Le Louarn Claude
French Society of Plastic and Reconstructive Surgery, 59 rue Spontini, 75116, Paris, France.
Aesthetic Plast Surg. 2004 Nov-Dec;28(6):359-72; discussion 373-4. doi: 10.1007/s00266-004-0053-1. Epub 2005 Jan 17.
Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural. A minimally invasive technique for malar and lower lid lift is proposed. Two incisions are used: the standard subciliary lower eyelid incision and one on the lateral part of the upper eyelid. Through these incisions a skin flap lower eyelid dissection and a subperiosteal malar dissection are performed. The arcus marginalis itself is not transected as is the case when the malar area is entered from the lower eyelid. Rather, a subperiosteral release of the arcus marginalis is performed through a muscle-splitting incision at the lateral canthus. Eyelid malposition is avoided because the muscles, vessels, and nerves converging toward the medial canthus are not interrupted. The subperiosteal dissection of the arcus marginalis extends to the medial canthus and also releases the insertion of the orbicularis oculi superior malar part. Consequently, all the attachments of the tear trough are released. Two subperiosteal suspensions connect the central part of the nasolabial volume and, more laterally, the central part of the malar area to the inferolateral orbital rim. The elevation of the malar volume resulting from these suspensions is concentric with the orbit. A final third suspension vertically connects the orbicularis oculi muscle with the underlying periosteum to the bone of the lateral orbital rim. Significant skin excess is removed from the lower eyelid. Complete disinsertion of the tear trough attachments combined with the malar elevation treats the entire palpebromalar groove. The lifted fat volume fills the space resulting from the subperiosteal disinsertion. A safer, more natural and more reliable result is achieved because the vectors of traction with this technique are exactly opposite those of the midface aging process, and because a very stable fixation is created between the lifted malar periosteum and the malar and latero-orbital rim bones.
中面部年轻化手术极具挑战性。下睑的误差范围约为0.5毫米，美容效果有时会显得不自然。本文提出了一种用于颧部和下睑提升的微创技术。采用两个切口：标准的下睑缘下切口和上睑外侧部分的一个切口。通过这些切口进行下睑皮瓣剥离和骨膜下颧部剥离。与从下睑进入颧部区域时不同，边缘弓本身不被横断。相反，通过外眦处的肌肉劈开切口进行边缘弓的骨膜下松解。由于朝向内眦汇聚的肌肉、血管和神经未被中断，避免了眼睑位置异常。边缘弓的骨膜下剥离延伸至内眦，也松解了眼轮匝肌上颧部的附着。因此，泪沟的所有附着均被松解。两个骨膜下悬吊将鼻唇沟容积的中央部分以及更外侧的颧部区域的中央部分连接至眶下外侧缘。这些悬吊导致的颧部容积提升与眼眶同心。最后第三个悬吊将眼轮匝肌及其下方的骨膜垂直连接至眶外侧缘的骨。从下睑去除大量多余皮肤。泪沟附着的完全分离与颧部提升相结合可治疗整个睑颧沟。提升的脂肪容积填充骨膜下分离产生的空间。由于该技术的牵引向量与中面部衰老过程的向量完全相反，并且在提升的颧部骨膜与颧部及眶外侧缘骨之间形成了非常稳定的固定，因此可实现更安全、更自然和更可靠的效果。
