改良中面部除皱术在临床中的应用

Application of a modified midface rhytidectomy in clinical practice

目的探讨改良中面部除皱手术的方法，以及手术要点与优势。方法对43例面中部皮肤及软组织松弛的女性，采用颞部“w”形＋耳前倒“L”形切口，在皮下和SMAS筋膜之间分离组织间隙达到设计范围，并在耳前纵向解剖分离一“舌形”SMAS筋膜瓣，大小约2．5em×1．5cm；将筋膜瓣掀开，在SMAS筋膜前侧断缘，斜向上45。对位拉紧缝合，使口角上提，鼻唇沟变浅；再将预制的SMAS筋膜瓣向上提紧，缝合固定于颧弓处；下颌缘及部分颈部皮肤上提，去除颞部及耳前多余皮肤并缝合固定。结果本组共43例患者，术后随访3～18个月，鼻唇沟明显变浅，下颌缘及颈部形态清晰，效果满意。结论采用改良中面部除皱术能有效改善口角、鼻唇沟、下颊部及部分颈部的皮肤松弛，同时手术切口张力小，瘢痕不明显，位置隐蔽，且术后皮肤紧致、弹性好，表情自然，值得临床推广应用。

Objective To investigate the operative method of a modified midface lifting and discuss its surgical procedures and advantages. Methods W-shaped incision in the temporal area and inverted L-shaped preauricular were applied in 43 cases of midface skin and soft tissue relaxation. The undermining between sub- cutaneous plane and SMAS was carried to the region defined, form a tongue shape SMAS-flap （size was about 2.5 cm x 1.5 cm） by longitudinal dissection pretragal. The fascia flap was lifting to present the edges of SMAS, then the edges were sutured by oblique upward reapproximation at 45-degree angles to make the sagging angulus oris up and the nasolabial fold superficial. The formed SMAS-flap was sutured upward to zygomatic arch to lift the madible and cervical skin, the temporal area and preauricular unnecessary skins were excised. Results This technique was used in 43 patients with 3 to 18 months follow-up, producing effective satisfactory results with smooth nasolabial crease, righting the jowls and neck skin. Conclusion Application of this innovative technique of a modified midface lift largely in correcting the laxity of skin around mouth, nasolabial fold, jowl and part of the neck, Mcanwhile, incision tension is moderated and the consequent scar is unnoticeable, and postoperative skin has good elasticity and natural looking, which is worthy of being recommended in clinical practice.