Bucky Louis P, Kanchwala Suhail K
Philadelphia, Pa. From the Hospital of the University of Pennsylvania.
Plast Reconstr Surg. 2007 Nov;120(6 Suppl):89S-97S. doi: 10.1097/01.prs.0000248866.57638.40.
Soft-tissue fillers can be used successfully to restore volume loss caused by facial aging. Injectable fillers can be used in isolation or in conjunction with other facial rejuvenation procedures. To achieve a superior aesthetic result, the plastic surgeon must understand the key components of facial aging: soft-tissue atrophy, gravitational descent, and loss of skin tone. An accurate assessment of the relationship of these factors will determine the role of soft-tissue augmentation through the use of fillers. Because the majority of facial volume loss through aging is attributable to fat loss, the authors believe that autologous fat represents the ideal soft-tissue replacement. The authors describe the appropriate use of autologous fat and improvements in technique that have enhanced the predictability of facial fat grafting. When autologous fat is not an option, alternative facial fillers including calcium hydroxylapatite and hyaluronic acid may provide excellent results. The authors' algorithm for filler selection is based on relative morbidity, recipient-site characteristics, and the physical characteristics of each filler. This algorithm is discussed in the following anatomical regions: the nasolabial folds, glabellar crease, malar region, nasojugal groove, and lips. When used appropriately, soft-tissue fillers can contribute significantly to overall facial rejuvenation.
软组织填充剂可成功用于修复面部衰老导致的容量缺失。可注射填充剂可单独使用，也可与其他面部年轻化手术联合使用。为获得卓越的美学效果，整形外科医生必须了解面部衰老的关键因素：软组织萎缩、重力性下垂和肤色丧失。准确评估这些因素之间的关系将决定通过使用填充剂进行软组织填充的作用。由于衰老导致的面部大部分容量缺失归因于脂肪流失，作者认为自体脂肪是理想的软组织替代物。作者描述了自体脂肪的恰当使用以及技术改进，这些改进提高了面部脂肪移植的可预测性。当自体脂肪不可行时，包括羟基磷灰石和透明质酸在内的其他面部填充剂可能会提供出色的效果。作者的填充剂选择算法基于相对发病率、受区特征和每种填充剂的物理特性。该算法将在以下解剖区域进行讨论：鼻唇沟、眉间纹、颧区、鼻颧沟和唇部。如果使用得当，软组织填充剂可对面部整体年轻化做出显著贡献。
