Li Xiu-Qi, Wang Jia-Qi
The Third Department, Plastic Surgery Hospital, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China.
J Craniofac Surg. 2018 Sep;29(6):1558-1561. doi: 10.1097/SCS.0000000000004620.
Forehead aging is characterized by wrinkles, loss of skin elasticity, brow ptosis, and soft-tissue atrophy. For patients with prominent rhytids and marked brow ptosis, forehead lift is still the most effective treatment with a persisting result. In order to eliminate the glabellar wrinkles, forehead lift usually requires the removal of the corrugator supercilii muscle and procerus, which can lead to glabellar flattening or depression. Instead of muscle removal, the corrugator supercilii muscle, procerus, and the underlying galea were dissected as a pedicled glabellar flap. Then reversed periosteum or dermal fat graft was used to cover the glabellar flap to restore the glabellar volume. From January 2005 to November 2014, a total of 164 coronal and 42 trichophytic forehead lifts were performed. Reversed periosteum was used to cover the glabellar flap in 191 patients while dermal fat graft was applied in 15 patients with a follow-up period ranging from 6 months to 10 years. There was no irregularity or depression in the glabellar region in the group of reversed periosteal flap. The take of dermal fat graft placed over the glabellar flap was minimal. Complications from surgical procedures occurred in 2.91% of the patients. There was 1 asymmetry, 4 patients with higher than desired frontal hairline for implantation of autologous follicular units, and 1 patient with scar hyperplasia. There was no hematoma or nerve injury, no permanent numbness, and no alopecia. The techniques are simple and effective to eliminate the glabellar wrinkles and maintain or restore the glabellar volume.
前额衰老的特征是出现皱纹、皮肤弹性丧失、眉下垂和软组织萎缩。对于有明显皱纹和显著眉下垂的患者，前额提升术仍然是最有效的治疗方法，效果持久。为了消除眉间皱纹，前额提升术通常需要切除皱眉肌和降眉间肌，这可能导致眉间变平或凹陷。我们采用将皱眉肌、降眉间肌及其下方的帽状腱膜作为带蒂眉间皮瓣进行解剖，而不是切除肌肉。然后使用翻转的骨膜或真皮脂肪移植来覆盖眉间皮瓣，以恢复眉间的容积。2005年1月至2014年11月，共进行了164例冠状前额提升术和42例毛发移植前额提升术。191例患者使用翻转骨膜覆盖眉间皮瓣，15例患者使用真皮脂肪移植，随访时间为6个月至10年。翻转骨膜皮瓣组眉间区域没有出现不平整或凹陷。放置在眉间皮瓣上的真皮脂肪移植成活率极低。手术并发症发生率为2.91%。出现1例不对称，4例患者因自体毛囊单位植入导致额发际线高于预期，1例患者出现瘢痕增生。没有发生血肿或神经损伤，没有永久性麻木，也没有脱发。这些技术对于消除眉间皱纹以及维持或恢复眉间容积简单有效。
