摘要
面部老化虽然是正常人的自然的病生过程,但由于人类的社会性特点,这种老化表现给人们造成了很大的心理压力。尤其是随着人们生活水平的提高,社会意识的增强,这种压力也就与日俱增。以外科手术的方法,使老化的面部再现年轻化,不仅使受术者再现青春魅力,更可改善心理健康度,增强自信心,提高生命质量。因此,面部老化的年轻化研究,也就成了当代整形美容外科研究的热点。10余年来,已有大量的文献报导了从不同角度、用不同的方法对面部老化机制以及年轻化的手术方法进行的研究,但仍有许多问题未能得到解决。
作者采用核磁共振及解剖学研究的方法,就面部老化的因素及其内在的联系进行了综合的分析,并根据研究结果提出了新的年轻化的手术方法。
200例不同年龄段核磁共振录像片测量分析结果发现:
1、面部的老化不仅表现为骨质的萎缩,而且表现为特定部位的骨质增生。作者首先发现颧骨增厚是老化的普遍规律。颧骨的突出使面容呈现出憔悴和衰老感。因此,适当去除部分过高的颧骨骨质,对已老化面容的年轻化表达有明显的效果。
The study to the facial aging and the facial rejuvenative surgery is the focal point of the plastic surgery in the ages. Up-to-now, there are many problems remained unsolved.
Through measuring and analyzing the aging
changes of the facial bone and facial soft tissues
in M.R, We studied the factors of facial aging and
their inter relationshipes. We modify the
procedure of the facial rejuvenative surgery.
Two hundred the MR images was divided into two groups
One aged twenty to thirty and the other aged over fifty-five years old.
Data obtained from MR revealed:
1.In the aging face there exists not only the atrophy but hypertrophy of the facial bone. The author first find that the zygoma hypertrophy are general law of the facial aging. The prominence of the zygoma produce the aging appearance. Reducing the prominence of the zygoma properly will be useful for rejuvenating the aging appearance.
2.The prominence of the zygoma and the atrophy
引文
1. G onza lez-U lloa M: The aging face. E lim in a tion of wrink les and other problem s.InG onza lezU lloaM (ed):A esthetic plastic Surerg, vol 1.st..Louis,cv M osby,1988,pp 13-30
2. A ston SJ :P latysm s-SM A S cervicofacialrhyticlop lasty. C lin Plast Surg. 40:507,1988
3. Barton F E Jr: R htidectomy and the nasolabialfold plast Reconstr Surg .90:601,1992
4. Barton FE Jr: The SM A S and nasolabialfold. plast. R econstr Surg .89:1054,1992
5. Connell B F: Suricalcorrection of aesthetic contours and problems of the neck. Clin plast surg .10:491,1983
6. Ellenbogen R. et al: Curette fat sculpture in rhytidectomy: Im proving the nasolabial and labiom and ibular follds. phst Reconstr Surg. 88 :433,1991
7. Gonzales-U lloa M. Flores Es : Senility of the face-basic study to understand its causes and effects. phst Reconstr Surg. 36 : 239,1965
8. Gosain AK, Yousif NJ, Madiedo G, et al:Surgical anatome of the SM AS; a reinvestigation. plast Reconstr Surg. 92:1254,1993
9. Guyuron B, M icheolw B : The nasolabial fold : A challenge, a solution, plast Reconstr Surg. 93:522,1994
10. Hamra ST: The deep-plane rhytidectomy. Plast Reconstr Surg. 86:53,1992
11. Hamra ST: Com posite rhytidectomy, Plast Reconstr Surg. 90:1,1992
12. Jost G, Levet Y : Parotid fascia and facelifting : A criticalevaluation of the SM A S concept. Plast Reconstr surg .74:42,1984
13. Lem m m on M L, ham ra ST : skoog rhytidectoom y : A fire year experience w ith 577 patients. Plast Recoostr surg. 65 : 283,1980
14. Loeb R : Nasolabial fold underm in ing and fatgrafting based on histological study, Aesthetic plast Surg .15 : 61,1991
15. Mendelson BC : Correction of the nasolabial fold :Extended SM A S dissection with periosteal fixa tion. Plast Reconstr Surg. 09 ; 822,1992
16. Millard DR . pigottRW , HeoA : Subm and : bular lipectomy, Plast Reconstr Surg. 41:513,1968
17. Millard D R . Yuan R T, pevine JW Jr : A chllenge to the underfested nasolabial folds, plast Reconstr Surg. 80 : 37,1987
18. Mitz V, peyronie M : The superfical muscula aponeurotic system (SM A S) in the parotid and cheek area. Plast Reconstr Surg. 58 : 80,1976
19. Owsley JQ : platysma-fascial rhytidectomy Plast Reconstr Surg. 60 : 847,1977
20. Owsley JQ: Lifting the malar fatpad for correction of prom inen tnasolabial folds. Plast Reconstr Surg. 91:463,1993
21. Psillakis JM, Rumbley To, Cam argos A : Subperiostealapproach as an improved concept forcorrection of the agion face. Plast Reconstr Surg. 82 : 383,1988
22. Ram irez OM, Maillard G F, Musolas A : The extended subperiosteal facelift: A definitive-soft-tissue rem odeling for facialrejuvenation. Plast Reconstr Surg. 88 : 227,1991
23. Skoog T : plastic Surgery-New Methods. Philadelphia, W B saunders, 1974
24. Stuzin JM, Baker T J, Gordon H L : The relationship of the superficial and deep facial fascisa : Relevance to rhytidectomy and aging. Plast Reconstr Surg. 89 : 401,1992
25. Yousif N J, Gosain AK, M atloub H S,et al: The nasolabialfold: A photogramm eric analysis. Plast Reconstr Surg. 93:70,1994
26. Yousif NJ, Gosuin AK ,M atloub HS,etal:The nasolabialfold : An anatomic and histologic reappraisalPlast Reconstr Surg. 93: 60,1994
27. Hamra ST: Com posite Rhytidectomy. St. Louis, Quality Medical publishing,1993
28. Hamra ST: Repositiong of the orbicularis oculi in the com posite rhytidectomy. plast Reconstr Surg. 90 : 14,1992
29. Rubin LR, MishrikiY. Lee G: Anatomy of the nasolabialfold : The keystone of the smiling mechanism. plast Reconstr Surg. 83: 1,1989
30. Cardoso de Castro C : Superfical musculoapon eurotic system-platysma : A continuous study. Ann Plast Surg. 26 : 203,1991
31. Freiliinger G, Gruber H , Happak W, Pechm ann U: Surgicalanatomy of the mimic muscle system and facialnerve: Importance for Reconstructive and aesthetic surgery. Plast Reconstr Surg. 80: 686- 690,1987
32. Furnas D W : The deep-plane rhytidectomy (discussion) Plast Reconstr Surg. 86 : 62,1990
33. Furnsa DW : The retainig Ligam ents of the cheek. Plast Reconstr Surg. 83 : 11-16,1989
34. Gosa in AK, Yousif N J, Madiedo G, et al: Surgical anatomy of the SM A S : Areinvestigation. Plast Reconstr Surg. 92 : 1254-1263,1993
35. Pensler JM , ward JW, Parry SW , The superficial musculoaponeurotic system in the upper lip.An anatom ic study in cadavers. Plast Reconstr Surg.75 : 488,1985
36. Ruess W R, Owsley JQ : The anatomy of the skin and fascial layers of the face in aesthetic surgery. clin plast surg. 14:677-682,1987
37. Stuzin JM , Wagstrom L , kawamoto H K , etal: Anatomy of the tem poral fatpad, plast Reconstr Surg .83 : 265,1989
38. Thaller SR , K im S, Patterson H et al: The subm uscular aponeurotic system (SM A S). A histologic and com parative anatomy evaluation. Plast Reconstr Surg. 86 : 690,1990
39. AbdulH assan H S, von Drasek Ascher G, A cland R D: Surgical anatomy and blood supply of the facial layers of the tem poralregion Plast Reconstr Surg. 77 : 17,1986
40. Baker DC : Com plications of cervicofacial rhytidectomy. clin plast Surg .10 : 543,1983
41. Baker D C : Conley J : Avoiding facialnerve in juries in rhytidectoomy : Anotom icvariations and Pitfalls. Plast Reconstr Surg .64 : 781,1979
42. Castanares S : Facilnerve paralyses coincidentw ith, or subseyuent to, rhytidectomy. Plast Reconstr Surg. 54 ; 637,1974
43. Correia PC, ZaniR : Surgicalanatomy of the facialnerve as related to ancillary operations in rhytidectomy. plast Reconstr Surg. 52 : 549,1973
44. Dingm an RO, Grabb W C : Surgical anatoomy of the mandibular ram us of the facial nerve based on the dissection of 100 facial halves, plast Reconstr Surg 29:266,1962
45. Furnas DW : Landm arks for the trunk and the tem porofacial division of the facial nerve B . J surg 52 : 694,1965
46. Gonzalez-Ulloa M : Facial wrinides, integral elim ination. Plast Reconstr Surg.29:658,1962
47. Leist F, Masson J, Erich JB : A review of 324 rhytidectom yie,em phasizing com plications and patientdissatisfaction Plast Reconstr Surg. 59 : 535, 1977
48. Lemmon M L :Superficialfascia rhytidectomy. A restora tion of SM A S with control of thecervicom entalangle clin plast Surg 10 : 449,1983
49. Loeb R : Technigue for preservation of the tem poral branches of the facial nerve during face-lift opera tions. Br J Plast Surg 23: 390. 1970
50. Ozersky D, Baek SM, Biller H F : Percu taneous identification of the tem poralbranch of the facialnerve. Ann Plast Surg 4 : 276,1980
51. Pitanguy 1 ,Ram os AS : The frontalbranch of the facial nerve: The in portance of its varia tions in face lifting. plast Reconstr Surg 38 : 352,1966
52. Ram irez O M : The subperiosteal rhytidectomy: The thirdgeneration face lift. Ann Plast Surg. 28 : 218,1992
53.Tchakerian A. Raulo Y . Baruch J : Surgical traum a of the tem porofronntalbranch of the facial nerve: Anatom ical Study and clin ical app lica tions.
54. Barton FE Jr : The SM A S and the nasolabialfold plast Reconstr Surg 89 : 1054,1992
55. Cardoso de castro C . The role of the superfical musculoaponurotic system in face lift. Ann plast Surg. 16: 279,1986
56. Clodius L : Reconstruction of the nasolabialfold. Plast Reconstr Surg 50 : 467-473,1972
57. Horibe EK Horibe K ,Yamaguchi CT : Prorounced nasolabialfold : A Surgicalcorrection. Aesthetic Plast Surg 13 : 99-103,1989
58. Kaphn E , Falces E , Tolleth H : Clinical utilization of in jectable collagen. Ann Plast Surg 10 : 438-451,1983
59. Kaye BL : Discussion of pensler JM, Lew is SR, Parry SW : Restoration of the upper lip and nasolabialarea plast Reconstr Surg 78 : 457-459,1986
60. Mckinney P, Cook JQ : Liposuction and the treatrnent of nasohbialfolds. Aesthetic Plast Surg 13 : 167-171,1989
61. Millarel DR Jr: Evalution of a technigue designed to correctnasolabialfolds, plast Reconstr Surg 89: 356, 1992
62. Rees TD. Aesthetic plastic Surgery, vol2 philadelphia, W B Saunders, 1980, p703
63. Rees TD : Silicone in jection therapy In Rees TD (ed): Conm etic Faeial Surgery philadephia, W B Saunders, 1973, pp 232-267
64. RiefkohlR : Thenasolabialfold lift. Ann plast surg 15: 1,1985
65. barton FE : Rhytidectomy and the nasohbialfold P .R .S 90:601-607,1992
66. Furnas D W: Anthropom etric Landm arks for precision planning in rhytidectomy. plast Reconstr Surg 14 : 639-661,1987
67. Miliarel D R Jr, Garst W P, Beck RL , Thorn pson ID.Submental and subm and ibular lipectomy in con junction with a face lift, in the male or fem a le. Plast Reconstr Surg 49 : 385-391,1972
68. Barton FE Jr: Rhytidectomy and the nasolabialfold phst Reconstr surg 90 : 601,1992
69. Hamra ST : The triplane facelift dissection, Ann plast Surg 12:260,1984
70. WhetzelTP, Mathes ST. Arterialanatomy of the face : An analysis of vascular territories and perferating cutaneous vessels, plast Reconstr 89 : 591,1992
71. Michel Wassef, M. D. Superficial Fascial and Muscular Layers in the Face and Neck: A Histological study Aesthetic plast surg 11: 171-176,1987
72. millarel DR. Jr. Achallenge to the underfeated nasolabialfolds plast Reconstr surg 80 : 37,1987
73. Ruess, W. The anatomy of the skin and fascial layors of the face in aesthetic surgery clin plast surg 14 : 677,1987
74. Alan Matarasso. M. D. Endoscoppically Assisted Forehead-Brow Rhytido plasty: Therry and practice. Aesth. plast surg. 19 : 141-147,1995
75. GasperoniC, Salgarello M, GarganiG :Subpharophsty Aesth plast surg 17: 243,1993
76. Rogers BO: (video review) Endoscopic technigues in coronalfacelifting, by luis O . Vasconez et al. Aesth Plast Surg 18: 106,1994
77. Matarasso A: Foreheab-brow Brhytide plast: reasseing the goals, plast Reconstr Surg 93: 1378, 1994
78. Antonio Fuente delcom po, M . D :Subperiosteal Facelift: open and endoscopic Apprach, Aesth plast surg 19: 149-160,1995
79. David L. Dingman, M D : sim ultaneous Deep-plane Face Lift andl Trichloroacetic Acid peal. Dlast Reconstrsurg 1:86,1993
80. A drien E. Aiache, M. D : The suborbicularisoculi Fat pads. An Amatomicandclinicalstudy. 1 : 37,1995
81. Bahm an Teim ourian, M. D: The Multiplane face lift Plast Reconstr Surg 1 : 78,1993
82. takuya Onizuka : Our Mini Facelift for orientals, Aesth. Plast Surg. 19: 49-58,1995
83. Krastinova-llolov. D : Mask lift and Facial Aesthetic Sculpturing. Plast Reconstr Surg. 1 : 21,1995
84. Ramirez OM : The anchor Subperiosteal Forehead lift plast Reconstr Surg. 6: 993,1995
85. joelE : Lndependent Effect of various Facialm im eric Muscles on the Nasolabial Fold. Aesth. Plast. surg. 16: 167-171,1992
86. Matarasso A : endoscopically Assisted Forehead-Brow Rhytido plasty : Theory and pratice Aesth. Plast. Surg. 19: 141-147,1995
87.宋业光、中华整形烧伤外科杂志 3:191,1990
88. Isse N G : Endoscopic facialrejuvenation; Endoforehead, the functional lift: case reports, Aesth Phst Surg 18;21,1994
89. Matarasso A , Terino EO : Forehead-brow rhytidophsty : reassessing the goals, phst Reconstr Surg 93 : 1378,1994
90. Tessier p: Face lifting and frontal rhytidectomy. In Ely JF(ed), Transactions of the Seventh International Congress of Plastic and Reconstructive Surgery. Rio de Janeiro, September,1980.