| 1. ObjectiveThere are various types of the aging face, such as the face dynamic wrinkle, the face flabby skin and the periorbital aging several categories of etc. Rhytidectomy is not only way to treat the aging face. To study the anatomic characteristics of different type of the aging face, and to investigate the results of the operations or methods for facial rejuvenation, it will help us treat the face aging more effectively.2. Materials and methods(1) Basic partThe way that adopts the clinical face observation, the corpse specimen anatomy observation to combine together with the face surgical operation anatomy observation, to study the anatomy characteristics of the face dynamic wrinkle, the face flabby skin and the periorbital aging.(2) Clinical partTo observe the actual results of treating the face dynamic wrinkles with different methods, and to adopt new method or micro-traumatic technique to treat the dynamic wrinkles. To observe the actual results of treating the face flabby skin with small incision or micro-traumatic technique, and to treat the central face flabby skin with the way that the classical face lift combined together with micro-traumatic technique. To treat the periorbital aging effectively with the way of dealing with the periorbital fat pads.3. Results(1) Basic partThe position, number and trend of the face dynamic wrinkles were all invariable. There was a little or no fat under the dynamic wrinkle skin, or it was the boundary of no-fat area and greasy area under the wrinkle skin. The facial muscles adhered to the subcutaneous tissue under the wrinkle skin. Superficial muscular aponeurotic system (SMAS) arose from platysma, and SMAS was continuous with superficial temporal fascia and epicranial aponeurosis cross zygomatic arch, investing orbicularis oculi and frontal muscle. SMAS was thick in the parotid area, but weak in the cheek area. The morphologic characteristics of the periorbital aging was determined by the local soft tissue's anatomic constructive characteristics, especially related with periorbital fat pads. External eyebrow was easy to loose due to two anatomic factors: the existence of brow fat pad, and subcutaneous brow fat was thick but flaccid. The observation of anatomy and clinic showed that the suborbicularis oculus fat and the orbital fat of the upper eyelid were both contributing factors to lateral upper eyelid fullness and heaviness and ptosis. The orbital fat and the suborbicularis oculus fat pad were the main anatomic components of the aesthetic changes and aging of the lower eyelid and malar area.(2) Clinical partWe could achieve the best result to treat the face dynamic wrinkles with the method of removing or cutting off muscle. The result of the method of A-botox injection was good, but maintaining time was short. Placing ePTFE thin slice to baffle the formation of the wrinkles, the result was good and maintaining time was long. The result of the method of removing the external part of the lower canthus muscle to treat lateral canthus wrinkle was good, and the region of lateral canthus wrinkle contracted almost 3/5～2/3. After some improvements were made during the operating process of treating the face dynamic wrinkles with special steel wire instrument, it was proved to be a kind of new micro-traumatic, safe, effective practical method.Adopting the method of the classical face lift combined together with micro-traumatic technique could treat the central face flabby skin (deep nasolabial fold) effectively, and avoiding the various risks of other methods. Apparent lifting results were achieved immediately during the operating process if the serrated sutures were implanted at the proper level of structure under the skin. There was no lifting result if the serrated sutures were implanted at the level of the fat layer or SMAS. Promoting brow skin-subcutaneous fat aponeurosis flap was used to correct the external flabby brow, it could gain a good result and keep good result for long term.The suborbicularis oculus fat and the orbital fat of the upper eyelid were both contributing factors to lateral upper eyelid fullness and heaviness and ptosis. We could acquire the good surgical operation result by dealing with both kinds of fat. The results of orbital fat preservation for lower eyelid pouches were not good, the result of orbital fat excision for lower eyelid blepharoplasty were satisfactory.4. ConclusionsThe anatomic factors of the dynamic wrinkles formation: The superficial situated mimetic muscles adhered to the subcutaneous tissue under the wrinkle skin, and there was a little or no fat under the dynamic wrinkle skin, or it was the boundary of no fat area and greasily area under the skin. We could achieve the best result to treat the face dynamic wrinkles with the method of removing or cutting off muscle. The result of the method of A-botox injection was good, but maintaining time was short. Placing material to baffle the formation of the wrinkles, the result was good and maintaining time was long. The result of the method of removing the external part of the lower canthus muscle to treat lateral canthus wrinkle was good, and the region of lateral canthus wrinkle contracted almost 3/5～2/3. After some improvements were made during the operating process of treating the face dynamic wrinkles with special steel wire instrument, it was proved to be a kind of new micro-traumatic, safe, effective practical method.SMAS was thick in the parotid area, but weak in the cheek area. Adopting the method of the classical face lift combined together with micro-traumatic technique could treat the central face flabby skin (deep nasolabial fold) effectively, and avoiding the various risks of other methods. There was no consistent or obvious lifting result if the method of small incision or gold silk implanting was adopted to treat the face flabby skin. The method of implanting special serrated sutures under the face skin to tighten the flabby tissue was only fit for correcting external eyebrow ptosis.The periorbital aging was especially related with periorbital fat pads. External eyebrow was easy to loose due to two anatomic factors: the existence of brow fat pad, and subcutaneous brow fat was thick but flaccid. The suborbicularis oculus fat and the orbital fat of the upper eyelid were both contributing factors to lateral upper eyelid fullness and heaviness and ptosis. The orbital fat and the suborbicularis oculus fat pad were the main anatomic components of the aesthetic changes and aging of the lower eyelid and malar area.We could acquire the good surgical operation result by dealing with both kinds of fat. The results of orbital fat preservation for lower eyelid pouches were not good, the result of orbital fat excision for lower eyelid blepharoplasty were satisfactory.
|
PDF Full Text Request