两级递进式提紧浅表肌腱膜系统除皱术

目的探讨两级递进式提紧面部浅表肌腱膜系统（superficial muscular aponeurotic system，SMAS）-颈阔肌除皱术效果。方法颞面颈部皮下小范围分离，颞区颞深筋膜浅面大范围分离，面颈部SMAS-颈阔肌下大范围分离，离断SMAS-颧颊部韧带。分SMAS-颈阔肌瓣为前、后两叶。先提紧前叶：在其前下方最远处以3-0涤纶线横褥式缝1针向后上提紧固定在SMAS的后上切缘处；再在其后上方以褥式缝合固定在颧弓根部骨膜上。后提紧后叶：在其前下方最远处以3-0涤纶线横褥式缝合，向后提紧固定在SMAS瓣的后切缘处；再在其后方横褥式缝合固定在胸锁乳突肌腱膜上。颞支蒂瓣也以两级递进式提紧固定，重建颈阔肌-耳韧带。额部除皱术的操作要点是确切地切除皱眉肌、降眉肌和额肌。结果共施术284例，绝大部分结果令医者与受术者双方满意。仅有9例发生中度（15～20ml）血肿，8例耳后乳突区皮瓣早期血运不良，经及时处理无不良后果产生。结论两级递进式提紧固定SMAS-颈阔肌瓣和颞支蒂瓣，对于提紧表情区，特别是鼻唇沟附近、颌缘前段的软组织松垂，具有比较明显的效果，但是对于静态脸型或（和）动态脸型比较宽大者，上述方法的效果不明显。

Faciocervical rhytidectomy by double-step SMAS tightening

Objective To study the techniques of rhytidectomy by tighting superficial muscular aponeurotic system (SMAS) and platysma. Methods The temporal and faciocervical subcutaneous tissues were seperated in a small region, and the superficial tissue above the deep temporal fascia was sufficiently seperated from the faciocervical tissues under SMAS and platysma with splitting SMAS zygomatic ligament. SMAS faciocervical muscle flap was divided into two parts, front and back. The front part was closely raised: the flap at the distal end of its anterior part was sutured with trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS; at the same time the posterior and superior parts were sutured in trans-mattress method to fix it on the periosteum at the root of the zygoma, and then the posterior part was closely lift, and the distal end of its anterior and inferior parts was also sutured in trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS. Meanwhile, the posterior part was sutured in the aponeurosis of sternoclavicular mastoid muscle. Temporal branch pedicle flap was closely fixed in the same two-step advanced method, and platysma auricular ligament was reconstructed. The most important operational skill of frontal rhytidectomy was to cut corrugator, procerus and frontal muscle accurately.Results From June 2002, we had performed this operation in 284 cases using the above procedures, in which the majority was satisfied by both patients and surgeons. Only 9 cases had minor or intermediate hematoma, and mastoid flap had bad blood supply at the early stage in 8 cases. With proper treatment, no poor complication occurred in those cases.Conclusions This two-step advanced procedure that raises closely and fix SMAS- faciocervical muscle flap and temporal branch pedicle flap has relative obvious advantages for fixing the droopping of the soft tissue near the nasolabial groove and the anterior part of maxillary edge. But, to the indiridual who has a static face and/or dynamic one, this method is not very effective.