RU2186530C2 - Method for surgical correction at the ptosis of facial and neck soft tissues - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: a subcutaneous fatty fiber is removed by liposuctioning ingenial area and along mandibular edge. A figured incision is applied upon the skin according to predetected marker's line. Skin is separated by capturing the part of subcutaneous fatty fiber. Upon surface facial fascia and above-covering fatty fiber the internal sutures are applied by using a nonresorptive material to be tightened upwards. In peculiar case, one line of internal sutures is applied in direction from the mouth's corner up to the upper tragus's edge, and another line - from the middle of mandibular area to the lower tragus edge. In peculiar case, liposuctioning of genial area is carried out under a marker's zone as two concentric ellipses, at the same time, the intensity of fatty fiber suction is decreased in direction from internal ellipse to peripheral one. The method enables to provide prolonged duration and stability of cosmetic effect and decrease the risk of post-operational complications. EFFECT: higher efficiency. 2 cl, 4 dwg

Description

 The invention relates to medicine, more specifically to aesthetic surgery, and can be used to eliminate age-related changes in the soft tissues of the face and neck.

 Under the influence of age-related changes, atmospheric and production factors, the skin fades, loses elasticity, skin folds and wrinkles become a reality. Atrophy of adipose tissue, weakening of its connection with the skin and deeper tissues, sclerotization of elastic fibers and muscle tissue lead to sagging (ptosis) of the cheeks and chin, the formation of a double chin, which dramatically changes and deforms the facial contour. The nature of the skin also changes. Losing the ability to retain water, undergoing sclerotic changes, it becomes dry, lethargic, atonic and flabby.

 The most effective way to correct ptosis of the soft tissues of the face and neck is to tighten them or the so-called face and neck lifting (face lifting).

 A known method of complete circular tightening of the soft tissues of the face and neck, including applying a curved cut to the skin along a previously drawn marker line, starting from the temporal region, further in front of the auricle, bordering the earlobe and rising along the behind the furrow, and ending on the hairy surface of the occipital region , separating the skin to the required limits, pulling the skin up and back, followed by excision of the excess skin in front of the auricle, in the temporal region and on the neck [Andreeva D.N. Handbook of medical cosmetics. L .: Medicine, 1978, p. 92-93].

 The disadvantages of this method are its high invasiveness and lack of effectiveness, since the tension of the skin has little effect on the chin area, where as a result of sagging skin and the accumulation of fat, a double chin is formed.

 A known method for correcting ptosis of soft tissues of the chin region, including a horizontal skin incision along the natural chin fold, lipectomy and excision of excess skin [Frisberg I.A. Facial cosmetic surgery. M .: Medicine, 1984, p. 179-181].

 The disadvantages of this method are the low cosmetic effect due to the correction of only the chin area, as well as the possibility of postoperative complications in the form of recurrence of deformation, pressure in the chin, cicatricial contractures and hypertrophy, which requires additional complex interventions to be eliminated.

 The closest to the claimed method, the prototype is a method of surgical correction of ptosis of soft tissues of the lower part of the face and neck, which is as follows [N. Michelson Facial cosmetic surgery. M .: Medicine, 1965, p.191-194].

 After antiseptic treatment of the surgical field with a medical pencil, a line of the future skin incision is drawn and local anesthesia is performed. A skin incision is made, starting from the upper edge of the tragus and, bordering the earlobe, continue it along the ear furrow to the level of the tragus, then the direction of the incision is changed, continuing along the upper edge of the hairline posteriorly and down to the neck to the level of the earlobe. The depth of cut is equal to the thickness of the skin. Next, a wide separation of the skin from subcutaneous fat is carried out, the skin flap is pulled up and back until the folds disappear and first it is fixed with strong silk sutures in front and behind the auricle, and then the excess skin is excised in a straight line. On the edges of the wound impose nodal or twisting stitches from the hair, which are removed for 6-7 days after surgery.

The disadvantages of this method are:
- insufficient stability of the cosmetic effect of skin tightening, since under the influence of muscle traction the skin again stretches and wrinkles after a while;
- the method does not provide restoration of the former contour and a clear oval of the chin;
- the possibility of surgical and postoperative complications due to superficial separation of the skin, fraught with increased bleeding.

 An object of the invention is to increase the efficiency of the method.

 The technical task is achieved by the proposed method, which consists in the following.

 At the first stage of the operation, liposuction of the chin area is performed. For this, a liposuction zone in the form of two concentric ellipses is marked with a marker and local anesthesia is performed. Then, with a scalpel or raspator, an injection is made into the middle of the natural transitional chin fold of the skin, the skin is bluntly separated with the capture of part of the subcutaneous fatty tissue in the form of a tunnel 3-4 mm wide to the middle of the internal ellipse, a special aspirator with a cannula of the desired diameter and three holes on the sides is inserted into the tunnel and suction of fatty tissue is carried out using a vacuum liposactor, first under the zone of the internal ellipse, and then under the zone between the two ellipses, reducing the intensity of the suction in the direction from morning ellipse to the peripheral.

 At the second stage of the operation, the lower half of the face and neck are lifted. To do this, a marker draws a line of a figured skin incision, starting from the upper edge of the tragus, bordering the earlobe, continuing along the behind the ear furrow to the upper edge of the ear canal and continuing posteriorly to the scalp. After local anesthesia of the marked side of the face, a skin incision is made with a scalpel along the intended line and the skin is separated to capture part of the subcutaneous fatty tissue along the contour of the proposed lifting. The boundaries of the separation of the skin-fat flap depend on the severity of soft tissue ptosis. Then a thorough hemostasis is carried out using gauze napkins and electrocoagulation of blood vessels. To align the line of the lower jaw, fatty tissue is sucked along the edge of the lower jaw using a liposactor. Next, strengthen the subcutaneous fat. To do this, internal seams of non-absorbable material are applied to the surface fascia of the face and the fatty tissue covering it, which are then pulled up and tied. Mostly the first row of internal sutures is laid in the direction from the corner of the mouth to the upper edge of the tragus, and the second from the middle of the lower jaw to the lower edge of the tragus. Additionally, if necessary, a third row of internal sutures can be applied in a downward direction from the angle of the lower jaw to the middle of the side surface of the neck. Next, the separated skin-fat flap is pulled laterally and posteriorly until the skin folds disappear, two fixing nodal suture-holders are applied in front and behind the auricle, and excess skin is excised behind and in front of the ear. The edges of the skin wound are adapted with interrupted sutures with a 5-0 polyester through 1 cm and a continuous suture with a 5-0 polyester over the entire wound.

 A similar operation is performed on the other half of the face.

 An aseptic pressure bandage is applied to the face, chin and neck.

The determining significant differences of the proposed method in comparison with the prototype are the following:
- separation of the skin is carried out with the capture of part of the subcutaneous tissue, which makes it easier to detach the skin, reduce bleeding and provide a faster and more durable subsequent fusion of the skin-fat flap with the underlying tissues;
- reinforcing internal seams of non-absorbable material are applied to the surface fascia of the face and the fatty tissue covering it and the internal flabby, sagging face structures are pulled upward, which allows for a long time to stabilize the skin tightening effect due to the formation of subcutaneous scars that counteract the traction of the muscles of the face and the effect of gravity, relieve stress on the skin of the face and provide a longer preservation of the results of the operation;
- additionally, in the chin region and along the edge of the lower jaw, subcutaneous fat is removed by liposuction, which improves the efficiency of the method by restoring the previous clear contour of the face and chin.

 Combined carrying out at the first stage of the liposuction of the chin area, and at the second stage - removing fatty tissue along the edge of the lower jaw and tightening the skin of the face and neck allows you to get a brand new, synergistic effect of facial rejuvenation. The proposed method is an interconnected sequential system of stages of the operation, contributing to the most complete correction of ptosis of the soft tissues of the face and neck. Using the proposed method allows two lifts in a microsurgical version, when the internal sagging face structures are pulled up with the help of internal seams, and the skin is only slightly stretched towards the earlobe.

 The invention is illustrated by the following examples of specific performance of the method.

 Example 1

 Patient L., 43 years old, was in the clinic about ptosis of soft tissues of the face and neck.

 From the anamnesis: skin folds and a double chin appeared about 5 years ago.

 Objectively: on the face and neck there are skin folds and wrinkles, deep nasolabial folds, drooping cheeks (“bulldogs”) and chin area (double chin).

 Correction of ptosis of soft tissues of the lower half of the face and neck by the claimed method.

 At the first stage of the operation, liposuction of the chin region was performed, for which, in the sitting position on the patient’s chin, the marker marked a liposuction zone of 3 • 5 cm in the form of two concentric ellipses. Local anesthesia was performed by infiltration of 50 ml of a 0.1% solution of lidocaine with adrenaline in a 1: 500 dilution into the intervention zone. Then, with a scalpel N 11, an injection was made along the chin fold 3 mm long, a tunnel in the subcutaneous tissue 2 cm long was separated with a mosquito clip, an aspirator with a cannula with a diameter of 2.4 mm was introduced into the obtained access, and fatty tissue was aspirated using an aspiration apparatus P = - 1 atm In this case, the suction rate of adipose tissue was reduced in the direction from the internal ellipse to the peripheral. Removed 50 ml of fat mass.

 At the second stage of the operation, the lower half of the patient's face and neck was lifted. First, the marker outlines the line of the future incision and the skin separation border, which is 5 cm anterior to the earlobe and 7 cm downward from the earlobe. Next, an antiseptic treatment of the surgical field and local anesthesia by infiltration of 250 ml of a 0.1% solution of lidocaine with adrenaline in a dilution of 1: 1000 per one right half of the face were performed. The abdominal scalpel N 15 produced a skin incision with the capture of part of the subcutaneous tissue from the upper edge of the tragus. Curving the earlobe, continuing it along the behind the ear groove 1 cm higher than the ear canal and then to the scalp 5 cm long. The skin-fat flap was separated to the intended border and thorough hemostasis was performed using hemostatic sponge and vascular electrocoagulation. To align the line of the lower jaw, fatty tissue was sucked along the edge of the lower jaw using a liposactor. Polyester 2-0 on the superficial fascia of the face and the fatty tissue covering it were applied reinforcing internal sutures in the direction from the corner of the mouth to the upper edge of the tragus and from the middle of the lower jaw to the lower edge of the tragus, which are pulled up, tied up and cut short. The skin-fat flap is slightly stretched to the side of the earlobe and posteriorly until the skin folds straighten and is fixed with two guiding interrupted sutures with polyester 2-0 in front and behind the auricle, and excess skin is excised 0.5 cm in front and 1 cm behind the auricle. The edges of the wound are adapted with interrupted sutures with 5-0 polyester through 1 cm and with a continuous suture of 5-0 polyester over the entire wound.

 A similar operation was performed on the left half of the face.

 An antiseptic pressure dressing is applied to the face, chin and neck.

 Examination of the patient after 3 months: microsurgical sutures are invisible, the skin is clean, smooth, a clear contour of the face and chin, wrinkles straightened, the woman looks much younger than her years.

 Example 2

 Patient Sh., 54 years old, was in the clinic about ptosis of soft tissues of the face and neck.

 From the anamnesis: skin folds and a double chin appeared about 7 years ago.

 Objectively: on the face and neck there are skin folds and wrinkles, deep nasolabial folds, drooping cheeks (“bulldogs”) and chin area (double chin).

 Correction of ptosis of soft tissues of the lower half of the face and neck by the claimed method.

 At the first stage of the operation, liposuction of the chin area was performed, for which, in the sitting position on the patient’s chin, the marker marked a 4 • 6 cm liposuction zone in the form of two concentric ellipses. Local anesthesia was performed by infiltration of 50 ml of a 0.1% solution of lidocaine with adrenaline in a 1: 500 dilution into the intervention zone. Then, with a scalpel N 11, a chin fold 4 mm long was injected, a tunnel in the subcutaneous tissue 2.5 cm long was separated with a mosquito clip, an aspirator with a cannula with a diameter of 3.7 mm was introduced into the obtained access, and fatty tissue was aspirated using an aspiration apparatus P = -1 atm. In this case, the suction rate of adipose tissue was reduced in the direction from the internal ellipse to the peripheral. Removed 58 ml of fat mass.

 At the second stage of the operation, the lower half of the patient's face and neck was lifted. First, the marker outlines the line of the future incision and the skin separation border, which is 5.5 cm anterior to the earlobe and 7 cm downward from the earlobe. Next, an antiseptic treatment of the surgical field and local anesthesia by infiltration of 250 ml of a 0.1% solution of lidocaine with adrenaline in a dilution of 1: 1000 per one right half of the face were performed. A skin incision with a N 15 scalpel was incised to capture part of the subcutaneous tissue from the upper edge of the tragus, bending around the earlobe, continuing along the ear furrow 1 cm higher than the ear canal and then onto the scalp 7 cm long. The skin-fat flap was removed to the target borders and thorough hemostasis with a hemostatic sponge and electrocoagulation of blood vessels. Fatty tissue was sucked along the edge of the lower jaw. On the surface fascia of the face and fatty tissue covering it with polyester 2-0, reinforcing internal sutures are applied in the direction from the corner of the mouth to the upper edge of the tragus, from the middle of the lower jaw to the lower edge of the tragus and in the downward direction from the angle of the lower jaw to the middle of the side surface of the neck, which pulled up, tied up and cut short. The skin-fat flap is stretched to the side of the earlobe and posteriorly until the skin folds straighten and is fixed with two guiding interrupted sutures with polyester 2-0 in front and behind the auricle, the skin is secondarily slightly stretched, and excess skin is excised 0.8 cm in front and 1, 5 cm behind the auricle. The edges of the wound are adapted with interrupted sutures with 5-0 polyester through 1 cm and with a continuous suture of 5-0 polyester over the entire wound.

 A similar operation was performed on the left half of the face.

 An antiseptic pressure dressing is applied to the face, chin and neck.

 Examination of the patient after 2 months: small wrinkles disappeared, skin folds on the face and neck decreased, the second chin disappeared, the previous correct face contour was restored.

Using the proposed method will allow, in comparison with the prototype:
- reduce postoperative complications in the form of bleeding and hematomas;
- to ensure the duration and stability of the cosmetic effect of the operation by imposing internal reinforcing sutures on the superficial fascia of the lower part of the face and the fatty tissue covering it;
- to increase the efficiency of the method due to complex rejuvenation of the skin by lifting the lower part of the face, coupled with liposuction of the chin area, providing straightening wrinkles and restoring the old face contour and a clear oval of the chin.

Claims (3)

 1. A method for surgical correction of ptosis of soft tissues of the face and neck by lifting, including applying a curved section to the skin along a previously marked marker line, separating the skin, stretching the skin flap to the required limits, applying fixation sutures in front and behind the auricle and excising excess skin, which differs the fact that in the chin region and along the edge of the lower jaw, subcutaneous fat is removed by liposuction, and when lifting is performed, the skin is detached with the capture of part subcutaneous fat, and on the superficial fascia of the face and the fatty tissue covering it, internal sutures are made from non-absorbable material and pull them up.  2. The method according to p. 1, characterized in that one line of the internal sutures is laid in the direction from the corner of the mouth to the upper edge of the tragus, and the other line is from the middle of the lower jaw to the lower edge of the tragus.  3. The method according to claim 1, characterized in that the liposuction of the chin region is carried out under the marker zone in the form of two concentric ellipses, while the suction of fatty tissue is reduced in the direction from the inner ellipse to the peripheral.

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