环耳SMAS高位悬吊技术在中下面部提升术中的应用

Application of Round-auricular SMAS High Suspension Technique in Middle and Lower Face Lift

目的:探讨环耳浅表肌肉腱膜系统(superficial musculoaponeurotic system,SMAS)高位悬吊技术在中下面部提升术中的临床效果及安全性。方法:2017年8月至2020年9月期间收治的中下面部衰老患者98例,在耳前设计隐蔽切口并延伸至颞区及耳后,在皮下层面分离皮瓣,使用不可吸收线于颞区高位深挂一针穿过颞深筋膜直至骨膜作为悬吊点,悬吊线于颞区顺行至面颊部行SMAS全层荷包缝合至耳后,环耳一周返回悬吊点打结固定以提升中下面部组织,术后一年随访,统计术后并发症、中下面部美学单位提升效果及术后满意度。结果:98例患者均顺利完成手术,术后患者出现血肿3例,瘢痕增宽4例;未出现感染、面神经及耳大神经损伤、腮腺损伤、皮肤坏死等严重并发症。术后一年随访到65例患者面部鼻唇沟、唇颌沟、下颌轮廓线、口周美学单位较术前均有改善(P<0.05);眶下缘凹陷及上下颊饱满度无改善,联合其他美容手术则可改善;患者总体满意度为95.4%。结论:环耳SMAS高位悬吊技术可同时提升中面部及下面部松弛下垂软组织,形成了自然的面部提升效果,术式简单,局麻条件下可完成,且具有创伤小、术后并发症发生风险低,恢复期短等优势,患者满意度高。

Objective To investigate the clinical effect and safety of high suspension technique of round-auricular superficial musculoaponeurotic system(SMAS)in middle and lower part face lifting.Methods From August 2017 to September 2020,98 patients with middle and lower facial aging were treated.A concealed incision was designed in front of the ear and extended to the temporal region and behind the ear.The skin flap was separated at the subcutaneous level,and a nonabsorbable sutures was placed high in the temporal region through the deep temporal fascia to the periosteum as the suspension point.The suspension line went straight from the temporal region to the cheek,and SMAS full-layer purse suture was performed to the back of the ear,and the sutures returns to the suspension point around the ear to tie and fix to lift the middle and lower facial tissue.One year after operation,the postoperative complications,the improvement effect of aesthetic units in the middle and lower face and the postoperative satisfaction were counted.Results All 98 patients successfully completed the operation,3 patients had hematoma and 4 patients had widened scar after operation.There were no serious complications such as infection,facial nerve and greater auricular nerve injury,parotid gland injury and skin necrosis.65 patients were followed up one year after operation.The facial nasolabial sulcus,labiomaxillary sulcus,mandibular contour and perioral aesthetic units were improved compared with those before operation(P<0.05).The depression of the lower orbital margin and the fullness of the upper and lower cheeks were not improved,but could be improved in combination with other cosmetic surgery.The overall satisfaction of patients was 95.4%.Conclusion Round-auricular SMAS high suspension technology can simultaneously lift the loose and sagging soft tissues of the middle face and lower face,forming a natural facial lifting effect.The operation is simple and can be completed under local anesthesia.It has the advantages of small trauma,low risk of postoperative complications,short recovery period,and high patient satisfaction.