The Mini Rhytidectomy

A technique is described in which superficial musculoaponeurotic system (SMAS) is plicated from the deep temporal fascia above the zygoma to the level of the earlobe. This procedure requires only an extended preauricular incision. The neck is dealt with by liposuction. This technique is ideally suited to the younger patient requesting facelift and is based on a sound understanding of the anatomy of SMAS. The outcome of 35 patients who underwent this procedure during a 3.5-year period are described. There were no cases of facial nerve paresis or hair loss. There were no cases of skin necrosis but two patients developed small hematomas and one patient complained of a stretched preauricular scar. The mini facelift leads to a satisfactory result in the younger patient requesting rhytidectomy. The technique is simple and safe and can easily be performed on an ambulatory basis. Complications are uncommon and of a minor nature.     

面部蜗轴的解剖及其在美容外科中的重要性

目的介绍面部蜗轴的相关解剖及其在美容整形外科中的重要作用。方法应用计算机检索PUBMED和网络上的相关文献,并限定语言种类为英文。同时检索中国期刊全文数据库的相关文章。结果共检索到包括电子文献在内的英文文章210余篇,中文文章36篇,将符合标准的21篇文献纳入本文的参考文献。结论面部蜗轴是口周肌肉的止点,与鼻唇沟的形成、SMAS、面部表情的表达、发音和语言等关系密切,在美容整形外科中具有重要作用。     

Facelift: Measurement of Superficial Muscular Aponeurotic System Advancement With and Without Zygomaticus Major Muscle Release

Multiple authors have sought ways to improve nasolabial folds, jowls, and jaw lines with face-lifting procedures. The retaining ligaments of the face support facial soft tissue in the normal anatomic position. However, with age, gravitational changes occur, and fat descends into the plane between the superficial and deep facial fascia. Face-lift procedures are designed to lift these sagging tissues. To date, the authors have not found a study that quantifies the amount of vertical advancement gain when a face-lift operation is performed with elevation of the superficial muscular aponeurotic system (SMAS). The movement was studied in 22 rhytidectomy SMAS flaps, and measurements of the vertical advancement were compared using two different SMAS patterns. Elevation and fixation of the SMAS was accomplished under the same conditions, and by the same surgeon. A high SMAS elevation was performed after skin and retaining ligaments were released. Precise measurements were obtained at the medial and lateral edges of the SMAS and before and after a backcut release from the zygomaticus major muscle. The results demonstrated an average improvement in medial flap shift gain of 14.04 mm after the release. There were no complications from these measurements during a 16-month follow-up period. The authors believe this is a particularly interesting finding because it demonstrates and quantifies an increased medial SMAS advancement shift with this maneuver, and therefore improves the cosmetic appearance of the jowls and the midface. Excellent aesthetic results were obtained with a high level of patient satisfaction.     

Avoiding Early Revision Rhytidectomy: A Biomechanical Comparison of Tissue Plication Suture Techniques

Background: Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress. Objective: To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double‐layered running locking (DRL) stitch and multiple horizontal mattress stitches. Methods: Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points. Results: There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P‐value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P‐value of .08. Conclusion: The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long‐lasting, youthful cosmetic result.     

SMAS研究在面部提升术中的临床应用

目的：为了提高面部除皱手术疗效和减少手术创伤，深入探讨面部表浅肌肉腱膜系统（SMAS）的形态学特点，明确SMAS与面神经的关系。方法：12具（24例）成人尸头行大体解剖观察。结果：SMAS分布于面中部，位于下脂肪深层，与颈阔肌直接延续，SMAS与腮腺咬肌筋膜之间有脂肪组织存在。面神经出腮腺后，并非在SMAS深面，而是在咬肌筋膜深面走行。结论：SMAS是面部皮下脂肪和腮腺咬肌筋膜之间的独立组织结构层次。面部多层次剥离除皱术应在颧弓以下0．5cm区域行SMAS剥离。     

Aesthetic parotid surgery: evolution of a technique

Objectives/Hypothesis:

Described is a technique adopted for surgical management of benign parotid neoplasms with an emphasis on facial reconstruction and prevention of postparotidectomy sequelae.

Study Design:

Observation/surgical technique.

Methods:

Patients chosen in the last 10 years with benign parotid neoplasms with the application of this technique.

Results:

In over 150 cases of benign parotid neoplasms performed in the last 10 years by the senior author using this technique, no cases of clinically significant Frey syndrome were identified. Two cases of marginal nerve paresis transpired, but spontaneously resolved within several months. No cases of postoperative hematoma, wound infection, salivary fistula, or hypertrophic scar formation were noted. Subjectively, patient satisfaction was uniformly high relating to scar appearance and facial contour. There have been no local recurrences to date despite six cases of nonviolated tumor capsule abutting the resection margin.

Conclusions:

The application of a superficial musculoaponeurotic system‐platysma flap can alleviate the depression in the retromandibular region following superficial parotidectomy for moderately sized benign neoplasms. It has also shown to help prevent postparotidectomy sequelae of Frey syndrome.