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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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4 Rhytidectomy (Cervicobuccal Plasty)
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Identical Appr oach on the Contralateral Side
䊏
The submental tumescence incisions are now sutured with 6/0 Prolene
and the forehead incisions with 3/0 Resolon.
Special Bandaging Technique
Following repeated disinfection and cleaning of the wound, a notched
Sofratyl gauze pad is placed on the periauricular wound and held in
place with a 10 × 10 cm dry compress (also notched).
A 6-cm wide soft Softban cotton bandage is dipped in an arnica solution diluted 1:5 with 0.9% saline, wrung out, and then wrapped around
the wound areas with measured traction. T o prevent the bandage from
slipping, a gauze strip should be wrapped around the neck several
times.
䊏
Now, two elastic bandages (6 × 5 cm) are wound relatively tightly like a
spica bandage. This bandage should also be wound intermittently
around the neck. Care should be taken to wind the bandage strips without creasing or folding them in order to achieve smooth healing of the
lipocutaneous flap.
This bandage is held in place with a mesh stocking pulled over the
head;itisleftinplacefor24h.
䊏
Controlled cooling of the surgical area with chilled saline solution compressesshouldbeinstitutedimmediately.
䊏
Hypotension is also maintained as the patient comes out of the anesthesia.
The patient should refrain from any sort of pressing in order to prevent
swelling and hematomas.
The patient’s systolic blood pressure should not be allowed to rise
above 130 mmHg.
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Postoperative Care and Precautions
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䊏
Antibiotic protection was already instituted during the operation and is
continuedorallyfor7dayspostoperatively,startingintheeveningof
the day of surgery. In addition, we administer nonsteroid antiphlogistic
agents to minimize swelling and inflammation.
䊏
The surgical wound should be cooled intermittently during the first
3 days postoperatively.
䊏
The patient is given strict instructions to restrict his or her activities
drastically for 8 days. He or she is advised to sleep on his or her back,
not to laugh or grimace, and to avoid strenuous activities.
䊏
The bandage and Redon drains are removed after 24 h. The patient can
subsequen tl y be discharged if arrangements have been made for aftercare at an outpatient facility.
䊏
The wounds are examined and cleaned daily by a physician.
Using a cotton swab, the patient applies a thin layer of healing ointment
to the sutured areas three times a day. In addition, he or she should
wear a loosely wound silk scarf during the day to protect the wound
againstdirtanddust.Atnightthepatientshouldwearaprotectivebandagetopreventinjuriestotheearregion.Theseprecautionsaretobe
followed for around 10 days.
4 Rhytidectomy (Cervicobuccal Plasty)
The patient is allowed to wash his or her hair under supervision on the
third day after the operation. We also recommen d that lymph drainage,
electrotherapy, and professi o n al cosmetic treatments be instituted on
this day to promote wound healing.
The patients should avoid exposure to solar radiation. Spectacle frames
should not be place directly on the ear in order to preven t infection and
pressure points.
The sutures may be removed between day 7 and day 10.
Sauna visits, sports, exposure to solar radiation, and hair dying should
be avoided for 4 weeks.
The patient will be able to return to work after 2 weeks.
The patient should be advised that the results of aesthetic surgery are
not visible for several weeks after the operation . Moreover, scars,
swelling, and a loss of sensation around the ears can last for months.
Finally , the patient should be advised that aesthetic surgery is not a
solution to emotional problems.
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Results
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ab
Fig. 4.54
a Before: A 54-year-old patient with an aging face
b After: The same patient12 months after ESP-tumescence lifting
Note the fresh natural appearance and intact facial mimicry
4 Rhytidectomy (Cervicobuccal Plasty)
ab
Fig. 4.55
a Before: A 65-year-old patient with an aging face
b After: The same patient 12 months after ESP-tumescence lifting accompanied by a
brow lift and upper eyelid blepharoplasty
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4 Rhytidectomy (Cervicobuccal Plasty)
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ab
Fig. 4.56
a Before: A 68-year-old patient with an aging face
b After: The same patient 12 months after brow lift (hairline cut), lower eyelid
blepharoplasty, stage 2 cheek/neck lift and chemical peeling (TCA 35%)
ab
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Fig. 4.57
a Before: A 67-year-old patient with an aging face
b After: The same patient 12 months after stage 3 cheek/neck lift, upper and lower
eyelid blepharoplasty
ab
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Fig. 4.58
a Before:
b After: The same patient 12 months after stage 3 cheek and neck lift
Fig. 4.59
a Before: A 64-year-old patient with cheek and neck sagging, double chin
b After: The same patient 12 months after face lift and submental platysma lift
A 76-year-old patient with cheek and neck (platysma) sagging
ab
4 Rhytidectomy (Cervicobuccal Plasty)
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Mini Lift
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Disinfection
The skin of the face and neck and the entire head, including the hair,
are disinfected with Cetrimide solution 1%. Bepanthen creme is applied
to the conjunctival gap of the eyes.
Premedication
One hour prior to the operation, the patient is sedated with Clorazepam 25 mg (up to 70 kg of body weight) and Clonidine 75`g(irrespective of the patient’s blood pressure).
4 Rhytidectomy (Cervicobuccal Plasty)
Anesthesia (Fig. 4.60)
Intraveno us sedation with analgesia consists of a mixture of Midazolam
5 mg and Piritramide 3.75 mg (up to 70 kg body weight).
The incision lines are infiltrated with Scandicaine 0.5% with Adrenalin
1:250,000 (10–15 ml each side).
The areas to be undermined in the temples, buccal regions, and in the
retroauricular region will also be infiltrated with approximately 50 ml
tumescence solution on each side (basic solution 500 ml 0.9% NaCl +
50 ml Xylonest 1%, + 0.5 mg Suprarenin 1 : 1000 + 0.5 ml T riamcinolone 40).
146
Fig. 4.60
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4 Rhytidectomy (Cervicobuccal Plasty)
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4 Rhytidectomy (Cervicobuccal Plasty)
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Preliminary Marking of Incision Lines (Maximum Dissection) (Fig. 4.61)
In a Mini Lift, the incision line runs in the preauricular region initially
from the tip of the ear lobe along the insertion of the ear , continues
along the posterior surface of the tragus and then further along the
base of the ear, up to 5 cm above the tip of the helix in an arch cranially
(here the incision corresponds to the usual cut when carrying out a traditional lift, p. 99).
In the retroauricular region, the incision extends from near the attachment of the posterior auricular muscle immediately into the postauricular sulcus. This gives an S-shape with the cranial limb in the temporal
hair region and with the caudal crus around the ear lobe in a dorsal
direction.
148
Fig. 4.61
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4 Rhytidectomy (Cervicobuccal Plasty)
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4 Rhytidectomy (Cervicobuccal Plasty)
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Incision (Fig. 4.62)
Once the skin has blanched (adrenaline effect), the surgeon starts the
incision in the preauricular or intra-auricular region. In the region of
the temporal hair, the incision is made as far as the temporal fascia
(and ligature of the superficial temporal vein and artery if required) in
order to protect the hair roots.
In the preauricular region, the incision is continued with a number 15
scalpel in the retrotragal region. During the retrotragal incision, it is
recommended that this incision be kept very superficial in order not to
damage the underlying cartilage and perichondrium.
The postauricular incision should be made in the form of a Burow’s
triangle.
150
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