Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5207_Библиотеки_им_академика_М_И_Перельмана.pdf
23 Soft Tissue Surgery Combined withZygoma Reduction
Case 2
A 52-year-old female patient with moderate skin sagging and wrinkle sought for minimally
invasive facial rejuvenation with a low risk of complications and rapid recovery time. She
underwent endotine midface lift and showed improved cheek drooping (Fig.23.9).
Fig. 23.9 Preoperative
views of a 52-year-old
female patient in Case 2
(left column).
Postoperative views
after elastic midface lift
(right column).
Postoperative views
showed that the contour
of midfacial margin was
smooth, which gives a
softer image
239
240
K. Lee
23.6 Discussion
Reversion of mongoloid slant reduces the wide
margin below the eyes and makes their high
cheekbones less conspicuous, especially when
smiling. Good candidates are patients with (1)
exophthalmic eyes, (2) a distance between the
lateral canthus and lateral orbital rim is 4mm or
more, and (3) a lateral fornix deeper than 3mm
[9]. It should be considered that the average value
of the slant of palpebral ssure was 8.5±2.0° for
males and 8.8± 2.5° for females. When lateral
canthoplasty is to be performed on an Asian
patient, it would be better to apply these values as
the standards.
Under-correction or immediate relapse are
most common complications, often resulting
from improper positioning of the canthal anchoring suture. Early revision of an under-corrected
lateral canthus can be undertaken within the initial weeks following surgery. However, beyond
this timeframe, it is advisable to delay any revisions until after a 6-month period or until the
hypertrophic response has signicantly
diminished.
Asymmetry, particularly in the lateral canthal
angle and its horizontal length, frequently necessitates revisions. To mitigate the need for unnecessary revisions, it is imperative to thoroughly
consult the patients about the inherent differences in the horizontal lengths and vertical orientations of the two lateral canthi.
Exposure of red conjunctiva is one of the
drawbacks in lowering lateral canthoplasty. It
may be transient, but be cautious not to excessively retract the conjunctiva during the surgery
and in xation.
As ancillary procedure for zygoma reduction,
minimal lifting procedures such as mini-lifting or
endotine lifting are preferred. Whether to comment on the necessity of soft tissue procedure is
tricky as it happens differently and patient’s
response also varies. Endotine midface lift has
advantages of no skin incision and scar from outside. And it can be easily done with the previous
incision and dissection from zygomatic reduc-
tion. Palpability of endotine is usually not the
problem and, if any, improves with dissolution of
the implant. Mini-lifting has advantages of excellent lifting effect with minimal scar. It is highly
recommend for the patients aged over 40.
Integrated diagnosis of facial soft and hard tissue is pre-requisite for patient satisfaction.
Achieving a natural and harmonious midface
contour, particularly for East Asian patients with
distinct anatomical features and specic aesthetic
desires, necessitates a comprehensive mastery of
techniques by the surgeon. This includes prociency in zygomatic reduction techniques as well
as complementary procedures such as lowering
lateral canthoplasty and midface lifting. When
these techniques are skillfully integrated and
applied, they yield a synergistic effect, enhancing
the overall aesthetic outcome.
References
1. Park DH. Anthropometric analysis of the slant
of palpebral ssures. Plast Reconstr Surg.
2007;119(5):1624–6.
2. Jin H.Reduction malarplasty. J Korean Soc Aesthetic
Plast Surg. 2010;16:1–8.
3. Baek RM, Kim J, Kim BK. Three-dimensional
assessment of zygomatic malunion using computed
tomography in patients with cheek ptosis caused by
reduction malarplasty. J Plast Reconstr Aesthet Surg.
2012;65(4):448–55.
4. Jin H. Reduction malarplasty using an L-shaped
osteotomy through intraoral and sideburns incisions.
Aesth Plast Surg. 2011;35(2):242–4.
5. Garvey PB, Ricciardelli EJ, Gampper T. Outcomes
in threadlift for facial rejuvenation. Ann Plast Surg.
2009;62(5):482–5.
6. Abraham RF, DeFatta RJ, Williams EF III.Thread-
lift for facial rejuvenation: assessment of long-term
results. Arch Facial Plast Surg. 2009;11(3):178–83.
7. Rachel JD, Lack EB, Larson B.Incidence of compli-
cations and early recurrence in 29 patients after facial
rejuvenation with barbed suture lifting. Dermatologic
Surg. 2010;36(3):348–54.
8. Huggins RJ, Freeman ME, Kerr JB, etal. Histologic
and ultrastructural evaluation of sutures used for
surgical xation of the SMAS. Aesth Plast Surg.
2007;31:719–24.
9. Fox SA.Opthalmic plastic surgery. 5th ed. NewYork:
Grune & Stratton; 1976. p.223–5.