (baby skin) is established from a clinical, functional, and histologic perspective. Each patient's skin is compared with the healthy skin model and graded before and after treatment by implementing our scoring system which encompasses objective and subjective criteria. Objective criteria include the following skin characteristics: smoothness, firmness, even coloration, normal texture, and absence of any clinically evident disease. Subjective criteria include proper hydration and normal tolerance, and are not considered in the final scoring. Grading of each element in the scoring system [minimal (1), average (2), maximal (3)], and subsequently the final score [excellent (12 to 15), average (7 to 11), poor (<7)] are done with reference to the healthy skin model defined. The scoring system is novel and easy to use, and can be implemented to help improve communication between physicians and patients as well as during the dissemination of knowledge during medical conferences. In conclusion, treatment end-results can be consistently and more accurately assessed when the scoring system (based on objective criteria and a model of healthy skin) is used. Adopting this protocol will also help in directing our treatment to achieve the best possible results.     

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.     

Facial rejuvenation and light: our personal experience

The treatment of ageing skin remains a very hot topic, and many systems have been reported as having varying degrees of success. Nonablative lasers were developed to avoid the problematic and uncomfortable sequelae following laser ablative resurfacing, and while there was no downtime, there was also poor patient satisfaction. The same was true of the intense pulsed light systems. The use of different modalities in various combinations was found to offer much better results, however, such as a 595-nm pulsed dye laser followed by a 1,450-nm diode laser, and so on, all used at subablative thresholds. The recent entry of blue and infrared tunable plasma light and light-emitting diodes into the skin rejuvenation arena has attracted a great deal of attention. The authors suggest that no single modality can accomplish all the complex events required for effective skin rejuvenation, suggest that combination phototherapy is the best approach combined with an adjunctive epidermal care regimen, and demonstrate their development of this methodology.     

Experience with the AMS 600 malleable penile prosthesis

A malleable penile prosthesis incorporating a stainless steel core has been designed to provide a more rigid prosthesis while still ensuring concealability. A total of 56 patients in our initial series underwent implantation of this malleable penile prosthesis. Our experience indicates that this prosthesis provides ease of implantation, outstanding cosmetic results, and a much simplified and reduced inventory.     

The McCollough Facial Rejuvenation System: a condition-specific classification algorithm

The search for the holy grail in facial rejuvenation is an ongoing quest. Perhaps the reason the "ideal" face-lift has yet to be discovered is a result of three factors. First, the term FACE-LIFT has never been adequately defined. Second, fads and trends play a role in how the operation is taught and performed. Third, surgeons searching for the prototypic technique have not had a way to index the physical signs of facial aging. After 37 years of practicing facial plastic surgery and performing more than 5000 face-lifts, the author determined that replacing chaos with order is long overdue. To achieve this goal, he developed a classification system that is designed to match each potential patient's problems with the most appropriate facial rejuvenation treatment plan and a "language" by which facial rejuvenation surgeons can communicate. Five progressive stages of aging have been identified and matched with recommended courses of face-lifting, blepharoplasty, volume augmentation, and skin resurfacing techniques. Ancillary procedures have also been included when indicated. It is the author's hope that a new classification system will bring order to mounting confusion within the aesthetic surgery professions as well as within the public sector.     

Rejuvenation in the early 20th century

Summary. The first theoretical reflections concerning the relation of hormone production with the ageing process stemmed from Charles Edouard Brown-Sequard (1817–1894). At the age of 72 years he experimented on himself with an injection of animal testicular extract.
The Viennese physiologist Eugen Steinach (1861–1944) gained world-wide acknowledgement for his theory of 'autoplastic' treatment of ageing. He deduced that after vasoligation, an increased incretory hormonal production would ensue following the cessation of the secretory output of the gonads. The first operation was performed in 1918 and resulted in a vasectomy boom over the next two decades.
The Russian Serge Voronoff (1866–1951), working in Paris, was one of the first to transplant testicular tissue from a monkey into a human reproductive gland in 1920. Five years later he had already performed this procedure on 300 patients and attracted patients from all over the world.
In America early efforts of human testicular transplantation were performed by Frank Lydston and V.D. Lespinasse. Steinach's vasoligation was taken over by many American doctors, e.g., Harry Benjamin and Charles H. Chetwood. Among the patients who underwent a rejuvenation operation according to Steinach's method were Sigmund Freud (1856–1939) and the Irish poet and Nobel Prize winner William Butler Yeats (1865–1939). Two caricatures from the German magazine Simplicissimus published in 1927, confirm that the rejuvenation operations were constantly in the limelight of the printed media. From 1935 onwards rejuvenation operations gradually lost their appeal due to the introduction of artificial androgens.     

Facial rejuvenation and concentric malar lift: the FACE RECURVE concept

Cell ageing is responsible for the increasingly creased appearance of our skin. The ageing of the structures of the face is attributed primarily to the effect of gravity on the tissues. The theory expounded below sets out to prove that the main and initial cause of this ageing is the repeated contractions of the mimic muscles. This concept attributes only a secondary role to gravity in the ageing process, which is initially brought about by muscular contractions. An MRI study recently made it possible to demonstrate the anterior convexity curve of the mimic muscles in the young subject. This curve is due to the existence at the back of these muscles of a deep fat pad. In the young subject, the extent of its convexity and its location give a specific, youthful character to the movements, in terms of direction and amplitude, of the facial muscles. With age, the muscle gradually straightens and shortens due to the repeated contractions that expel the underlying fat and increase the tonus at rest. The application of these new findings to the ageing of the face gives rise to new technical possibilities both in the field of medicine and aesthetic surgery. These new techniques have the same targets: segments of the mimic muscles (maintain over time a good muscular curve and a low tonus at rest) and the underlying fatty convexities. As far as medicine is concerned, the combination of botulinum toxin and filling has proved its worth. But two technical elements are new: the filling products must, at several points, be injected primarily behind the muscle to treat the depressions naturally and restore the initial curve of the overlying muscle. A very low number of units (a quarter to one unit) of botulinum toxin must be injected into certain muscles to diminish the tonus at rest of these muscles without diminishing their strength in maximum contraction. In surgery, new possibilities to treat premature ageing include procedures that combine segmentary muscular weakening, micro liposuctions and retromuscular reinjections. The advantage with regard to the medical procedures is greater stability over time and the greater precision of these muscular actions (one third of a muscle can be weakened for example) and the fat reinjections can be more stable. These procedures can be performed under local anesthesia. In cases of more advanced ageing, surgery offers new treatment possibilities that include, for the midface region, the concentric malar lift. It replaces, on the orbital rim, the sub-orbicularis oculi fat that has descended eccentrically as a result of the contractions of the orbicularis oculi muscle. The procedure, using the subperiosteal detachment plane, is therefore stable over time. At the same time, specific muscles are weakened. The aims of restoring fatty volumes and muscular tonuses are thus achieved. Similarly, in the neck, the platysma muscle is specifically weakened. Each area is studied in line with its specificities. For the first time, the skin tension of the facelift has no more to be maximum to treat the relief of the jawl line, of the palpebro malar groove and so on. The skin tension becomes moderate, just to remove the excess of skin. The relief is faded with the specific muscular and fatty action. The name of this new concept is Face Recurve.     

点阵激光应用于面部皮肤年轻化的研究进展

面部皮肤年轻化是当今临床实践和美容领域的热点话题,鉴于手术治疗存在一定创伤,多种非 手术治疗方法受到广泛关注。其中点阵激光属于激光疗法的一种,可分为剥脱性点阵激光和非剥脱性点阵 激光。点阵激光单独应用或与其他治疗方式联合应用的疗效确切,具有良好的应用前景。本文就不同类型 的点阵激光疗法应用于面部皮肤年轻化的相关研究进展作一综述,以期为面部皮肤年轻化需求患者提供更 为全面、有效地医疗美容服务。     

Laser treatment of photodamaged skin

The market for skin rejuvenation has grown vastly during the last decade. Many new laser technologies are now available to the practitioner for the treatment of sundamage. Ablative laser techniques, while currently less popular because of associated protracted healing times and greater risk of scarring and pigmentary change, remain the gold standard in the treatment of severe sundamage, rhytides, and dermatoheliosis. Newer nonablative techniques have increased in popularity and are an effective method of skin rejuvenation for mild to moderate sundamage; however, they are of limited benefit in the treatment of more severe sundamage. New fractional photothermolysis laser technology is a promising method of rejuvenation that combines much of the efficacy of the ablative procedures with the convenience and safety of the nonablative laser procedures.     

鼻唇沟年轻化的最新进展

鼻唇沟是位于颧颊部与上唇之间充当分界线的凹陷性面部线条,随着年龄的增长而逐渐加深,是面部老化的标志之一。鼻唇沟皱纹的治疗是比较困难的,缺乏有效的技术手段以达到疗效持久的目的,并尽可能减少其复发。本文就鼻唇沟年轻化治疗的研究进展进行综述。     

Rejuvenation of the aging face using fractional photothermolysis and intense pulsed light: a new technique

Photoaging is an inevitable occurrence for people who have a fair skin type, who live in a sunny climate, and who enjoy the outdoors. In the past the remedies for this condition were limited to dermabrasion or chemical peeling. Both dermabrasion and chemical peels have hazards of their own. With phenol peels, cardiac and renal toxicity was real concern. There is an increasing demand for an effective and safe laser treatment that repairs photoaged skin. Two treatment modalities, ablative skin resurfacing (ASR), and nonablative dermal remodeling (NDR), have been developed to address this demand. All currently available laser treatments, however, exhibit significant problems, and these laser systems typically operate safely and effectively only over a narrow, patient-dependent treatment range. This study aimed to analyze a new protocol of fractional rejuvenation and intense pulsed light for skin rejuvenation regarding its efficacy, safety, and complications. Twenty-nine patients (27 women and 2 men), age ranging from 40 to 73 years, answered the questionnaire and were included in the study. The use of intense pulsed light after the fractional rejuvenation allows us to enhance the effects of this new procedure especially in skin pigmentation disorders and telangiectasia and to continue to stimulate the deep dermal component.     

Full-face photorejuvenation of photodamaged skin by intense pulsed light with integrated contact cooling: initial experiences in Asian patients

BACKGROUND AND OBJECTIVES: For Asian skin, recent "non-ablative" skin rejuvenation techniques have become the focus of attention for darker complected patients. In our earlier research, we have shown that intense pulsed light (IPL) technology can be applied to Asian skin with a high degree of safety and efficacy. In this study, we performed full-face photorejuvenation using a new IPL device incorporating a 560 nm filter and integrated contact cooling system for the improvement of various symptoms associated with photoaging in Asian patients. STUDY DESIGN/MATERIALS AND METHODS: A total of 73 patients were treated with a series of five or more full-face treatments at 3-4 week intervals using IPL with integrated contact cooling. One month after the third and fifth treatments, the patient and the treating physicians subjectively evaluated improvement in five areas-in pigmentation, telangiectasia, fine wrinkles, skin texture, and over-all improvement. In addition, histological changes were evaluated. RESULTS: Pigmentation improvement, telangiectasia reduction, fine wrinkle reduction, smoother skin texture, and over-all improvement were evaluated according to five grades of percentage improvement. In addition, the subjective rating by the patients and the physicians was averaged, and the combined results were evaluated. After the fifth treatment, a combined rating of greater than 60% improvement was given to more than 80% of patients for pigmentation improvement, telangiectasia reduction or removal, smoother skin texture, and overall improvement. Histological evaluations showed strong staining of Type I and Type III collagen. Complications were minor and transitory, with burning sensations and erythema in only two patients. CONCLUSION: Full-face photorejuvenation for Asian patients using this device is not only effective but is also associated with fewer post-treatment complications than other more invasive modalities. We conclude that IPL photorejuvenation can be the basis for safe and effective skin rejuvenation in Asian patients.     

Refining the goals of oculofacial rejuvenation with dynamic ultrasonography

Volume enhancement/restoration addresses a key component of facial aging and plays an increasingly central role in facial rejuvenation. Advancing our understanding of the structure and morphology of facial aging-and the changes that can be induced with currently-available fillers-will optimize treatment and provide a consensus for appropriate selection of agents and procedures. By elucidating anatomic relationships-particularly dynamic relationships-ultrasonography may facilitate the selection and application of rejuvenation agents and procedures such as lower eyelid blepharoplasty with hyaluronic acid reinforcement of the middle lamella and lateral canthal retinaculum, en glove lysis and dermal fat grafting in the retractor plane for lower eyelid retraction, "posterior girdle" effect with high-viscosity fillers for malar festoons, dynamic analysis of hyaluronic acid within the levator plane for upper eyelid retraction, and serial distribution and integration of autologous fat injection in the lower lid compartments. In this article, the authors describe use of dynamic high-resolution ultrasonography as a tool in defining and improving the outcomes of periocular facial rejuvenation.     

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.     

Tear trough deformity: review of anatomy and treatment options

The lower eyelid can be a challenging area in facial rejuvenation. While lower eyelid bags are commonly the reason that patients present for lower eyelid rejuvenation, a separate entity known as a tear trough deformity may occur in conjunction with lower eyelid bags or alone. In this article, the authors outline the current understanding of the tear trough anatomy; describe multiple classification systems, which provide an objective means of evaluating the deformity and aid the surgeon in choosing appropriate treatment options; and review surgical and nonsurgical techniques for correcting the tear trough deformity. Treatment options include hyaluronic acid filler, fat grafting, skeletal implants, and fat transposition. Each procedure is associated with advantages and disadvantages, and each should be considered more complex than traditional lower blepharoplasty alone. While lower blepharoplasty removes excess fat and may tighten the anterior lamella, tear trough procedures require the addition of volume to the underlying depression. These procedures requiring release of the ligamentous structures and orbicularis (of which the tear trough is composed), as well as fat transposition or fat grafting, are associated with additional complications, which are also reviewed.     

Full Face Rejuvenation in Three Dimensions: A ``Face-Lifting' for the New Millennium

Traditional facial rejuvenation techniques address the face by lifting the soft tissues in one or two dimensions. The face is a tri-dimensional structure and aging occurs in three dimensions, therefore, facial rejuvenation should be done in three dimensions. Sagging of facial soft tissues occurs inferiorly and inferomedially. The ideal reorientation during rejuvenation is in the opposite direction: vertically and supero-laterally. Two other elements not routinely addressed by traditional rejuvenative operations are reduction of skeletal framework and atrophy of soft tissues, particularly subcutaneous fat layer. These are the third dimension of facial aging. By principle, any technique that unfolds, pulls, or lifts produces a flattening effect of the structure being treated. They may give a false impression of augmentation if these tissues are advanced over bony prominences. These stretched out tissues also have a tendency to recoil. For that reason, the author suggests use of structures or methods less susceptible to a stretch relaxation or recoil. A prerequisite to 3-D facial rejuvenation is to perform a 2-D-(bi-dimensional) lift. A third dimension is integrated into it. There are four methods to provide the third dimension: (1) augmentation of the skeletal framework; (2) augmentation of subcutaneous layer with fat injection; (3) imbrication of soft tissues; (4) mobilization and repositioning of fat pockets as pedicle flaps. These methods are not exclusive to each other. One, a few, or all methods could be integrated according to the patient's needs and aesthetic goals. Tridimensional changes in facial rejuvenation can be assessed by a standard photographic comparison, using tools for in-vivo measurements or 3-D digital imaging. 3-D facial rejuvenation is an advanced concept in our pursuit to provide superior results with the more aesthetic, natural, and harmonious youthful look to our patients.