RU2563227C1 - Method for surgical correction of age-related facial changes in senior patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: facial changes are surgically corrected. An incision is made in temporal, parotideomasseteric and postaural regions. An adipo-dermal flap of the face and neck is separated to a nasolabial fold. A superficial musculo-aponeurotic system is excised from an apex of a zygomatic bone in a straight line to a lower border of an ear lap and further 3-4 cm down along a clavisternomastoid muscle. The excessive superficial musculo-aponeurotic system is fixed as a duplex to an immobilised flap of the superficial musculo-aponeurotic system, parotideomasseteric fascia and mastoid. The excessive adipo-dermal flap is excised by fixing it to a posterior edge of the incision.

EFFECT: producing a long-term aesthetic effect in the patients with the weak superficial musculo-aponeurotic system.

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Description

This invention relates to medicine, namely to the field of aesthetic surgery, and can be used for surgical correction of age-related changes in the face in patients of the older age group and other patients with weak structures of the superficial muscular-aponeurotic system in the upper lateral part of the middle zone of the face.

Despite the variety of methods used to correct age-related changes in the face, facelift with mobilization of the superficial muscular aponeurotic system (SMAS) is difficult for older patients because of the insufficient strength of the SMAS structures in the upper lateral part of the middle third of the face.

There is a method of surgical correction of age-related changes in soft tissues of the lateral surfaces of the face and neck by dissecting tissues in the temporal, parotid-chewing and behind-the-ear areas, peeling the skin-fat flap to the projection of the nasolabial fold. Next, a dissection of the superficial muscular aponeurotic system (SMAS) is performed along the front edge of the auricle and zygomatic arch, separating from it the fascial flap in the medial direction from the outer surface of the adjacent facial muscles. Next, the SMAS flap is pulled laterally and upward, the excesses are excised and fixed with interrupted sutures to the periosteum of the zygomatic arch, posterior edge of the SMAS incision, and also to the mastoid process in the behind the ear region.

The skin-fat flap is also pulled laterally and upward, excess tissue is excised, the flap is fixed to the posterior part of the incision in the temporal, parotid-chewing and behind-the-ear areas [Belousov A.E. et al. “Plastic, reconstructive and aesthetic surgery” - St. Petersburg: Hippocrates, 1998. - P.588-589].

The disadvantage of this method is the impossibility of reliable fixation of the mobilized flap of the superficial muscular aponeurotic system due to the eruption of fixing sutures in patients of the older age group, as well as in other patients with weak SMAS structures in the upper lateral part of the middle third of the face.

The technical result of this invention is to obtain a long-term aesthetic effect in patients with SMAS weakness.

The technical result is achieved by the fact that in the method of surgical correction of age-related changes in the face in patients of an older age group by performing a skin incision in the temporal, parotid-chewing and behind-the-ear areas with peeling of the skin-fat flap in the face and neck to the level of the nasolabial fold, dissection of the superficial muscular -aponeurotic system, its detachment, pulling up and fixing, followed by excision of excess skin-fat flap and fixing it to the posterior edge of the incision, a distinctive feature of It is believed that the dissection of the superficial muscle-aponeurotic system is carried out from the top of the zygomatic bone to the lower border of the earlobe and then along the sternocleidomastoid muscle 3-4 cm downward, excesses of the superficial muscular-aponeurotic system in the form of a duplicate are fixed to the non-mobilized flap of the superficial muscle-aponeurotic system, parotid-chewing fascia and mastoid process.

The method is as follows.

Preliminarily, within the entire skin surface of the face and neck, the boundaries of the subcutaneous detachment to the nasolabial fold are marked (Fig. 1, 2, 3) (1), then through the body of the lower jaw in the form of a semicircle along the upper third of the neck to the back point of the proposed incision in the behind the ear. The incision is performed in the temporal (2), parotid-chewing (3) and behind the ear (4). In the scalp of the temple, a skin incision is performed in the form of an arc (5), convex back. From the level of the base of the upper pole of the auricle (6), a dissection line is drawn in the parotid chewing region along the base of the anterior surface of the earlobe (7) and the behind the furrow (8) to the level of the external auditory meatus (9) and then at an angle of 80 ° -100 ° continue into the behind-the-ear region (4). A cutaneous-fatty flap (10) is cut out at the marked boundaries above the underlying superficial muscular-aponeurotic system (11).

Next, they mobilize, pull up and fix the superficial muscular aponeurotic system (11). The superficial muscular aponeurotic system (11) is dissected along a straight line from the top of the zygomatic bone (12) to the lower border of the earlobe (7) and further along the sternocleidomastoid muscle (13) 3-4 cm down. Then, the detachment of the superficial muscular aponeurotic system to the nasolabial fold is performed (1), it is pulled in the posterior-upper direction and fixed in the form of duplicature to the unmobilized flap of the superficial muscular aponeurotic system (14), the parotid chewing fascia, and also to the mastoid process.

Next, a peeled skin-fat flap (10) is pulled up, its excesses are excised and fixed to the posterior edge of the incision.

Example

The patient of the Peninsula, 59 years old, was admitted to the clinic with complaints of age-related transformation of the face in the form of an oval change, the appearance of bryl, pronounced nasolabial folds, and a decrease in skin turgor. From the anamnesis it was established that the above complaints appeared about 10 years ago, after which it notes a progressive deterioration. An external examination revealed the following age-related changes in the face: moderate atrophy of the skin and subcutaneous fat; displacement of integumentary tissues down and to the midline; deepening and lengthening of existing furrows; contouring of underlying structures in the parotid and submandibular regions. Changes in the adjacent near-mouth area were mainly manifested in a decrease in volume and flattening of the lips, omission of the commissures of the mouth. Based on the noted changes in the soft tissues of the face, surgical intervention is recommended according to the described method for surgical correction of age-related changes in the face.

Operation progress

Under endotracheal anesthesia in the supine position with the arms set aside under 90 °, the borders of the subcutaneous detachment are marked out over the entire skin surface of the face and neck: to the nasolabial fold, then through the lower jaw body in the form of a semicircle along the upper third of the neck to the back of the proposed incision in the behind the ear area . In the planned area of detachment of the skin-fat flap, local infiltration anesthesia (0.25% solution of trimecaine in an amount of 150-200 ml) is done at the level of the subcutaneous fat layer.

The incision is performed in the temporal, parotid-chewing and behind-the-ear areas. In the scalp of the temple, a skin incision is performed in the form of an arc, convex back. From the level of the base of the upper pole of the auricle, a dissection line is drawn in the parotid-chewing region along the base of the anterior surface of the earlobe and behind the furrow to the level of the external auditory meatus and then continues to the behind-the-ear area at an angle of 90 °. At the marked borders, a skin-fat flap is cut out over the underlying superficial muscular-aponeurotic system.

Then, mobilization, pulling up and fixing of the superficial muscular-aponeurotic system are carried out. The superficial muscular aponeurotic system is dissected along a straight line from the top of the zygomatic bone to the lower border of the earlobe and further along the sternocleidomastoid muscle 3.5 cm down. Then, detachment of the superficial muscle-aponeurotic system to the nasolabial fold is performed, pulled in the posterior-upper direction and fixed in the form of duplicature to the unmobilized flap of the superficial muscular-aponeurotic system, parotid chewing fascia, and also to the mastoid process.

The mobilized skin-fat flap is uniformly pulled up in the upper back direction and first fixed with two guiding provisional sutures in the region of the mastoid process and the base of the upper pole of the auricle. Then sequentially excised excess skin-fat flap along the incision line in the temporal, parotid-chewing and behind-the-ear areas. The edges of the surgical wound are connected by continuous intradermal sutures. Before suturing, a 3 mm tubular drainage is installed, which is removed through a separate puncture in the behind-the-ear area. A similar surgical intervention is performed on the opposite side.

Within 2-3 days, the patient is prescribed bed rest, wearing a compression dressing, cold on the area of the surgical wound and painkillers. The postoperative period without complications. Healing of postoperative wounds by primary intention. There were no signs of skin trophic disturbance and motor innervation. At the control examination after 1 month, mild uniform swelling remained in the area of detachment of the skin-fat flap. At a repeated clinical examination (after 3 and 6 months), the anatomical and functional results of the operation were satisfactorily evaluated.

Thus, the proposed method is advisable to use in patients with weak structures of the superficial muscle-aponeurotic system in the upper lateral part of the middle zone of the face, which is most often observed in patients of the older age category.

The proposed method provides reliable fixation of the exfoliated flap of the superficial muscular aponeurotic system and avoids the eruption of sutures, since the dissection of the superficial muscular aponeurotic system is performed in the zone of the highest strength of its structures.

Claims (1)

A method for surgical correction of age-related changes in the face in patients of an older age group by performing a skin incision in the temporal, parotid-chewing and behind-the-ear areas with peeling of the skin-fat flap in the face and neck to the level of the nasolabial fold, dissection of the superficial muscular-aponeurotic system, its detachment, pulling up and fixing, followed by excision of excess skin-fat flap and fixing it to the posterior edge of the incision, characterized in that the dissection of the superficial muscular-aponeurotic system topics are carried out from the top of the zygomatic bone to the lower border of the earlobe and then along the sternocleidomastoid muscle 3-4 cm down, excesses of the superficial muscular aponeurotic system in the form of a duplicate are fixed to an unmobilized flap of the superficial muscular aponeurotic system, parotid chewing fascia and mastoid process.

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