Nassif Paul S
Department of Otolaryngology, University of Southern California School of Medicine, Los Angeles, CA, USA.
Facial Plast Surg. 2007 Feb;23(1):27-42; discussion 43-4. doi: 10.1055/s-2007-970130.
As we become more confident with our surgical skills following our fellowship training, some of our approaches and techniques will be modified or changed. My primary evolutionary change involves procedures of the upper third of the face, primarily the brow lift and treatment of lower eyelid fat techniques. Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts, have provided facial plastic surgeons with effective brow elevation for many years. In the past decade, the endoscopic brow lift has rapidly become accepted as part of the surgical armamentarium and is frequently the technique of choice. In general, the temporal dissection, temporal fixation, forehead subperiosteal or subgaleal dissection with release, and treatment to the brow depressor musculature have been standardized. Methods of bony fixation remain a controversial topic as there are numerous methods. We advocate deep temporal fixation only without bone fixation to achieve effective, long-term brow elevation. Traditionally, lower eyelid herniated fat is removed, which may cause a sunken or hollow lid appearance, especially in patients with a tear trough deformity (nasojugal groove). Lower eyelid transconjunctival fat repositioning, defined as the subperiosteal repositioning of the medial and central lower eyelid herniated orbital fat into the nasojugal fold, may prevent the surgical, hollow lower eyelid appearance while treating the herniated fat. Fat repositioning may be combined with an endoscopic subperiosteal midface-lift, transcutaneous skin pinch, and transconjunctival orbicularis oculi excision. This technique offers a powerful tool in the surgical armamentarium of the facial plastic surgeon.
随着我们在 fellowship 培训后对手术技能越来越有信心，我们的一些方法和技术将会被修改或改变。我的主要演变性改变涉及面部上三分之一的手术，主要是提眉术和下睑脂肪处理技术。传统的前额和眉部年轻化方法，如冠状、发际前和直接提眉术，多年来一直为面部整形外科医生提供有效的眉部提升效果。在过去十年中，内镜提眉术已迅速被接受为手术器械库的一部分，并且常常是首选技术。一般来说，颞部剥离、颞部固定、前额骨膜下或帽状腱膜下剥离并松解，以及对眉降肌的处理都已标准化。骨固定方法仍然是一个有争议的话题，因为有众多方法。我们主张仅进行颞深固定而不进行骨固定以实现有效、长期的眉部提升。传统上，下睑突出的脂肪会被去除，这可能会导致眼睑凹陷或空洞外观，尤其是在有泪沟畸形（鼻颧沟）的患者中。下睑经结膜脂肪重新定位，定义为将下睑内侧和中央突出的眶脂肪骨膜下重新定位到鼻颧沟，在治疗突出脂肪的同时可防止手术导致的下睑空洞外观。脂肪重新定位可与内镜骨膜下中面部提升、经皮皮肤捏起和经结膜眼轮匝肌切除术相结合。这项技术为面部整形外科医生的手术器械库提供了一个强大的工具。
