Department of Plastic Surgery, Iran University of Medical Sciences, St. Fatima Hospital, No. 8, Esmaeeli St., Keyhan Ave., Zaferanieh, Tehran, Iran.
Aesthetic Plast Surg. 2011 Aug;35(4):516-21. doi: 10.1007/s00266-010-9649-9. Epub 2011 Feb 7.
In certain cases of endoscopic forehead lift without muscle resection, patients were incidentally noted to develop weakness or loss of their ability to frown during the postoperative period despite intact musculature. This finding suggested the possibility of decreasing frown strength using the disinsertion of the relevant muscles. This finding persuaded the authors to try to eliminate or decrease the sensory problems resulting from open or endoscopic frowning muscle resection by disinserting these muscles. We therefore sought to determine the efficacy of a brow/forehead lift that involved disinsertion rather than muscle resection.
From September 2004 through December 2006, 22 endoscopic forehead lifts (20 females and 2 males) were performed using the conventional corrugator muscle resection technique (group 1). From January 2007 through October 2009, 43 patients (38 females and 5 males) underwent endoscopic forehead lift with a muscle-preserving technique (group 2). In both groups, small scalp incisions were made, and an endoscope was used to elevate the brows and forehead to perform glabellar and forehead muscle resection in group 1 and disinsertion of the frowning muscles in group 2. The skin of the forehead was then reanchored to a more superior location using sutures attached to deep temporal fascia as well as outer table screws and skin staples.
Aesthetically pleasing eyebrow and forehead with reduced power in the frowning muscles were achieved in the majority of patients in both groups. A significant decrease in the depth of vertical and horizontal glabellar creases was obtained in these patients. In group 1, 19 of 22 patients completely lost the ability to frown and 3 patients (13.6%) suffered permanent sensory loss. In group 2, 33 of 43 patients lost their ability to frown but only 2 cases (4.5%) developed minimal unilateral forehead partial sensory deficit after a 12-month follow-up period.
Disinsertion of the corrugator supercilli, procerus, or orbicularis oculi muscles can decrease contractility with less chance of damaging nearby or intermingled sensory nerves than offered by resection.
在某些情况下，内镜额部提升术不切除肌肉，尽管肌肉完整，但患者在术后会意外地出现无力或无法皱眉的情况。这一发现提示通过切断相关肌肉可能会降低皱眉强度。这一发现促使作者尝试通过切断这些肌肉来消除或减少开颅或内镜皱眉肌切除术引起的感觉问题。因此，我们试图确定一种涉及切断而不是切除肌肉的眉/额部提升术的疗效。
从 2004 年 9 月至 2006 年 12 月，22 例行常规皱眉肌切除术的内镜额部提升术（20 名女性和 2 名男性）（组 1）。从 2007 年 1 月至 2009 年 10 月，43 例患者（38 名女性和 5 名男性）行内镜额部提升术，采用保留肌肉技术（组 2）。两组均采用小头皮切口，内镜抬眉、额部，行皱眉肌和额肌切除术（组 1），皱眉肌切断术（组 2）。然后使用缝线将额部皮肤重新固定到更上方的位置，缝线连接颞深筋膜、外板螺钉和皮肤钉。
两组患者的眉毛和额头均具有美学吸引力，皱眉肌力量减弱。这些患者的垂直和水平眉间横纹深度显著降低。组 1 中，22 例患者中有 19 例完全丧失皱眉能力，3 例（13.6%）患者出现永久性感觉丧失。组 2 中，43 例患者中有 33 例丧失皱眉能力，但在 12 个月的随访期内，仅 2 例（4.5%）出现轻微单侧额部部分感觉缺陷。
切断皱眉肌、降眉间肌或眼轮匝肌可以降低收缩力，同时比切除术更不容易损伤附近或混杂的感觉神经。
