Swanson Eric
Swanson Center, Leawood, KS.
Plast Reconstr Surg Glob Open. 2020 Feb 26;8(2):e2640. doi: 10.1097/GOX.0000000000002640. eCollection 2020 Feb.
Despite their name, "short scar" procedures leave scars in the temples and the postauricular scar often requires extension. Redraping the orbicularis muscle for periorbital rejuvenation increases the risk of facial nerve injury. This retrospective cohort study was undertaken to clinically evaluate a surgical approach that eliminates the temporal incision.
A sub-superficial musculoaponeurotic system (SMAS) facelift was used, incorporating a triple-vector platysmaplasty and fat injection for periorbital rejuvenation. From 2009 to 2019, 225 consecutive outpatients underwent a sub-SMAS facelift with a triple-vector (superior, lateral, medial) platysmaplasty, either alone or in combination with fat injection, laser resurfacing, blepharoplasties, endoscopic forehead lift, and other cosmetic procedures. Release of the retaining ligaments optimized SMAS mobilization. A temporal incision was not used. Fat (mean volume 32 ml) was injected into the undissected subcutaneous tissue plane. The mean follow-up time was 28 months.
The most frequent complication was a neuropraxia (7.6%), usually affecting a frontal nerve branch, and always temporary. Two deep venous thromboses were detected by ultrasound surveillance. No significant correlation was detected between complications and age, sex, body mass index, smoking history, or a previous facelift. Sixteen patients (7%) returned for a secondary facelift (mean interval, 3.5 years).
A sub-SMAS facelift and triple-vector platysmaplasty with fat injection combine effective neckline rejuvenation with facial volume restoration. Avoiding a temporal incision eliminates a telltale scar. Orbicularis preservation avoids additional dissection, possibly reducing the risk of neuropraxia. Fat injection provides a net increase in facial volume. Long-term measurement studies are recommended.
尽管名为“短瘢痕”手术，但颞部仍会留下瘢痕，耳后瘢痕通常也需要延长。重新悬吊眼轮匝肌以实现眶周年轻化会增加面神经损伤的风险。本回顾性队列研究旨在对一种消除颞部切口的手术方法进行临床评估。
采用皮下-表浅肌肉腱膜系统（SMAS）除皱术，联合三向量颈阔肌成形术及脂肪注射以实现眶周年轻化。2009年至2019年，225例连续门诊患者接受了皮下SMAS除皱术及三向量（上、外侧、内侧）颈阔肌成形术，单独或联合脂肪注射、激光磨皮、眼睑成形术、内镜下额部提升术及其他美容手术。松解固定韧带可优化SMAS的活动度。未使用颞部切口。将脂肪（平均体积32毫升）注射到未解剖的皮下组织平面。平均随访时间为28个月。
最常见的并发症是神经失用（7.6%），通常影响额神经分支，且均为暂时性。通过超声监测发现2例深静脉血栓形成。未发现并发症与年龄、性别、体重指数、吸烟史或既往除皱手术之间存在显著相关性。16例患者（7%）再次接受除皱手术（平均间隔3.5年）。
皮下SMAS除皱术、三向量颈阔肌成形术联合脂肪注射可有效实现颈部年轻化并恢复面部容积。避免颞部切口可消除明显瘢痕。保留眼轮匝肌可避免额外的解剖操作，可能降低神经失用的风险。脂肪注射可使面部容积净增加。建议进行长期测量研究。
