鼻唇沟除皱术的局部解剖学与临床应用研究

目的提高鼻唇沟除皱手术效果。方法对１０例成人尸体２０侧鼻唇沟局部解剖及组织切片研究，发现鼻唇沟形成机理，改进手术方法。结果提出表情肌长期反复运动使得皮肤—皮下组织与ＳＭＡＳ—表情肌之间产生剪切应力及向下相对位移，鼻唇沟部位上下两种质地、结构密度相差较大的组织之间产生相对运动，形成了鼻唇沟及鼻唇沟脊。采用新手术方法为１３例患者进行鼻唇沟除皱手术，获得较好的近期及远期效果。结论鼻唇沟除皱手术须在ＳＭＡＳ表面、皮下组织深面正确层次中进行，切断ＳＭＡＳ与表情肌及上唇的联系，解剖复位颧颊部组织，重建颧弓韧带。     

鼻唇沟除皱术的局部解剖学与临床应用研究

目的提高鼻唇沟除皱手术效果。方法对10例成人尸体20侧鼻唇沟局部解剖及组织切片研究,发现鼻唇沟形成机理,改进手术方法。结果提出表情肌长期反复运动使得皮肤—皮下组织与 SMAS—表情肌之间产生剪切应力及向下相对位移,鼻唇沟部位上下两种质地、结构密度相差较大的组织之间产生相对运动,形成了鼻唇沟及鼻唇沟脊。采用新手术方法为13例患者进行鼻唇沟除皱手术,获得较好的近期及远期效果。结论鼻唇沟除皱手术须在 SMAS 表面、皮下组织深面正确层次中进行,切断 SMAS 与表情肌及上唇的联系,解剖复位颧颊部组织,重建颧弓韧带。     

鼻唇沟的解剖学研究

目的 从解剖学角度对鼻唇沟做出准确描述和定义,为解剖学和整形外科学、美容外科学、颌面外科学提供理论基础.方法 对10具（20侧）成人新鲜尸头行福尔马林血管灌注固定后,在10倍手术放大镜下进行形态学观测.结果 （1）鼻唇沟是面中部多脂肪区与无脂肪区的分界.（2）鼻唇沟起于鼻肌横部在鼻翼上缘皮肤的止点,终止于口角降肌在口角外下方皮肤的止点.（3）从解剖学角度可将鼻唇沟分为上、中、下3段,上段（Ⅰ）：为鼻肌横部区,长（20.38±0.74）mm;中段（Ⅱ）：为上唇提肌区,长（17.13±0.57）mm;下段（Ⅲ）：为蜗轴区,长（20.81±0.70）mm.（4）鼻唇沟是7种表情肌在皮肤上止点形成的连线区域,表层肌腱膜系统（SMAS）与组成鼻唇沟的7块表情肌同属同一层次.结论 鼻唇沟是7种表情肌在皮肤上止点形成的连线区域,不分年龄.永恒存在.不同于面部老化形成的鼻唇沟皱褶和面部老化或表情变化形成的鼻唇沟脊.     

鼻唇沟区域解剖学研究

目的对颌面整形美容外科提供形态学依据。方法对２０侧成人新鲜尸头行１０％福尔马林血管灌注固定后,在手术放大镜下进行形态学观测。结果①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为１３ｍｍ,外侧为４５ｍｍ。③鼻唇沟内侧真皮层有肌纤维附着,外侧也有稀少肌束附着。④面部表浅肌肉之间不但存在腱膜,还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论进一步证实了有关ＳＭＡＳ中央腱的理论假说。     

下睑眼轮匝肌悬吊的中面部除皱术

人到中年之后,眶区睑袋的出现及颊区鼻唇沟纹的加深是面部老化的主要表现。目前尚无理想的方法去除鼻唇沟处的皱纹,鼻唇沟皱纹已成为困扰中年女性的难题,所以,矫正中面部老化的研究应将提紧眶、颧区下垂的组织作为主要方面。自2006年9月-2008年6月,笔者采用下睑眼轮匝肌悬吊的中面部除皱技术治疗了25例鼻唇沟皱纹患者,获得了较为理想的临床效果,现报道如下。     

脱细胞真皮基质医用组织补片在鼻唇沟充填中的应用

目的 探索脱细胞真皮基质医用组织补片在鼻唇沟充填术中的应用,并对各种材料充填效果进行初步评价.方法 自2005年3月至2006年6月,经口内入路、松解、剥离鼻唇沟皮下粘连,应用脱细胞真皮基质医用组织补片充填于鼻唇沟凹陷皮下,所有病例随访3个月～6个月.结果 本组23例病人除1例因放置不平取出重放,另1例因放置腔隙出血、青紫,清创后重新放置,其余21例均取得满意效果.结论 鼻唇沟皱纹祛除术,除中面部切开拉紧皮肤筋膜效果肯定外,其他的充填材料虽然有效,但效果不是很满意或容易复发.脱细胞真皮基质医用组织补片用鼻唇沟充填术不仅有良好的组织相容性,手术操作简单、损伤小、易成活等特点,充填效果满意,并且在鼻唇沟参与动态表情方面不会随面部运动显现充填物轮廓,是一种理想的鼻唇沟充填的新型生物材料.     

真皮组织瓣修复中重度鼻唇沟凹陷

鼻唇沟是由面颊部有动力的组织和无动力的组织相互作用而形成。鼻唇沟明显是面部老化的重要表现之一,一旦鼻唇沟变平、变浅,人立即显得年轻、漂亮。既往通常采用中面部除皱来改善,但效果常不尽人意,近年多采用玻尿酸或胶原蛋白填充治疗,但价格又较昂贵,普通工薪阶层难以承受,笔者于2006～2009年间采用真皮组织瓣修复中重度鼻唇沟凹陷,效果满意,现报道如下。     

膨体聚四氟乙烯面部皱纹填充31例

为提高面部皱纹舒平的手术效果，延长效果的持续时间，采用膨体聚四氟乙烯（ｅＰＴＦＥ）对鼻唇沟加深及其他面部皱纹进行填充治疗，在治疗区域边缘做小切口，治疗区域皮下潜行分离形成遂道或腔穴，将修剪成形大小适合的ｃＰＴＦＥ皮下填充材料（ＳＡＭ）软组织补片或ｅＰＴＦＥ缝线植入皱纹下，并将其填充舒平，小切口缝合，在１周内拆线，采用此项技术矫正鼻唇沟加深及面部皱纹共３１例，其中１例（１个植入体）因形成血清肿，不得     

鼻唇沟区域解剖学研究

目的 对颌面整形美容外科提供形态学依据。方法 对20例成人新鲜尸头行10％福尔马林血管灌注固定后，在手术放大镜下进行形态学观测。结果 ①首次对少数国人与鼻唇沟区域相关的各表情肌逐块进行长、宽、厚的显微解剖测量。②测得鼻唇沟内侧脂肪厚度为1．3mm，外侧为4．5mm。③鼻唇沟内侧真皮层有肌纤维附着，外侧也有稀少肌束附着。④面部有浅肌肉宰不但存在腱膜，还由筋膜、肌肉、腱膜共同构成一个立体网状结构。结论 进一步证实了有关SMAS中央腱的理论假说。     

A型肉毒毒素治疗鼻唇沟纹的临床应用

目的研究A型肉毒毒素治疗鼻唇沟纹的方法,以期达到较佳的除皱效果.方法采用A型肉毒毒素行面部肌肉多点注射,3～6个月可重复注射.结果本组28例患者,治疗后48～72 h起效,随访3～6个月,鼻唇沟纹去除效果满意.结论 A型肉毒毒素稀释后定点、定量注射用于治疗鼻唇沟纹,安全有效,操作方法简单,并发症少.     

颞部发际缘保留毛囊锯齿形切口除皱术

目的 探讨颞部发际缘保留毛囊锯齿形切口除皱术在临床中的应用。方法 采用颞部发际缘保留毛囊锯齿形切口、眼轮匝肌悬吊固定、SMAS折叠缝合的方法,提升下垂的外眦角和颧部,去除鱼尾纹,减轻较深的鼻唇沟。结果 本组66例患者,其中58例患者经6个月至3年的随访,除2例患者左侧、1例患者右侧切口前缘无毛发生长外,余者切口愈合佳且前缘有毛发生长隐蔽性好,鱼尾纹明显减轻,下垂的外眦角和颧部、较深的鼻唇沟有较明显的改善。结论 颞部发际缘保留毛囊锯齿形切口、眼轮匝肌悬吊固定、SMAS折叠缝合的手术方法是一种简便、安全、有效且切口隐蔽的较新的除皱方法。     

The extended SMAS facelift: identifying the lateral zygomaticus major muscle border using bony anatomic landmarks

Extended superficial musculoaponeurotic system (SMAS) rhytidectomy has been advocated for improving nasolabial fold prominence. Extended subSMAS dissection requires release of the SMAS typically from the upper lateral border of the zygomaticus major muscle and continued dissection medial to this muscle. This maneuver releases the zygomatic retaining ligaments and achieves more effective mobilization and elevation of the ptotic malar soft tissues, resulting in more dramatic effacement of the nasolabial crease. Despite its presumed advantages, few reports have suggested greater risk of nerve injury with this technique compared with other limited sub-SMAS dissection techniques. Although the caudal extent of the zygomaticus muscle insertion to the modiolus of the mouth has been well delineated, the more cephalad origin has been vaguely defined. We attempted to define anatomic landmarks which could serve to more reliably identify the upper extent of the lateral zygomaticus major muscle border and more safely guide extended sub-SMAS dissections. Bilateral zygomaticus major muscles were identified in 13 cadaver heads with 4.0-power loupe magnification. Bony anatomic landmarks were identified that would predict the location of the lateral border of the zygomaticus major muscle. The upper extent of the lateral border of the zygomaticus major muscle was defined in relation to an oblique line extending from the mental protuberance to the notch defined at the most anterior-inferior aspect of the temporal fossa at the junction of the frontal process and temporal process of the zygomatic bone. The lateral border of the zygomaticus major muscle was observed 4.4 +/- 2.2 mm lateral and parallel to this line. More accurate prediction of the location of the upper extent of the lateral border of the zygomaticus major muscle using the above bony anatomic landmarks may limit nerve injury during SMAS dissections in extended SMAS rhytidectomy.     

Autologous superficial musculoaponeurotic system graft as implantable filler in nasolabial fold correction

OBJECTIVE: To determine whether superficial musculoaponeurotic system (SMAS) graft implantation can improve the appearance of the nasolabial fold. METHODS: Single-blinded cohort study in a private facial plastic surgery practice. Treatment and control patients were selected from those presenting for aesthetic surgery. All patients underwent rhytidectomy with SMAS imbrication by a single surgeon. In addition, treatment patients underwent subcutaneous implantation of excised SMAS strips to the nasolabial fold. Treatment and control patients were matched for any other simultaneous procedures known to affect appearance of the nasolabial folds. Preoperative and postoperative photographs were graded by 3 blinded observers using the Wrinkle Severity Rating Scale to evaluate the nasolabial fold. Postoperative photographs were evaluated approximately 3 months and again 1 year after the procedure. RESULTS: Compared with controls, there was a significant difference in the nasolabial folds of patients undergoing SMAS implantation at the 3-month postoperative evaluation (P = .03; chi(2) = 4.696). This benefit was lost when the results were evaluated 1 year after the procedure (P = .88; chi(2) = 0.0212). CONCLUSION: Superficial musculoaponeurotic system implantation to the nasolabial folds offers modest temporary improvement to this area in patients undergoing rhytidectomy with SMAS imbrication.     

Anatomy of the SMAS Revisited

Despite the relevance of the superficial musculoaponeurotic system (SMAS) in facial rejuvenation a clear anatomic definition of the SMAS is still lacking. Therefore, the morphology of the SMAS in 18 cadavers was investigated using different macroscopic and microscopic techniques. The region-specific anatomy of the SMAS is described in the forehead, parotid, zygomatic, and infraorbital regions, the nasolabial fold, and the lower lip. The SMAS is one continuous, organized fibrous network connecting the facial muscles with the dermis. It consists of a three-dimensional scaffold of collagen fibers, elastic fibers, and fat cells. Two different types of SMAS morphology were demonstrated: type 1 SMAS architecture is located lateral to the nasolabial fold with relatively small fibrous septa enclosing lobules of fat cells, whereas type 2 architecture is located medial to the nasolabial fold, where the SMAS consists of a dense collagen–muscle fiber meshwork. Overall, it was demonstrated that different facial regions show specific morphological characteristics, and thus region-specific surgical interventions may be necessary in facial rejuvenation.     

Observations on a New Concept for Correction of the Nasolabial Fold in Rhytidectomy

Correction of the nasolabial fold has been the challenge constantly faced by the plastic surgeon since the start of attempts at facial rejuvenation. In this paper we intend to show observations which were made in a quite different method of approach to the correction of this challenging anatomic detail. It consists of taking the subcutaneous tissue which forms the nasolabial fold, underneath the same fold, following the law of gravity, without touching or dissecting the superficial aponeurotic muscular system (SMAS) and without using any other artifice which could make it difficult to observe this different procedure. The technique was used on 15 patients who requested facial rhytidectomy.     

Dermofat Graft in Deep Nasolabial Fold and Facial Rhytidectomy

Fat and dermis or the combined tissues are used commonly in augmentation of the nasolabial fold. Guyuron obtained the dermofat graft from either the suprapubic or the groin region. The thickness of the preauricular skin was measured in seven Korean cadavers, five male and two female. We used the dermofat graft out of the preauricular skin remnant after facial rhytidectomy to augment the deep nasolabial fold in a patient. The average thickness of the epidermis was 56 ± 12 µm, the dermis was 1820 ± 265 µm thick, and the subcutaneous tissue was 4783 ± 137 µm. More dense connective tissues, such as SMAS, are seen in the preauricular skin. The dermofat graft was easily obtained and prepared from the leftover preauricular skin after dissection of the lax skin in face lifting. This technique could be employed effectively and successfully to alleviate a deep nasolabial fold and concomitant facial rhytidectomy in an Asian with a thick preauricular skin.     

改良骨膜下综合剥离除皱术100例分析

目的　为了更有效地使面中部老化组织向上提紧复位。　方法　采用扩大的面部骨膜下剥离 ,或加用 SMAS下和皮下多层次综合剥离除皱术。尤其在颧弓部骨膜下进行剥离松解 ,掀起颧弓韧带的起点 ,以解除面中部老化组织上提复位的屏障。　结果　本组 10 0例术后显示恢复了面部各层组织年轻时的解剖关系 ,获得了年轻时鼻唇沟的形态和颌线轮廓 ,效果满意。未出现面神经额支受牵拉损伤的征象。　结论　本法适用于不同年龄 ,尤其是 40岁左右的除皱者     

Treatment of the Aging Face Using the “Round-lifting” Technique

Background: Characteristics of the aging face include not only senescence and flaccidity of the skin, but also sagging of deeper tissues, especially in the fascial and fatty layers. Objective: This study was undertaken to evaluate the different surgical approaches to the aging face, specifically the techniques available for correction of the prominent nasolabial fold, which is a significant sign of facial aging. Methods: Through a total of 7446 cases in more than 40 years of experience in the surgical correction of the aging face, the senior author has emphasized the importance of the repositioning of the skin and the facial soft tissues. After appropriate treatment of the superficial musculoaponeurotic system (SMAS) and the malar fat pad has been completed, adequate placement of the skin flaps is done by rotation, as described in the round-lifting technique, rather than by direct traction. The anatomic basis of this correction is discussed. Results: Traction of the SMAS was found to soften the appearance of the nasolabial fold to varying degrees, but other complementary procedures such as collagen injection or fat grafting often were necessary to achieve a more satisfactory correction. Durability of nasolabial fold correction with simple SMAS traction varied with each individual and his or her unique aging process. Simple traction of the SMAS did not include treatment of the fascial fatty layer. The senior author has included the treatment of the fascial fatty layer in his standard rhytidectomy over the last 2 years, with improved aesthetic results. Again, long-term correction by this technique is related to the aging process, and the final result was deemed superior to treatment of the SMAS alone. Direct excision of the nasolabial fold was performed in patients ranging from 35 to 60 years of age who had extremely prominent folds. In these very select cases, the results were considered satisfactory to both the surgeon and patient, with correction of the fold and acceptable scars. Conclusions: There is as yet no ideal solution for the surgical correction of the naso-labial fold component of the aging face. However, all of the techniques described are considered safe and have precise indications. It should be stressed to the patient that the nasolabial fold is part of the anatomy of the face and that the goal of treatment is to soften the appearance of the fold, not to eliminate it completely.