应用埋没导引技术对高位SMAS面部提升术的改进及意义

Improvement and significance of high SMAS facelift with embedded guidance technology

目的采用埋没导引技术对高位表浅肌肉腱膜系统(superfical musculo-aponeurotic system,SMAS)面部提升术进行改进并分析其临床效果及意义。方法自2018年5月至2021年6月,哈尔滨医科大学附属第二医院整形外科对36例中下面部松弛患者行高位SMAS面部提升术时进行改进,采用埋没导引技术向中面部内侧前徙SMAS固定点,使之更接近面中线位置和鼻唇沟区域、同时复位深层和浅层脂肪室并提升收紧颈阔肌。超声测量术前、术后中面部软组织厚度;由2名非手术主任医师及患者对术前、术后3个月和术后24个月的随访照片进行评分,内容包括鼻唇沟凹陷程度、下颌缘及皮肤松弛程度。患者采用面部整体美容效果改善评分(global aesthetic improvement scale,GAIS)进行自我评价。结果本组共36例患者,所有患者中面部深层和浅层脂肪室均得到有效复位。术前中面部软组织厚度平均值为(9.13±0.12)mm,术后3个月平均值为(11.63±0.19)mm、术后24个月后平均值为(10.83±0.11)mm。术前面部平均得分为(3.24±0.16)分;术后3个月为(7.63±0.23)分;术后24个月后为(6.15±0.31)分,手术前后比较,差异有统计学意义(P<0.05)。术前与术后3、24个月比较,差异有统计学意义(P<0.05)。患者自评中19例患者完全改善、14例患者明显改善、3例患者轻微改善,总改善率为100%。结论针对高位SMAS面部提升术的技术局限,采用埋没导引技术弥补高位SMAS技术的不足和缺陷,复位中下面部深层和浅层脂肪室,改善鼻唇沟和下颌缘形态,进一步优化高位SMAS面部提升术的效果。

Objective To investigate the application of embedded guidance technique in high SMAS facelift and analyze its clinical effects and significance.Methods From May 2018 to June 2021,the Plastic Surgery Department of the Second Affiliated Hospital of Harbin Medical University applied embedded guidance technology to make the SMAS fixation point closer to the medial face and nasolabial groove of the middle and lower face in 36 patients with lower face relaxation,while repositioning the deep and shallow fat chamber,and lifting and tightening the platysma.The thickness of facial(middle facial)soft tissue was measured by ultrasound before and after operation.Preoperative,3 months and at least 24 months follow-up photos were scored by two non-surgical chief physicians and patients,including the degree of nasolabial depression,mandibular margin and skin relaxation.The longest follow-up time was more than 5 years.Patients were assessed using the Global Aesthetic Improvement Scale(GAIS).Results In this group of 36 patients,ultrasound confirmed that the deep and shallow facial fat chamber was effectively reseted and the platysma muscle was raised and tightened in all patients.The average thickness of facial soft tissue was(9.13±0.12)mm before surgery,(11.63±0.19)mm 3 months after surgery,and(10.83±0.11)mm 24 months after surgery.The average facial score before surgery was(3.24±0.16).Three months after surgery,the score was(7.63±0.23).The score was(6.15±0.31)24 months after operation,and the difference between preoperative and postoperative was statistically significant(P<0.05).In patient self-evaluation,19 patients showed significant improvement,14 patients showed moderate improvement,and 3 patients showed slight improvement,with a total improvement of 100%.Conclusion Embedding guidance technique can make up for the deficiency and defect of high SMAS technique,restore the deep and shallow fat compartment of middle and lower face,improve the nasolabial groove and mandibular margin,and improve and optimize the surgical effect of high SMAS facelift.