摘要
目的:探讨面部除皱术在皮肤老化症整形外科治疗中的应用。方法:回顾性分析2005年10月至2009年4月行面部除皱术求美者17例。其中男性1例,女性16例;年龄为42~64岁,平均年龄53.47岁。上面部除皱术在帽状腱膜下层剥离,并切断部分皱眉肌、降眉肌,祛除部分额肌提紧皮肤,达到面上部年轻化目的。中面部除皱以提紧松弛下垂的面中部组织为目的。据除皱术受术者面部皮肤老化部位,选择性实施下睑袋成形术等辅助术式操作。结果:运用面上部或面中上部除皱术临床治疗17例面部皮肤老化求美者,随访时间3月~2年,所有的求美者对手术效果满意,术后未观察到严重并发症发生,仅个别受术者出现头皮瘙痒、局部脱发。结论:充分利用整形外科手术设计和操作原则,面部除皱术可以消除面部老化所致的皱纹,纠正眉下垂,避免严重的并发症,为面部松弛老化的求美者创造持续、有效的年轻化外观。
Objective: To discuss the technique of upper and middle face aging and study the clinical experience. Methods: Between October 2005 and March 2009, 17 patients underwent upper face rhytidectomy or upper-middle face rhytidetomy. These procedures were 16 women and 1 man,at a mean age of 53.47years (range 42-64 years). Upper face rhytidectomy performed dissection under the epicranial aponeurosis layer,with corrugator supercilii to depressor supercilii resection,frontal muscle removal,skin tighting. Midface rhytidectomy performed by elevatoed laxity midface softtissue ptosis. Concurrent procedures included blepharoplasty. Results: 17 patients with aging face have been treated using upper face rhytidectomy or upper-middle face rhytidectomy, followed-up for 3 month to 2 years,all patients obtained good curative effects without any severe complications. Conclusion: Make full use of plastic surgery principles of design and operation, upper face rhytidectomy or upper-middle face rhytidectomy can remove wrinkles of skin, correct the prolapse of eyebrow and avoid the severe complications. The approach brings youthful human facial appearance to patients and produces a lasting curative effect.
引文
[1]张涤生.整复外科学[M].上海:上海科学技术出版社, 2002: 837-838.
[2]高景恒.美容外科学[M].北京:北京科学技术出版社, 2003: 478-495.
[3]王炜.整形外科学[M].杭州:浙江科学技术出版社, 1999:1110-1124.
[4]席刚明,黄朝芬,何国厚,等. A型肉毒毒素除皱美容100例[J].中华医学美学美容杂志, 2004, 10 (1) :50.
[5]虞瑞尧.肉毒毒素注射上面部除皱的解剖学基础[J].中华医学美学美容杂志, 2007, 13 (6) :379-380.
[6]闫迎军,王晓军,乔群,等.肉毒毒素注射治疗面部动力性皱纹[J].中华医学美学美容杂志, 2006, 12 (2) :127-128.
[7]郑锐,韩颖,孙娜.冷触激光除皱118例疗效观察[J].中华医学美学美容杂志, 2004, 10 (1) :39-40.
[8] Yousif NJ, Matloub H, Summers A. The midface sling: A new technique to rejuvenate the midface[J]. Plast Reconstr Surg, 2002, 110(6):1541-1553.
[9] Hester TR, Codner MA, McCord CD, et al. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: Maximizing results and minimizing complications in a 5-year experience [J]. Plast Reconstr Surg, 2000, 105(1):393-406.
[10] Little JW. Volumetric perceptions in midfacial aging with altered priorities for rejuvenation [J]. Plast Reconstr Surg, 2000, 105(1):252-262.
[11] Owsley JQ, Zweifler M. Midface lift of the malar fat pad: Technical advances [J]. Plast Reconstr Surg, 2002, 110(2):674-685.
[12] Sasaki GH, Cohen AT. Meloplication of the malar fat pads by percutaneous cable-suture technique for midface rejuvenation: Outcome study (392 cases, 6 years’experience) [J]. Plast Reconstr Surg, 2002, 110(2): 635-654.
[13] Psillakis JM, Rumley TO, Camargos A. Subperiosteal approach as an improved concept for correction of the aging face [J]. Plast. Reconstr. Surg, 1988.82:383.
[14]郑行跃,宋业光.改良骨膜下综合剥离除皱术100例分析[J].中华整形外科杂志, 2000, 16 (6):336-339.
[15] Isse NG. Endoscopic facial rejuvenation: Endoforehead, the functional lift [J]. Aesthetic Plast Surg, 1994, 18:21.
[16]叶秀娣,乐淑君,虞渝生.内窥镜骨膜下额部除皱骨固定术[J].中华整形外科杂志,2005,21(5):342-344.
[17]甫京京,陈若琼,罗瑞茹,等.提眉切眉同期行额颞部除皱术[J].中华医学美学美容杂志, 2004, 10 (4) :236-237.
[18]倪慧宇.提切眉术联合重睑术矫治中老年人眼周衰老现象[J].中国基层医药, 2005, 12 (7) :910.
[19]解永学,李战强,杜太超,等.眉间“川”字纹手术方法的改良与应用[J].中华医学美学美容杂志, 2006, 12 (5) :307-308.
[20]陈小平,宋建良,肖圣祥,等.面部轮廓老化的形态特征[J].中华医学美学美容杂志, 2006, 12 (1) : 1- 4.
[21] Ferdinand FB, Richard DC. Safety of face-lifts in the older patient [J]. Arch Facial Plast Surg, 2004, 6:311-314.
[22] Kim EJ, Ramirea AL, Reeck JB, et al. The role of botulinum toxin type B in the treatment of hyperkinetic facial lines [J]. Plast Reconstr Surg, 2003, 112:88s-93s.
[23]乔群,闫迎军,赵茹,等.保留耳前鬓角形态的面中上部多层次除皱术[J].中华整形外科杂志, 2005, 21(3) : 181- 183.
[24]郑行跃,张志宏,梁伟中,等.额颞部小切口多层次剥离除皱[J].中华整形外科杂志, 2005,21(3):184-186.
[25] Mitz V,Peyronie M. The superficial musclo-aponeurotic system (SMAS) in the parotid and cheek area [J]. Plast Reconstr Surg, 1976, 58:80.
[26] Zide BM. What you can do is not what they want [J]. Plast Reconstr Surg, 2003,111:1753–1755.
[27] Isse NG. Endoscopic facial rejuvenation [J]. Clin Plast Surg, 1997, 24:213.
[28]黄罡,柳大烈,莫振东.面神经颧支的应用解剖学研究[J].中华医学美学美容杂志, 2005, 11 (4) :197-199.
[29]齐向东,胡志奇,高建华,等.面神经分支在颞区的显微解剖学研究[J].中华整形外科杂志, 2003, 19(3):217-219.
[30]崔海燕,陈锦安.颞浅筋膜瓣充填颞部凹陷在除皱术中的应用[J].中华医学美学美容杂志, 2006, 12(2): 74-75.
[31] Joseph LL. Facelift [J]. Operative techniques in Otolaryngology, 2007,18:189–194.
[32] Furnas DW. Strategies for nasolabial levitation [J]. Clin Plast Surg, 1995, 22:265-278.
[33]陈学善,王寿宇,王江宁,等.地塞米松对全面颈部除皱术后疼痛的影响[J].中国医师进修杂志, 2006, 29(5): 52-53.
[34] Atian M, Ramsey KM, Damon SC, et al. Follicular anatomy of the anterior temporal hairlineandimplications for rhytidectomy[J]. Plast Reconstr Surg, 2007, 119: 1891- 1895.
[35] Patrick T, Alexis V. The MACS-lift Short Scar Rhytidectomy[J]. Aesthetic Surg J, 2007, 27(2):188–198.
[36] LaTrenta GS. Tumescent cervicofacial rhytidectomy[J]. Aesthetic Plast Surg, 1998, 18(6): 423-430.
[37] Allison TP, Edwin FW. The Evolution of Midface Rejuvenation Combining the Midface-lift and Fat Transfer [J]. Arch Facial Plast Surg, 2006, 8:300-305.
[38] Baek RongMin, Lee SangWoo. Face lift with reposition malarplasty[J]. Plast Reconstr Surg, 2009,123(2):701-708.
[39] Badin AZ, Casagrande C, Roberts T, et al. Minimally invasive facial rejuvenation endolaser mid-face lift [J]. Aesthetic Plast Surg, 2001, 25(6): 447-453.
[40] Brenton BK, Stephen WP. Simultaneous Rhytidectomy and Full-Face Carbon Dioxide Laser Resurfacing [J]. Arch Facial Plast Surg, 2002, 4:227-233.
[41] Brackup AB. Combined cervicofacial rhytidectomy and laser skin resurfacing [J]. Ophthal Plast Reconstr Surg, 2002, 18(1):24–39.
[42]王志军,王娜,张晨,等.两级递进式提紧浅表肌腱膜系统除皱术[J].中华医学美学美容杂志, 2006, 12 (6) : 335- 338.
[43]王佳琦,赵作钧,王黔,等.浅表肌腱膜系统多重悬吊的全颜面除皱术[J].中华医学美学美容杂志, 2005, 11 (1) :1-4.
[44]富晓雷,辛静.采用发际缘双侧小切口额部除皱术的体会[J].黑龙江医学, 2008, 32(2) :143.
[45] Baker DC. Lateral SMASectomy[J]. Plast Reconstr Surg, 1997, 100(2):509–513.
[46] Norman W, Martin V, Neil W. Modified Lateral SMASectomy[J]. Plast Reconstr Surg, 2007, 119(3): 1021-1026.
[47] Little JW. Three-dimensional rejuvenation of the midface: Volumetric resculpture by malar imbrication[J]. Plast Reconstr Surg, 2000, 105(1): 267-285.
[48] Ramirez OM. Full face rejuvenation in three-dimensions:A“face-lifting”for the new millennium[J]. Aesthetic Plast Surg, 2001, 25(3): 152-164.
[49] Ramirez OM. Three-dimensional endoscopic midface enhancement: A personal quest for the ideal cheek rejuvenation [J]. Plast Reconstr Surg, 2002, 109(1): 329-340.
[50] Tonnard P, Verpaele A, Monstrey S,et al. Minimal access cranial suspension lift: A modified S-lift[J]. Plast Reconstr Surg, 2002, 109(6):2074-2086.
[51] Verpaele A,Tonnard P,Gaia S,et al. The third suture in MACS-lifting: making midface-lifting simple and safe [J]. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007, 60(12):1287-1295.
[52] Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies[J]. Plast Reconstr Surg, 1996, 98(7):1135–1143.
[53] Barry MJ, Damian DM, Gary LR. Volumetric short scar rhytidectomy e indications, technique and outcomes [J]. Journal of Plastic Reconstructive & Aesthetic Surgery, 2008, 61:736-743.
[54] Adamson PA, Dahiya R, Litner J. Midface effects of the deepplane vs the superficial musculoaponeurotic system placation face-lift [J]. Arch Facial Plast Surg, 2007, 9:9-11.
[55] Hamra ST, Owsley JQ, Ramirez O. Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-Up [J]. Journal of Plastic Reconstructive & Aesthetic Surgery, 2009, 123:1025-1033.
[56]陆文鹏,王忠媛,李孟倩.面部除皱术效果探讨[J].中国美容整形外科杂志, 2008, 19(5) : 370-372.
[1] Owsley JQ, Zweifler M. Midface lift of the malar fat pad: Technical advances[J]. Plast Reconstr Surg, 2002, 110(2):674-685.
[2] Little JW. Volumetric perceptions in midfacial aging with altered priorities for rejuvenation [J]. Plast Reconstr Surg, 2000, 105(1):252-262.
[3] Baker DC. Lateral SMASectomy[J]. Plast Reconstr Surg, 1997, 100(2):509–513.
[4] Norman W, Martin V, Neil W. Modified Lateral SMASectomy[J]. Plast Reconstr surg, 2007, 119(3): 1021-1026.
[5] Little JW. Three-dimensional rejuvenation of the midface: Volumetric resculpture by malar imbrication[J]. Plast Reconstr Surg, 2000, 105(1): 267-285.
[6] Ramirez OM. Three-dimensional endoscopic midface enhancement: A personal quest for the ideal cheek rejuvenation [J]. Plast Reconstr Surg, 2002, 109(1): 329-340.
[7] Saylan Z. Purse string-formed plication of the SMAS with fixation to the zygomatic bone [J]. Plast Reconstr Surg, 2002, 110(2):667–671.
[8] Patrick T, Alexis V. The MACS-lift Short Scar Rhytidectomy[J]. Aesthetic Surg J, 2007, 27(2):188–198.
[9] Verpaele A, Tonnard P, Gaia S, et al. The third suture in MACS-lifting: making midface-lifting simple and safe [J]. Journal of Plastic, Reconstructive & AestheticSurgery, 2007, 60(12):1287-1295.
[10] Sasaki GH, Cohen AT. Meloplication of the malar fat pads by percutaneous cable-suture technique for midface rejuvenation [J]. Plast Reconstr Surg, 2002, 110: 635–654.
[11] Little JW. Applications of the classic dermal fat graft in primary and secondary facial rejuvenation [J]. Plast Reconstr Surg, 2002, 109(2):788-804.
[12] Allison TP, Edwin FW. The Evolution of Midface Rejuvenation Combining the Midface-lift and Fat Transfer [J]. Arch Facial Plast Surg, 2006, 8:300-305.
[13] Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies[J]. Plast Reconstr Surg, 1996, 98(7):1135–1143.
[14] Barry MJ, Damian DM, Gary LR. Volumetric short scar rhytidectomy e indications, technique and outcomes [J]. Journal of Plastic Reconstructive & Aesthetic Surgery, 2008,61:736-743.
[15] Adamson PA, Dahiya R, Litner J. Midface effects of the deepplane vs the superficial musculoaponeurotic system placation face-lift [J]. Arch Facial Plast Surg, 2007, 9: 9-11.
[16] Ferdinand FB, Richard DC. Safety of face-lifts in the older patient [J]. Arch Facial Plast Surg, 2004, 6:311-314.
[17] Hamra ST, Owsley JQ, Ramirez O. Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-Up [J]. Journal of Plastic Reconstructive & Aesthetic Surgery, 2009, 123:1025-1033.
