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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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Fig. 4.62
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4 Rhytidectomy (Cervicobuccal Plasty)
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Dissection (Fig. 4.63, 4.64)
The dissection should be carried out in the cranial section (blun t) on
the tempo ral fascia. In the preauricular region this will be dissected
with the Mang dissecting scissors. During this, the clear cutaneous flap
should be dissected only as far as the start of the ligament (maximum
of 3–4 cm from the tragus), which connects the SMAS with the parotid
fascia and the overlying skin. Protection of these ligaments ensures
tightening of the SMAS en bloc with the skin – this is the trick during a
Mini Lift. (If these ligaments are transected, ligament connections to
the skin in a further ventral direction will be lost and, as a result, the
skin there can only be transplanted independently of the SMAS.)
In the caudal region, the lobe is dissected to the point where the platysma-auricular fascia can be identified and divided.
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Fig. 4.63
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.64
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Resection (Fig. 4.65)
The ventral cutaneous lobe with the attached SMAS under maximum
tension is rotated in a cranial direction by approximat el y 70° and temporarily fixed to the scalp with clamps. Due to the S-shaped design at
both the cranial and caudal ends, there is Burow-like excess skin. The
excesspartsofskinaregraduallyincised,startingatthekeypoints.The
first key point is at the transition of the tragus to the helix. Following
incision, the first key suture should be made with Polyamide 3/0 at this
point. The second holding suture should be placed at the tip of the helix
and the third and last holding suture should be in the region of the
incisura antitragica. Between the key sutures, the skin is then be gradually resected corresponding to the base of the ear. In order to achieve a
step-free transition, the skin is slightly tapered during resection.
In the caudal region of the ear lobe, the skin is resected free of tension
in order to avo id pulling the ear lobe in a caudal direction. The excess
skin at the ear lobe is moved in a dorsal direction where it is redraped
with very small creases.
The cutaneous creases will smoothen out within 6 months postoperatively at the latest.
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Fig. 4.65
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4 Rhytidectomy (Cervicobuccal Plasty)
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Wound Revision, Hemostasis, Cutaneous Suturing (Fig. 4.66–4.68)
Meticulous hemostasis with bipolar diathermia is carried out and the
skin is closed without a drain being fitted. In the hair region, the skin is
closed in one lay er using Ethilon 3/0 with interrupted sutures, while in
the periauricular region the key sutures are replaced with subcutaneous
sutures using Polyglecaprone 25 4/0 Ethilon. Definitive cutaneous closure is carried out with spiraling sutures using Polyamide 6/0 (these
preauricular sutures are removed on the seventh postoperative day).
The wounds are covered with Steri-Strips™. There is no need for further dressings.
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Fig. 4.66
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.67
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Fig. 4.68
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Results
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ab
4 Rhytidectomy (Cervicobuccal Plasty)
cd
Fig. 4.69
a, cBefore: A 49-year-old patient with deep nasolabial folds and double chin
b, d After: The same patient 12 months after minilift (M-lift) and submental
liposuction
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ab
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4 Rhytidectomy (Cervicobuccal Plasty)
Fig. 4.70
a Before: A 52-year-old patient with nasolabial folds
b After: The same patient 12 months later after minilift (M-lift)
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