Ivy E J, Lorenc Z P, Aston S J
Department of Plastic and Reconstructive Surgery, Manhattan Eye, Ear and Throat Hospital, New York, N.Y., USA.
Plast Reconstr Surg. 1996 Dec;98(7):1135-43; discussion 1144-7. doi: 10.1097/00006534-199612000-00001.
Presented is a prospective study comparing limited SMAS (lateral SMASectomy), conventional SMAS, extended SMAS, and composite rhytidectomies. Randomized patients received either a limited SMAS or conventional SMAS face lift on one side and an extended SMAS or composite rhytidectomy on the other. All procedures were performed at Manhattan Eye, Ear and Throat Hospital in accordance with their well-defined surgical descriptions. Postoperative courses were followed clinically for at least 1 year. Photographs were taken preoperatively and at 6 and 12 months postoperatively. Photographs were reviewed by three independent experienced face lift surgeons. The study comprises 21 patients, 20 women and 1 man, with a mean age of 59 years (range 47 to 70 years). Nineteen patients underwent primary rhytidectomies; two underwent secondary face lifts. For the first 12 patients, each had an extended SMAS procedure performed on one side; on the other, 7 had a conventional SMAS and 5 had a limited SMAS (lateral SMASectomy) face lift. In the last 9 patients, a conventional SMAS was carried out on one side in 8, a limited SMAS in 1, and on the opposite side, a composite rhytidectomy was performed. Complications were few. Temporary weakness of the buccal branch of the facial nerve occurred in 2 patients on the side of the more extensive surgery. On the operating table at completion of the surgery, there was more improvement in reversal of midfacial ptosis and flattening of the nasolabial folds with both extended SMAS and composite rhytidectomies. The composite flap had the most dramatic effect on the nasolabial folds and oral commissure. After 24 hours, once swelling developed and facial motion became reactivated, the noticeable differences in the midface and nasolabial folds were lost. No discernible differences in facial halves were noted again. Differences between facial sides on the 6- and 12-month postoperative photographs were not detectable. We conclude that for routine facial plasty, comparable clinical outcomes are obtained at 6 months and 1 year with limited (lateral SMASectomy) and conventional SMAS face lifts compared with extended SMAS and composite rhytidectomies. All procedures are lacking in their improvement of midface ptosis and the nasolabial folds. The increased surgical risks, morbidity, and convalescence associated with those more extensive procedures do not seem to be warranted in the average patient.
本文呈现了一项前瞻性研究，比较了有限SMAS（外侧SMAS切除术）、传统SMAS、扩大SMAS和复合除皱术。随机分组的患者一侧接受有限SMAS或传统SMAS面部提升术，另一侧接受扩大SMAS或复合除皱术。所有手术均在曼哈顿眼耳鼻喉医院按照其明确的手术描述进行。术后临床随访至少1年。术前及术后6个月和12个月拍摄照片。照片由三位经验丰富的独立面部提升外科医生进行评估。该研究包括21例患者，20名女性和1名男性，平均年龄59岁（范围47至70岁）。19例患者接受初次除皱术；2例接受二次面部提升术。对于前12例患者，每例患者一侧进行扩大SMAS手术；另一侧，7例进行传统SMAS手术，5例进行有限SMAS（外侧SMAS切除术）面部提升术。在最后9例患者中，8例一侧进行传统SMAS手术，1例进行有限SMAS手术，另一侧进行复合除皱术。并发症较少。2例患者在手术范围较大一侧出现面神经颊支暂时无力。在手术结束时的手术台上，扩大SMAS和复合除皱术在改善面中部下垂和鼻唇沟变平方面效果更佳。复合皮瓣对鼻唇沟和口角的效果最为显著。24小时后，一旦肿胀出现且面部活动恢复，面中部和鼻唇沟的明显差异消失。未再次观察到面部两侧有明显差异。在术后6个月和12个月的照片上，面部两侧之间的差异无法检测到。我们得出结论，对于常规面部整形手术，与扩大SMAS和复合除皱术相比，有限（外侧SMAS切除术）和传统SMAS面部提升术在术后6个月和1年可获得相当的临床效果。所有手术在改善面中部下垂和鼻唇沟方面均存在不足。对于普通患者而言，那些更广泛手术所带来的手术风险增加、发病率提高和康复期延长似乎并不合理。
