颞深部眶颧骨膜下除皱及SMAS剪力除皱术

Orbital and zygomatic subperiosteal facial lifting from deep temporal fascia and SMAS facial lifting

笔者报告１９９３～１９９６年４６例面部除皱的经验，其中１２例颞深部眶颧骨膜下除皱（内含６例颧弓缩小整形），有或没有合并ＳＭＡＳ剪力除皱，３４例进行两个层次的除皱及剪力ＳＭＡＳ除皱。颞深部眶颧骨膜下除皱术采用颅面外科手术进路，在颞窝前方，眶周，外眦韧带区，部分眶内，颧弓周围及上颌骨前、外侧方分离骨膜，将其与帽状腱膜，颞浅筋膜及上半面部的皮肤、头皮同时提紧。有的病例同时进行颧弓缩小整形，术后使上半面部皮肤提紧，并使眼轮匝肌及其周围组织提紧，眉弓及眼角上悬，上、下眼睑松弛矫正，眼鼻沟，鼻唇沟变浅。特别对中年以上的上２／３面部除皱有效。ＳＭＡＳ剪力除皱是下半面部除皱。将皮肤及ＳＭＡＳ两平面进行提紧，耳前制成Ｓ状ＳＭＡＳ瓣，在其中央剪成两半，向上及向耳后方提紧，使颊、下颌、颈部松弛组织提紧，鼻唇沟变浅。颏下区松坠的脂肪作抽吸或切除。

From 1993 to 1996, 46 cases of facial lifting were performed in our group, 11 cases of deep temporal subperiosteal facial lifting (6 cases of malar reduction included) with or without SMAS facial lifting and 35 cases of face lift in two layers, skin subcutaneus and SMAS facial lifting included.Orbital and zygomatic subperiosteal facial lifting apply craniofacial exposure techniques. The periosteum was elevated at periorbital, lateral canthus, 0.8 to 1.0 cm insite of orbital fossa, zygomatic, and fronto, latteral maxilla through deep temporal fascia. The malar reduction were taken three osteotomies at the lateral and medial regions of zygoma and the lateral region of maxilla, this procedure make good results of upper face lift, imroed the ptosis of orbicularis complex, brow ptosis, nasolabial crease, upper and lower lid laxity. It is specially for the middle ages women.The lower face lifting was going on at the level of SMAS. AS-Shape AMAS flap was made in front of the ear, then this flap was divided two part, lifted thde upper part of SMAS flap toeard to temporal direction, the others toward to back of ear. The results of this procedure were made satisfactory reduction of nasolabial crease and check mandibular, neck skin laxity, liposection some time were used for double chin deformity. 