RU2707063C1 - Surgical facial surgery method - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to aesthetic surgery. It involves hydropreparation of facial soft tissues, skin incision, skin-fat flap detachment, muscular-aponeurotic tissue system (SMAS) dissection, SMAS detachment, SMAS flap fixation, skin surplus removal, SMAS visualization. Hydropreparation of the facial soft tissues is performed by means of a pressure pump in an amount of up to 400 ml per side. Skin incision is limited to 2 cm in the temple and occiput, along the auricle and along the tragus inner surface. Skin-fat flap is detached at distance of 3–4 cm from the incision line of the skin; the SMAS is incised 4–5 cm vertically in the anterior zone. Moisture detachment is performed in space of bilge area, in space of free cheek and in space of predigested area, fixation of tissues – SMAS flap is performed by nonabsorbable material Etibond 3-0. Excess skin is removed without disturbing the hair growth line in the temporal and occipital region. Visualization of the SMAS is performed only in the skin separation zone – 3–4 cm from the skin incision line, besides, the bilge block is raised and fixed to the orbit edge, method involves suturing and lifting the area of the fatty body of the cheek to an anterior fascia, and lifting, movement and fixation of the premasseter space to the retroauricular fascia.

EFFECT: method enables restoring all operated face areas depending on the degree of age-related changes, reducing the recovery period.

1 cl, 4 dwg

Description

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

The closest analogue to the claimed method is the method of facial plastic surgery SMAC - lifting (Hamra ST. Composite Rhytidectomy, Plast. Reconstr. Surg. 1992: 90: 1-13)

It is based on the fact that the face has a special muscle-aponeurotic tissue system (SMAS), which is located between the skin and bones of the skull. At the same time, if you work not only with the skin, but also with this underlying layer during a facelift, you can get a much more noticeable and lasting result. The result of the usual “skin” plastic surgery of the face has a limited time period of effectiveness from one to two years, due to the fact that the skin has a tendency to stretch, under the influence of deeper not restored tissues. SMAS - lifting (lifting the muscle-aponeurotic layer) increases the effectiveness of the operation for 10-15 years.

Indications for SMAS lifting are age-related changes in the tissues of the face and neck. In particular, their ptosis, that is, dropping under the influence of gravity. The main age-related changes are:

- Loss of clarity of the oval of the face;

- The formation of the "second" chin and "bryly";

- Laying deep nasolabial and oral folds;

- Age-related changes in the zygomatic zone of the face.

With this method, skin and SMAS are detached, excesses are removed, and then tissues are fixed at a certain angle in order to return them to their original “young” position. In this case, skin incisions are made around the ear and in the scalp in the temple and occiput. SMAS lifting is always performed under general anesthesia.

The first stage of rehabilitation after SMAS lifting, i.e. SMAS facelift takes about a week. During this period, the activity of the operated person is limited and it is generally recommended that you rest at home in a comfortable atmosphere.

The second stage of rehabilitation, after a planned visit to the surgeon on the 10-14th day, allows you to return to normal activities.

In the first month after the operation, it is recommended to limit physical activity (sports, stress, physical work), to refuse to visit baths, saunas and a solarium.

The final result of the operation can be estimated 3-4 months after the operation.

A known method of plastic surgery of the face includes hydrotreating the soft tissues of the face with a 0.5% lidocaine solution with adrenaline 1: 100 to 200 +/- 40 ml per side, injecting the solution with a 20 ml syringe. According to preliminary marking, a skin incision is made in the temporal region, around the auricle, the incision is continued into the anteroposterior and occipital region along the border of the hairline. Detachment of the skin-fat flap is carried out within the planned zones (temporal, zygomatic, cheek, cheek, lower jaw, neck, neck). Dissection of the superficial muscle aponeurotic system (SMAS) is carried out from the tragus to the outer border of the circular muscle of the eye, as well as along a line running vertically from the tragus to the angle of the lower jaw.

Then, SMAS detachment is carried out with the removal of excesses and the facial tissues are moved along the upper lateral vector with fixation to the temporal fascia, parotid fascia and the parotid fascia. In this case, the fixation of the SMAS flap is carried out using the absorbable filament material Vicryl 3-0.

Then carry out the movement of the skin flap and its cutting according to the marking and natural lines, and also remove excess skin. The latter is carried out taking into account the location of the seam in the natural folds around the auricle and the border of the hairline.

After that, hemostasis control and wound closure are performed.

A postoperative wound is sutured with Nylon 6-0 suture.

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

The disadvantage of this method of facial plasty is:

firstly, the length of the postoperative scar: 5-10 cm in the temple area and 5-10 cm in the occipital region;

secondly, a wide detachment of the skin and as a result pronounced edema, possible hematomas, seromas, inflammations and a long recovery up to 3-4 weeks;

thirdly: a wide detachment of SMAS and, as a consequence, the risks of damage to the facial nerve and the same long recovery period;

fourthly: the consequence of a wide detachment of tissues is a violation of the sensitivity of the skin and a long restoration of sensitivity up to 12 months or more;

fifthly: in addition, the disadvantage of combining skin grafting and SMAS - grafting is the instability of the result in the area of the free cheek with an ideal contour of the face oval.

The technical task of the proposed method is to increase the efficiency, safety, naturalness and durability of the result of the operation when correcting age-related changes in all areas of the face.

The technical result of the claimed invention consists in restoring all operated areas of the face, depending on the degree of age-related changes, reducing the recovery period, eliminating the aforementioned disadvantages of the prototype due to a short skin incision.

Proposed for patenting a method associated with the introduction of the concept of front spaces.

The essence of this technique is to work precisely with these facial spaces. The person’s face by nature itself is arranged so that the skin and muscles of the face are connected to the bones of the skull not by a continuous canvas, but by means of a ligamentous apparatus, which limits these spaces that allow facial expressions. At the same time, the facial muscles are attached with one side to the bones, and the other is woven into the mucous membrane and facial skin.

Between the fibers of the facial and masticatory muscles there are sliding spaces that are noticeable in the relaxed state of the face and are clearly visible during the operation. The presence of free spaces allows anatomically separate the chewing and facial muscles, which allows the surgeon to implement this method.

The surgeon is required to enter the desired space with the help of special surgical instruments and use it to move and fix relaxed and toned tissues to a new, higher position. More precisely, to return the descending tissue blocks to the position in which they were at a young age.

The inventive method eliminates large-scale detachment of the skin and limits its rise along the entire lateral surface of the face, which allows the operation to be performed with minimal violation of the sensitivity of the skin and reduce the recovery time to 1-2 weeks.

The inventive method eliminates large-scale detachment of SMAS and eliminates the risk of damage to the facial nerve.

First of all, we will define thin and wide types of faces that determine the minimum and maximum boundary values mentioned above (3, 4 cm and 4, 5 cm).

In this case, we will proceed from the distance from the tragus to the outer corner of the eye. In persons of a thin type, this distance is up to 8 cm inclusive (narrow faces). In individuals, this distance is more than 8 cm (wide faces).

The technical result of the implementation of the proposed method is achieved by the fact that in a surgical procedure for facial plastic surgery, including hydropreparation of soft tissues of the face, skin incision, detachment of a skin-fatty flap, dissection of SMAS, detachment of SMAS, fixation of SMAS flap, removal of excess skin, visualization of SMAS, hydropreparation of soft facial tissues are performed by means of an injection pump in a volume of up to 400 ml per side, a skin incision is carried out, limiting it to 2 cm in the temple and occiput, along the auricle and on the inner surface the tragus, the detachment of the skin-fat flap is carried out at a distance of 3-4 cm from the skin incision line, the dissection of SMAS 4-5 cm is carried out vertically in the anterior zone, the detachment of SMAS is carried out in the space of the zygomatic region, in the space of the free cheek and in the space of the masticatory region, fixation (of tissues) of the SMAS flap is carried out with Etibond 3-0 non-absorbable material, removal of excess skin is carried out without disturbing the hairline in the temporal and occipital region, visualization of SMAS is carried out only in the area of skin detachment - 3-4 cm from inii skin incision furthermore carried zygomatic lifting unit and its fixation to the edge of the orbit, and the rise carried suturing space fat body cheeks to prootic fascia and carried out lifting, moving and fixing predzhevatelnogo space to retroauricular fascia.

Claims (1)

The method of surgery for facial plastic surgery, including hydropreparation of soft tissues of the face, skin incision, detachment of a skin-fat flap, dissection of the muscular aponeurotic tissue system - SMAS, detachment of SMAS, fixation of SMAS flap, removal of excess skin, visualization of SMAS, characterized in that hydropreparation of soft facial tissues are performed by means of an injection pump in a volume of up to 400 ml per side, a skin incision is performed, limiting it to 2 cm in the temple and occiput, along the auricle and on the inner surface of the tragus, the skin-fatty flap is worn at a distance of 3-4 cm from the skin incision line, 4-5 cm SMAS is cut vertically in the anterior zone, SMAS is detached in the zygomatic region, in the space of the free cheek and in the space of the masticatory region, tissue fixation is SMAS flap is carried out with Etibond 3-0 non-absorbable material, removal of excess skin is carried out without violating the hairline in the temporal and occipital region, visualization of SMAS is carried out only in the area of skin detachment - 3-4 cm from the skin incision line, in addition, the cheekbone is lifted and fixed to the edge of the orbit, suturing and raising the space of the fatty body of the cheek to the anterior fascia are performed, as well as lifting, moving and fixing the masticatory space to the anterior fascia.

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