Fagien S
Boca Raton Center for Ophthalmic Plastic Surgery, Fla, USA.
Plast Reconstr Surg. 1999 Feb;103(2):701-13. doi: 10.1097/00006534-199902000-00055.
Our improved understanding of the pathophysiology of facial lines, wrinkles, and furrows has broadened the treatment options for a variety of facial cosmetic blemishes. The persistence or recurrence of certain facial rhytids after surgery has confirmed the lack of full comprehension of their origin. Glabellar forehead furrows (frown lines) and lateral canthal rhytids (crow's feet) have been the most popular facial lines that have been shown to be mostly the result of regional hyperkinetic muscles, and their eradication may be more suitable, at times, to chemodenervation than to soft-tissue fillers, skin resurfacing, or surgical resection. Aesthetic surgical procedures that have yielded suboptimal results may also occur from failure to recognize other causative factors including hyperkinetic or dynamic musculature, which may contribute to etiology of the visible soft-tissue changes and lack of persistent effect after surgery. Chemodenervation with botulinum toxin A (Botox) has proven to be useful both as a primary treatment for certain facial rhytids and as an adjunctive agent for a variety of facial aesthetic procedures to obtain optimal results.
我们对面部纹路、皱纹和沟壑病理生理学的深入理解，拓宽了针对各种面部美容瑕疵的治疗选择。某些面部皱纹在手术后持续存在或复发，这证实了我们对其成因仍缺乏全面的理解。眉间额头沟壑（皱眉纹）和外眦皱纹（鱼尾纹）一直是最常见的面部纹路，已证实这些纹路主要是由局部肌肉过度运动所致，有时，根除这些纹路采用化学去神经支配法可能比使用软组织填充剂、皮肤磨削术或手术切除更为合适。美学外科手术效果欠佳，也可能是由于未能识别其他致病因素，包括过度运动或动态肌肉组织，这些因素可能导致可见的软组织变化，并导致手术后效果无法持久。事实证明，使用A型肉毒杆菌毒素（保妥适）进行化学去神经支配，作为某些面部皱纹的主要治疗方法以及各种面部美容手术的辅助手段，都能取得最佳效果。
