高位SMAS筋膜联合"拉网式"脱垂颊脂垫悬吊中下面部除皱术  

The dragnet fixation for buccal fat pad in high-SMAS rhytidectomy

作　　者：吴乐昊 张畅 赵思纯 王湘月 王佳琦 Wu Lehao;Zhang Chang;Zhao Sichun;Wang Xiangyue;Wang Jiaqi(Department of Plastic and Reconstructive Surgery,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院面颈整形美容中心,100144

出　　处：《中华整形外科杂志》2020年第12期1303-1307,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨行中下面部除皱手术时,对于脱垂的颊脂垫进行"拉网式"多重悬吊提升的临床效果。方法2016年12月至2019年10月,中国医学科学院整形外科医院面颈整形美容中心,对42例面部松垂伴颊脂垫膨出松垂的患者,在行经典高位面部表浅肌肉筋膜系统(SMAS筋膜)悬吊手术的同时行"拉网式"颊脂垫多重悬吊。患者均为女性,年龄46~65岁。术中采用经典的颞部至耳周切口,进行皮肤瓣、SMAS瓣的分离和常规悬吊后,再用起自口轮匝肌外侧缘止于颧突点水平的5针"网兜式"排布悬吊线,改善颊脂垫下垂膨出的状态,达到中下面部年轻化的目的。术后总结各种短期、长期并发症,并对患者进行满意度调查。结果所有患者手术进展顺利,术后1例血肿形成,经局部抽吸后再次加压包扎自愈。其余41例均无并发症发生。术后随访9~12个月,患者面部老化特征,特别是口周垂肉、口角下垂等改善显著,面中部容量恢复,面部轮廓、外形自然。满意度调查显示,十分满意28例,满意12例,不满意2例,主观满意率达95.2%(40/42)。2例不满意患者自觉术后面部局部凹陷形成,其中1例诉面部不对称,1例患者轻度面颊部触感异常。结论"拉网式"脱垂颊脂垫悬吊技术可较好地改善中下面部老化状态,获得年轻化效果。Objective To investigate the clinical effect of middle and lower facial rhytidectomy by lifting the prolapsed buccal fat pad using a consecutive suspensions in a dragnet fashion.Methods from December 2016 to October 2019,42 female patients aged 46 to 65 with aging faces and prolapsed buccal fat pads were treated with multiple suspension method.The incision was the classic temporal to peri-auricular incions.After the skin flap and superficial musculoaponeurotic system(SMAS)flap was elevated.The suspending stitches were arranged with 5 lines from the lateral edge of orbicularis oris muscle to the level of zygomatic process to lift the sagging buccal fat pad and achieve facial rejuvenation.The short and long term complicationsas well as post-operative satisfaction rate were also investigated.Results After 9-12 months of follow-up,the facial aging characteristics were significantly improved,especially sagging mandibular bag and loose perioral skin.The volume of middle face was restored with natural contour.Post-operative complications included local facial depression(2 patients),slight asymmetry(1 patient)and mild tactile abnormalities(1 patient).Satisfaction survey showed that 28 patients were very satisfied,12 were satisfied and 2 were dissatisfied.The subjective satisfaction rate was 95.2%(40/42).There were no serious complications such as facial nerve injury or flap necrosis.Conclusions This technique has a good outcome combined with conventional rhytidectomy,as it can achieve good effect of rejuvenationin the middle and lower face.

关 键 词：表浅肌肉腱膜系统 面部 解剖学 悬吊 

分 类 号：R622[医药卫生—整形外科]