Reece Edward M, Rohrich Rod J
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9132, USA.
Aesthet Surg J. 2008 Nov-Dec;28(6):668-74. doi: 10.1016/j.asj.2008.09.007.
The lower third of the face is often an afterthought in aesthetic plastic surgery. Aging across the mandibular border may be described by several mechanisms: fat atrophy and volume loss; shifting of subcutaneous fat compartments; and mandibular septum dehiscence with submandibular fat hypertrophy. Accurate diagnosis of the apparent mechanism of jaw line aging is critical to successful facial rejuvenation. Diagnosis directs the plastic surgeon as to which key anatomic components in this region to manipulate to optimize rejuvenation. The senior author's technique for facial rejuvenation across the mandibular border is described with an algorithm for facial rejuvenation of the jaw line. Several consistent patterns of facial aging are apparent and a theory of their mechanism is suggested: (1) patients with thin skin and minimal jowling resulting from fat atrophy; (2) jowl ptosis with normal skin and loss of submalar hollow and midface fullness, caused by displacement of fat compartments; and (3) cascading confluent fat over the mandible, produced by septum dehiscence. Fat atrophy is treated with fat replacement, either injectable or autologous fat. Jowl ptosis is treated with septum release and superficial musculoaponeurotic system elevation to restore jaw line definition. Confluent fat is treated by septum release, superficial musculoaponeurotic system elevation, and direct excision of fat over the mandible. Application of techniques without proper analysis and definition may lead to an operated look with a swept jaw line. Undertreatment may not achieve jaw line definition.
在美容整形手术中，面部下三分之一部位常常被视为次要部位。下颌缘的衰老可通过多种机制来描述：脂肪萎缩和体积减少；皮下脂肪层移位；以及下颌隔膜裂开伴颌下脂肪肥大。准确诊断下颌轮廓衰老的明显机制对于成功的面部年轻化至关重要。诊断能指导整形外科医生确定该区域哪些关键解剖结构需要进行调整以优化年轻化效果。本文介绍了资深作者在下颌缘进行面部年轻化的技术，并给出了下颌轮廓面部年轻化的算法。面部衰老存在几种一致的模式，并提出了其机制理论：（1）因脂肪萎缩导致皮肤薄且双下巴不明显的患者；（2）因脂肪层移位导致皮肤正常但颧下凹陷和中面部饱满度丧失的双下巴下垂；（3）由隔膜裂开导致的下颌骨上脂肪层叠融合。脂肪萎缩可通过注射脂肪或自体脂肪移植来治疗。双下巴下垂可通过隔膜松解和表浅肌肉腱膜系统提升来治疗，以恢复下颌轮廓清晰度。脂肪层叠融合可通过隔膜松解、表浅肌肉腱膜系统提升以及直接切除下颌骨上的脂肪来治疗。在没有进行适当分析和明确诊断的情况下应用这些技术可能会导致下颌轮廓呈扫帚状的手术痕迹外观。治疗不足则可能无法实现下颌轮廓的清晰化。
