Ramirez O M, Maillard G F, Musolas A
Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Plast Reconstr Surg. 1991 Aug;88(2):227-36; discussion 237-8.
The subperiosteal face lift described by Psillakis has been criticized for not showing a more dramatic improvement over conventional brow/face lift procedures. His approach also has a significantly high incidence of nerve injury. This study reports our anatomic findings and surgical modifications, which have permitted a significant improvement in the safety of execution and clinical results using the subperiosteal face lift concept. Pertinent points of applied local anatomy and dissection techniques are as follows: First, we use extensive interconnected subperiosteal dissection that includes the entire zygomatic arch. This allows better repositioning of the deep soft tissues of the entire upper face, most of the midface, and indirectly, key structures of the lower face. Second, the upward pull of the muscles of the cheek and mouth will produce an elevation of the corner of the mouth, affecting positively the smiling mechanism, the oral frowning, and the jowls. Third, the dissection deep to both layers of the temporal fascia decreases the risk of injury to the frontalis nerve. Fourth, the temporal fascia is used as a lifter and anchoring element of the entire cheek-perioral soft tissues as opposed to the periorbital fibrofatty tissues. This will decrease the risk of injuring the frontal and zygomatic branches of the facial nerve. These modifications have been used in 28 patients. Our rate of patient satisfaction has been high, and no complications with regard to nerve injury have been observed. This compares favorably with our initial 60 patients, in whom the Psillakis or Tessier approach was used. In these patients, there was an 11 and 20 percent rate of nerve injury, respectively.
西拉基斯所描述的骨膜下除皱术因相较于传统的眉部/面部提升手术未展现出更显著的改善效果而受到批评。他的手术方法还存在神经损伤发生率显著较高的问题。本研究报告了我们的解剖学发现及手术改良方法，这些方法使得采用骨膜下除皱术理念在手术实施安全性和临床效果方面有了显著提升。局部应用解剖学及解剖技术的相关要点如下：首先，我们采用广泛的相互连通的骨膜下剥离，包括整个颧弓。这能更好地重新定位整个上半面部、大部分中面部的深层软组织，并且间接对下半面部的关键结构进行定位。其次，脸颊和口腔肌肉的向上牵拉会使口角抬高，对面部微笑机制、口腔皱纹及下颌赘肉产生积极影响。第三，在颞筋膜两层的深层进行剥离可降低额神经损伤风险。第四，与眶周纤维脂肪组织不同，颞筋膜用作整个颊周 - 口周软组织的提升和锚固元件。这将降低损伤面神经额支和颧支的风险。这些改良方法已应用于28例患者。我们的患者满意度较高，且未观察到神经损伤相关并发症。这与我们最初使用西拉基斯或泰西埃方法的60例患者相比有优势。在这些患者中，神经损伤发生率分别为11%和20%。
