浅表肌腱膜系统多重悬吊的全颜面除皱术

目的探索一种操作简单、安全、效果持久的全颜面除皱术式，以利于推广应用。方法采用浅表肌腱膜系统(superficial musclo-aponeurotic system，SMAS)多重悬吊法进行全颜面除皱术，首先进行广泛皮下组织分离；接着应用1号丝线折叠缝合切口前1～2cm的SMAS，缝合间距1cm，折叠量约1～2cm，将颈阔肌后缘略做分离，向后上与胸锁乳突肌筋膜缝合；再用4-0可吸收线将眼轮匝肌及口角、鼻翼附近的SMAS分区向外上悬吊缝合。结果两年来临床应用此法为48例进行手术，术后随访6～16个月，无面神经损伤、血肿等严重并发症，受术者对手术效果均满意。并发症包括：颞部秃发3例，暂时性不对称2例，耳后瘢痕增生2例。结论本法克服了单纯皮下分离除皱时疗效不持久的缺点，避免分离SMAS造成的面神经损伤。实践证明，SMAS多重悬吊的全颜面除皱术是一种操作简单、安全、效果持久的除皱术式。

Multiple suspension of superficial musclo-aponeurofic system for complete face lift

Objective To find a procedure for facial rejuvenation w hi ch is simple, safe with lasting aesthetic results and to make it popularized eas ily. Method We performed complete face lifting first by extens ive subcutaneous detatchment. Secondly we plicated the superficial musclo-apon eurofic system (SMAS), including the superficial temporal fascia and the SMAS su perior to the parotid fascia, 1 cm anterior to the incision line by No.1 silk su tures. The distance of plication was about 1-2 cm. Interval of suture was 1 cm. After dissection under the platysma for 1-2 cm, we pulled the posterior edge of platysma postlaterally, and sutured it to the sternocleiodomasoid fascia. The n we suspended the obiculoris oculi and the SMAS lateral to the nasoalar and com issura oris by 4-0 absorbable surtures. If necessary, we plicated the platysma near the anterior border of the detachment. Results We performe d rhytidectomy on 48 patients by extesive subcutaneous detachment and multiple S MAS suspension in the past two years. The results were satisfactory after 3-16 months follow -up. There were no serious complications (including injury of fa cial nerve and skin necrosis and severe bleeding which needed another operation to clean up the hematoma). The aesthetic results were lasting. Complications in cluded temporal hair loss in 3 cases, in which one patient accepted hair transpl antation, and in another two patients alopecia zone were incised and sutured pri marily. Two cases had scar hyperplasia behind the ear, who required revision. Tw o cases had temporary asymmetry which were given no treatment and recovered 3 mo nths after operation. Conclusion This procedure overcomes the s hortcoming caused by simple subcutaneous rhytidectomy, in which improvement is t emporary. The SMAS is well perserved to avoid the facial nerve injury, the most severe complication of rhytidectomy. Therefore, rhytidectomy by extensive subcu taneous detachment and multiple SMAS suspension is a simple and safe procedure w ith lasting aesthetic results.