SMAS——颈阔肌区两级递进悬吊中下面、颈部提紧术

Faciocervical tightening by "SMAS-platysma" two-level progressive suspension

目的探讨表浅肌肉腱膜系统(SMAS)在面颈部除皱术时,对该部位软组织松弛下垂的提紧效果。方法将SMAS瓣分离、裁剪、悬吊,颧脂肪垫上移,颊脂肪垫释放、悬吊,提升面、颈软组织松弛下垂,辅以颞部组织代用品填充,颊、颏下部皮下脂肪抽吸。对下颌骨骨性肥大截除,以改变脸型。结果本组患者共220例,3例术后48h内发生血肿,经对症处理后痊愈,切口均Ⅰ期愈合。对120例随访3个月至2年,患者皮肤松弛软组织下垂得到明显改善,术后眉梢、眼外眦、口角明显向上提升,鼻唇沟变浅,面颈部呈现年轻化。结论SMAS的处理是面颈部提升术中的关键,SMAS-颈阔肌瓣两级递进式悬吊,基本上消除了面颈部软组织下垂,同时缓解了皮肤切口张力,切口瘢痕轻,避免损伤面神经,是去除面部皱纹、提升下垂组织、改善脸型的有效手段。

Objective To discuss the effect of superficial muscle aponeurosis system （SMAS） used in fatiocervical rhytidectomy on strengthening the facioeervical parenchyma ptosis suspending, reshape facial feature, resume the state of youth. Methods The SMAS flap was firstly separated, cut out and suspended to treat faciocervieal parenehyma ptosis, and then the cheekbone fat pad was moved upward, check fat pad was released, and meanwhile temporal was filled with tissue substitute, pump hypodermic fat of check and chin part was treated by liposuction and the mandible hypertrophy was exeided finially to change facial features. Results All 220 patients were all primary heals exepte 3 cases with hematoma within 48 h after surgery which were cured after symptomatic treatments. 120 cases were followed up for 3- 24 months, the anetoderma and parenchyma ptosis improved obviously, brow tips, eye canthus and the angle of mouth obviously moved upward, nasolabial groove was shallowed after operation, the faeiocervieal showed younger. Conclusion The processing of the superficial muscle aponeurosis system was the key in the faeiocervieal tightening operation, the suspension of ＂SMAS- platysma＂ two- level progressive basically eliminated the faeiocervical parenchyma ptosis, meanwhile it remitted the skin tension, lightened the sear, avoided facial nerve side damage. It＇s an effective method of dispelling facial wrinkle, suspending ptosis tissue and reshaping facial feature.