Byrd H S
Division of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Clin Plast Surg. 1997 Apr;24(2):233-46.
The endoscopic extended browlift adds to the armamentarium against aging, serving as an excellent stand alone procedure in the younger patient in whom the lower face and neck are minimally affected. It accomplishes a repositioning of the orbital portion of the orbicularis oculi muscle thereby minimizing resection of eyelid skin, muscle, and fat. Its lift of the malar pad causes a pleasing transition onto the upper face blending nicely into the lower face. In more advanced aging, the extended browlift serves as a powerful adjunct to procedures on the eyelids, lower face, and neck. It corrects troublesome orbital festoons and malar bags and reduces the upper third of the nasolabial fold. Its transition effect in the lower face has allowed an alternative procedure with more limited SMAS-skin undermining to be performed in smokers. The primary disadvantage of the procedure is the necessity of thoroughly understanding and familiarizing oneself with the somewhat confusing temporal anatomy, the location of the retaining ligaments of the cheek, and the relationship of the facial nerve to the deep plane. A failure to recognize and release the retaining structures will limit significantly the outcome of the procedure. Careless or misdirected dissection over the zygomaticus major muscle may directly injure the muscle or the nerve branches to the orbicularis oculi muscle. Forty-two patients who underwent an endoscopic extended browlift now have been followed from 6 to 18 months. The patient representing the first endoscopic attempt had unilateral weakness of the forehead and bitemporal fat atrophy. The forehead weakness resolved at 4 weeks postoperatively. The temporal fat atrophy was corrected at 1 year postoperatively with micro fat grafts. A second patient done as a demonstration at another institute had forehead weakness and excessive tension on one side. The weakness and tension reportedly resolved at 3 months. No patients have had permanent weakness. The most frequent occurrence following the procedure was the return of brow asymmetry that was present before surgery. Attempts at correcting this preoperative finding were generally unsuccessful.
内镜下扩大额部提升术为抗衰增添了新手段，对于下脸和颈部受影响较小的年轻患者而言，是一种出色的独立手术。它实现了眼轮匝肌眶部的重新定位，从而最大程度减少眼睑皮肤、肌肉和脂肪的切除。其对颧脂肪垫的提升使上脸与下脸之间形成令人满意的过渡，与下脸完美融合。在衰老更严重的情况下，扩大额部提升术是眼睑、下脸和颈部手术的有力辅助手段。它可矫正恼人的眶周皱襞和颧袋，并减少鼻唇沟上三分之一。其在下脸的过渡效果使在吸烟者中可采用一种对颞浅筋膜 - 皮肤分离范围更有限的替代手术。该手术的主要缺点是必须彻底了解并熟悉有些复杂的颞部解剖结构、颊部固定韧带的位置以及面神经与深层平面的关系。未能识别和松解固定结构会严重限制手术效果。在颧大肌上方进行粗心或方向错误的解剖可能直接损伤该肌肉或眼轮匝肌的神经分支。42例行内镜下扩大额部提升术的患者现已随访6至18个月。首例内镜手术患者出现单侧额部无力和双侧颞部脂肪萎缩。术后4周额部无力症状消失。术后1年通过微量脂肪移植矫正了颞部脂肪萎缩。在另一家机构作为示范手术的第二例患者出现额部无力和一侧张力过大。据报道，无力和张力在3个月时缓解。没有患者出现永久性无力。该手术后最常见的情况是术前就存在的眉不对称复发。矫正这一术前表现的尝试通常未成功。
