Facial rhytidectomy
Plastic Surgery Hospital, Chinese Academy of Medical Sciences, director of safe patient
Professor Ma Jiguang Welcome
Plastic Surgery Hospital, Chinese Academy of Medical Sciences of plastic surgery clinics
Ping in Beijing, China Academy of Medical Sciences Plastic Badachu Surgical Hospital is the most prestigious cosmetic surgery hospital.
institute under the China Academy of Medical Sciences and Peking Union Medical College, is the first graduate of the plastic surgery training base, with more than 40 professors with senior professional titles and the team of physicians, her graduate training and continuing education students throughout the country.
For the convenience of the people inside and outside of Beijing for treatment, the hospital opened in Beijing on peace in the cosmetic surgery clinic was January 19, 2001 officially opened!
The clinic is located in the famous Ping Street, Beijing, in the past with convenient transportation facilities, fully equipped, comfortable visits by outstanding senior hospital doctors surgery and consulting services host.
exact Ping clinics Location: Ping An Lixi Street, Xicheng District, Beijing Post Code No. 4: 100035
Tel: 66182233
subject site: www.pinganzhengxing.com
Tel: 66151156 (fax, Ma Zhuren Office)
Facial rhytidectomy
Plastic Surgery Hospital, Chinese Academy of Medical Sciences plastic surgery face and neck, director of the Center Director Wang Jiaqi
Ping Ma Jiguang
one patient, the classification of facial rhytidectomy
1. by facial rhytidectomy the site
(1) the amount of rhytidectomy (2) surface 1 / 3 rhytidectomy (3) temporal rhytidectomy (4) surface, the lower 2 / 3 rhytidectomy (5) neck Rhytidectomy
(6) full-face resurfacing
2. divestiture by face lift surgery when the level of
(1) subcutaneous rhytidectomy (2) SMAS rhytidectomy (3) subperiosteal Rhytidectomy (4) multi-level complex of deep plane rhytidectomy
3. According to equipment classification
(1) endoscopic rhytidectomy
(2) Laser Beauty rhytidectomy
that these several categories are not completely independent, are interrelated. sometimes intertwined should be used, depending on the circumstances more appropriate to choose the surgical method, which can obtain satisfactory results, and avoid unnecessary trouble.
1. the top of the superficial temporal vein branch
2. frontal branch of superficial temporal vein
3. jugular vein
4. auricular nerve
5.
facial nerve parotid duct frontal branch of the branch
1 2 3 zygomatic cheeks (lower) marginal mandibular branch 4 5 cervical branches
Mitz and Peyronie1976
Superfacial superficial aponeurosis System Muscular system muscles Aponeurotic
two frontal Rhytidectomy
eliminate or improve the forehead, glabella, nasion wrinkles, correction of crow's feet, brow and upper eyelid skin laxity. based on the degree of aging and requirements of patients with different surgical methods to improve the local aging, common surgical procedures There are several.
(a) directly on the raised eyebrow surgery
1. surgical technique
(1) cut: According to the drooping eyebrows choose a different shape in different parts of incision, excision of skin and subcutaneous tissue of different shapes .
(2) Separation: within the subcutaneous tissue along the incision in the skin peel on, for special patients, their scope should be enough to peel.
(3) suture: subcutaneous tissue and skin sutured.
2. indications
eyebrow raised up to frontal surgery than cosmetic effects, can still be used as: ① redundant upper eyelid skin auxiliary plastic surgery. ② separate line correction of bilateral drooping eyebrows. ③ When both sides of the asymmetric eyebrows , the possible side alone raised eyebrow to corrective surgery. ④ tattoo eyebrow removal of the failure of the whole or part requires eyebrow resection.
3. complication
(1) early postoperative swelling is obvious, then gradually swelling, may from time to deal with.
(2) recurrence: a few years will be maintained under normal circumstances, not pay attention to skin care such as surgery, some patients will quickly relapse.
(3) inflammatory response: a rare, mostly by sutures cause, timely application of antibiotics given.
(4) scar clear: the general was not obvious, as obvious scar, can not find the exact cause, the line tattoo cover up.
(b) of the wrinkles between the eyebrows Correction
1. glabellar suture removal wrinkles wrinkle along the eyebrow to ask for elliptical excision, including skin, subcutaneous tissue and some frown muscle resection, hemostasis, layered suture wounds (muscle, subcutaneous and skin).
surgical method of permanent scar left in the eyebrows should be carefully chosen, on the face than skin color than red or black patients, but should carefully.
2. frowning muscle ablation inside the eyebrows or forehead for the incision, separation of the scope of frown muscles, remove part or all of the frown muscles. may be conducted under the endoscope, particularly making the case the amount of incision.
This procedure applies to the more developed frown muscles, the patient those who do not want to forehead scar.
complications: ① correction is not complete, ② oppression caused by subcutaneous scar contracture bad, shape is not ideal.
(c) horizontal forehead wrinkles direct suture removal
Board Ma. supine position, 75% alcohol disinfection of the face, the forehead wrinkles to be removed at the design of incision, local injection of lidocaine 0.5% (within plus epinephrine 1:100 000), anesthesia satisfaction of the incision along the design will skin excision, hemostasis, 5m0 subcutaneous absorbable suture, non-invasive skin closure sutures, dressings. postoperatively without using antibiotics, wound suture removal 1 week. choose this method, be careful, made it clear to the patient will form a permanent scar after surgery.
(d) Removal of forehead wrinkles cosmetic surgery
1. surgical procedure
(1) Anesthesia: local or general anesthesia, according to the patient situation to be.
high hairline scar and can accept the forehead, using the hair of the central forehead incision edge design, and gradually into the hair. anesthetic satisfaction, along the scalp incision to the periosteum.
(3) stripping : In the subgaleal layer or lower the amount of muscle to blunt or sharp dissection, the level of organization is loose, easy to peel; to both sides of the strip extends to the lateral brow, carefully separating the fibrous connections supraorbital margin ( outside to inside), not to damage the supraorbital nerve. stripped down to the eyebrows, the nasion Free Ministry, confirmed that frown muscle and excised or cut off, can reduce or eliminate the vertical wrinkles between the eyebrows. Separation of muscle between the eyebrows fall off eliminating or reducing wrinkles nasion Department rampant. sometimes cut off or the removal of frown muscles between the eyebrows down muscle and trochlear nerve injury when the branch, but did not find a local numbness after the main complaint. supraorbital margin above the level of cut in the amount of muscle, so that the full relaxation of the forehead, to eliminate forehead wrinkles. The incision has the advantage of generating fresh wound, not to cut the amount of muscle surgery, removal of the amount of muscle will lead to to produce artificial appearance. to both sides of the superficial temporal fascia stripped to near the level of the zygomatic arch can be.
(4) bleeding: In order to avoid massive bleeding, should be sub-incision surgery carried out should be those of the surgeon and his assistant cut both sides of the scalp, or on top of wallet, or the edge of the cut before the incision was sutured. Application of electric coagulation, or surgical ligation of bleeding, to prevent postoperative bleeding and blood clots, infection and thus affect the results of operations.
( 5) resection, suture: removal of excess scalp, along the direction of the hair follicle to reduce hair loss patients. Notice to retain under the removal of subgaleal scalp to 2-0 absorbable suture subgaleal, reduce tension, reduce operation scar and local depression, 4 silk interrupted suture the scalp.
(6) place the drainage strip: After suture, placed rubber strips or rubber drainage tube drainage, and suction drainage device.
(7) dressing: place the gauze and gauze and pad, bandage.
(8) post-operative treatment: antibiotics 3d, 24 ~ 48h removal of drainage or in drainage.
2. complication
(1) nerve damage: mainly the amount of nerve injury, is not familiar with operations due to rough or dissected.
(2) hair loss or alopecia: temporary hair loss (especially temporal) is due to reduced blood supply to hair follicles caused by ,2-3 months, gradually ease, the incidence of permanent hair loss is about 1% -3%. reasons: first flap separation too thin, damaged hair follicles, or use the electric knife injury of the hair follicle separation; incision suture tension is too large, the hair follicle degeneration. hair transplantation possible correction.
(3) scar or hypertrophic scar: scar or postoperative scar is the result of excessive tension caused by suture. If this complication may be six months after surgical correction. to avoid this from happening is to cut the design in a relatively hidden location of the site and intraoperative removal of tissue mass 不要 many and Daozhi tension is too large. it should cause people to note that cut design in the scar at the hairline, where the scar or scar and irregularly shaped scar is difficult to correction.
(4) infection: rare, largely because of the strict sterilization or aseptic concept is not strong and the resulting hematoma caused by bleeding. Once postoperative infection should be given prompt such as drainage or antibiotics.
(5) hematoma: rare is the result of a thorough intraoperative and postoperative bleeding is not caused by poor drainage. For a small hematoma may be handled, for large hematoma should be promptly removed, to avoid affecting the healing.
(6) itching: After the first few weeks may have itching, it does not happen often, will gradually disappear, do not have to do special processing. The reason may be related to flap nerve regeneration. For the intolerable itching, itching and sedation drugs can be applied to the treatment, iso triazine, each 2.5m5mg, once every 4-6h.
(7) numbness: After the initial numbness may be, is due to surgery dissection flap in the region will govern the injured nerve. Usually, no special treatment, 6 to 8 months return to normal. there permanent numbness rare.
(8) correction to have is: the amount of forward on the flap of tissue migration and excessive removal of skin, there is the phenomenon of correction to have. patients
III midface rhytidectomy
midface rhytidectomy is split between the eye and mouth cleft surgery
(a)
midfacial surgical indications for forehead rhytidectomy chin and neck wrinkles and aging is not obvious, obvious eye area wrinkles and loose skin of the cheek patients.
(b) of the operative techniques
1. narcotic anesthesia, surgical dissection limited in scope, and peeling layers are not deep.
2. incision into the design of the tragus hair up in front of about 4 ~ 5crn, extending down to the ear lobe.
3. incision and dissection along the design line of 0.5% lidocaine injection, After satisfactory anesthesia, skin incision along the design line, subcutaneous dissection. divestiture range: meet or exceed the nasolabial fold forward and upward over the outer canthus, mouth to the issued, severe up to the submandibular 线.
4.SMAS the Treatment of parotid gland from the front surface of the tragus started under the SMAS dissection, incision SMAS, the SMAS SMAS flap was separated form. range to the zygomatic process, down to the lower jaw line, the transfer to the nasolabial fold area of the zygomatic major muscle SMAS on the surface. SMAS flap will form the back and push forward, to do with 4m0 absorbable mattress suture, the SMAS flap were fixed in the deep temporal fascia, front fascia surface of the ear and mastoid surface of the sternocleidomastoid only point, the flap back the same way too over the top fixed.
5. resection and suture sutured after the removal of excess skin.
Fourth, the amount of the amount of temporal rhytidectomy
also known as the surface of the temporal rhytidectomy l / 3 rhytidectomy, is the frontal and temporal rhytidectomy surgery together. feature is that it can eliminate the stripes and the forehead, eyebrow asked wrinkles, nasal horizontal pattern, but also to remove crow's feet, drooping eyebrows and corrected, the lower eyelid skin laxity.
(a) indications
rhytidectomy basically the same amount, in the amount of rhytidectomy on the basis of combined and lower eyelid skin laxity and wrinkles increase of eyelids.
(b) surgical contraindications
(1) with the frontal rhytidectomy.
(2) midface skin not loose (of the eye below nose above the tragus ago) are not suitable.
(3) wrinkles not obvious.
(c) of the preoperative surgical preparation
3d, shampoo, shampoo, 1 day; 0.02% before surgery ld benzalkonium bromide soaking hair and shave in the surgical 2.5cm wide strip of hair (the hair should be away from the edge of about 5 ~ 6cm).
(d) operative
1. tragus up to the hair prior to their heads, and the contralateral design line convergence. incision within the hairline design line with the amount of rhytidectomy.
2. anesthesia: local anesthesia under general anesthesia and surgery in patients with specific conditions determine the anesthesia.
3. incision in the scalp and head along the design line to cut the periosteum, temporal superficial to deep temporal fascia, the layer of blunt and sharp dissection, dissection into the superior orbital margin and zygomatic arch above the level of treatment the amount of muscle and frown muscles (the same amount of rhytidectomy approach). incision along the temporal preauricular area down to the forward and the outer canthus anterior temporal, subcutaneous for blunt and sharp dissection. Peel levels to be consistent and not too deep, so as not to damage the facial nerve; but not too shallow, so as not to affect the flap blood supply and lead to flap necrosis, or damage hair follicles after the root cause alopecia.
4.SMAS treatment under the circumstances decision. In general, the SMAS (superficial temporal fascia) up pulling out to the appropriate position, folded on the 1st suture thread, or open suture, or the removal of part of the SMAS suture.
5. resection and suture: flap suture to the proper position after the first fixation, removal of excess skin, followed by intermittent subcutaneous and skin suture.
6. dressings: gauze, gauze pad, bandage.
(V) the same amount of postoperative management
rhytidectomy.
(f) is essentially the same amount of postoperative complications
rhytidectomy. with the frontal lifting operation by different complications.
1 . facial nerve injury rarely occurs. Most of the patients in the stripping level too deep or the facial nerve branches to the various levels of ignorance. intraoperative cut will cause serious consequences, requiring careful observation during surgery and found that facial nerve injury, cut off should immediately line nerve anastomosis; caused by excessive traction, may be handled.
2. wound scar general wound scar is not obvious, and for six months or 1 year later will become very obvious. But For patients in the removal of skin caused by excessive tension is too big to easily lead to significant scar formation, influence outcome. a very small number of patients appeared in front of the ear keloids, may be associated with the physique.
3. skin necrosis rarely occurs . But this happens, patients will cause great suffering. There are several reasons:
(1) local tension is too large: most of intraoperative removal of excess skin tissue caused by the formation of hematoma or postoperative To. To avoid this, intraoperative sentinel to be accurate, removal of excess skin is too tight when you first try, or whether there is tension, the tension is not re-determine the removal of skin.
(2) infection: surgical operations and caused violent skin tissue damage, strict aseptic technique and postoperative hematoma caused. To avoid such a situation, requiring surgery in the operation carefully, strictly in accordance with non-invasive technology for aseptic operation, intraoperative bleeding completely.
4. alopecia the same amount of rhytidectomy.
five surface of 2 / 3 rhytidectomy
surface of 2 / 3 of the following rhytidectomy is the eyes, neck, facial rhytidectomy above.
( a) Indications
(1) 40 years old healthy female. (2) the amount of loose skin and wrinkles not obvious. (3) surface were significantly lower skin relaxation.
(b) Anesthesia
under the circumstances of the patient and surgical anesthesia, local anesthesia can also be carried out under general anesthesia. generally choose local anesthesia.
subcutaneous dissection surgery alone】 【
(1) incision design: the ear up to the front panel within the hairline, down to the ear lobe, around the top of the post-auricle.
(2) cut: anesthesia satisfaction of the skin incision along the design lines, in the subcutaneous layers were blunt and sharp dissection, to be stripped to maintain the same level of peel, peel too deep to avoid injury of the facial nerve and superficial peeling off of skin flap blood supply. divestiture range: up to the lower eyelid, inward to the nasolabial fold, down to the chin.
(3) bleeding: Intraoperative electrical condenser complete hemostasis.
(4) fixed, cut and stitching: the direction of the lateral flap up after pulling off a suitable location to be fixed a few needles, removal of excess skin, the skin with silk suture and skin. suture placed after the rubber drainage tube drainage or in vacuum.
(5) dressing: put the oil operation areas in order yarn, flat yarn and pad, bandage.
【flap and SMAS dissection flap at the same time surgery】
(1) incision design: the case of a simple skin peel surgery.
(2) cut: the scope of the same incision and peeling skin peeling above the simple surgery, SMAS dissection, and then pull the top of the SMAS out pulled, folded or cut to form after suturing fascia sutured after excision of excess skin suture.
(3) bleeding.
(4) fixed, removal of excess skin and sutures.
( 5) Peel the skin with simple surgical dressing exactly the same.
six, full facial full facial rhytidectomy rhytidectomy
refers to the entire facial surgery, from forehead to chin and neck surgery. operation range, operation large wound, requiring the surgeon carefully.
(a) indications.
(1) non-systemic, systemic disease (including heart, liver, kidney and other organs without structural or functional lesions and hematologic diseases).
(2) 45 years old or older.
(3) or facial skin, facial wrinkles and more relaxed.
(b) of the contraindications
(1) is not obvious forehead wrinkles .
(2) younger, mean 40 years of age.
(3) surface under the 2 / 3 of the loose skin is not obvious.
(4) had systemic, systemic disease.
( c) Anesthesia
large range of the operation, extensive wounds, blood loss more unbearable under local anesthesia, general anesthesia should be chosen.
(d) operative
1. incision design: cut line is designed around the ear weeks, the temporal incision design line hair, that is from within the temporal hairline and forehead hair Tonggao Chu started down Wancheng arc, into the hairline in 4cm, upward and contralateral incision line in the header at the top of the design phase convergence (ie, coronal incision), the first Pi Neiqie mouth hair design line from the edge should be about 5 - 6cm; feet down to the helix along the helix under the rear feet turning wrinkles along the ear the side of the screen, down to the earlobe, tragus line can be designed before the incision is straight, but its easy to see traces of surgery, even if little or almost no, they should be cut into a curved line design; around the ear lobe to ear lobe sulcus, along the back into the arc of auricular sulcus (about 90.) into the hair in about 2 ~ 3cm, to avoid the formation of an acute angle and the tip of the neck flap flap tip necrosis and reduce the recurrence of skin relaxation. < br> 2. incision and dissection along the coronal scalp incision to the skull periosteum, in the subgaleal layer under the blunt and sharp dissection, up to eyebrow level, dealing with frown muscles and the amount of muscle. incision along the design line skin incision from the top of the temporal beginning of the organization to the subcutaneous tissue shear stretching upward to the forehead hairline to the superficial temporal fascia (as this area is relatively free of blood vessels), the organization's sharp dissection scissors forward to continue to separate until the temporal full-thickness flap off to ensure that patients are not due to hair loss caused by ischemia. to the zygomatic process at the skin peeling, keep peeling layers deep, however, especially after the middle cheek, to avoid injury facial nerve zygomatic branch and buccal branches. In the surface layer of SMAS dissection, will not damage the facial nerve. facial aging is not obvious, especially the nasolabial fold is not obvious who can peel the middle range to the surface; on the nasolabial fold more obvious, they will be dissection extended to the nasolabial fold at the very few go beyond the nasolabial fold. often the zygomatic arch apparent fat pad for the aging neck skin peeling .. (a double chin), the stripping operation should be continued to the neck ; the platysma treatment without surgery or lower jaw without fat resection, can be stripped to the midline. If two or more units are required, or excessive loose neck skin, the peel should extend the range, from one side to the other side, are connected to both sides so far. For to do the submental incision, the natural folds in the skin should choose online, you can cover up the scars left behind after surgery. chin down to the lower part of incision can not be moved to the neck, to do so The result is easy to see the scar. chin and neck on both sides of the lower part and connected after fully stripping cervical area is easy to see the vision, when the stripping is completed, we will find the normal form of the neck flap because of the situation arising from curl reserved. subcutaneous fat neck flap 3 ~ 4mm thick, close to the neck skin to avoid postoperative neck muscles, resulting in irregular neck. on both sides of the neck flap to the midline from the peel should be careful operation, platysma to avoid damage due to the platysma and the skin near the midline adhesion closer, especially in the subcutaneous fat, platysma with or less were more common in the shallow platysma were stripped, will not damage the facial nerve neck and the marginal mandibular branch
3.SMAS processing
(1) SMAS of folding:
1) Indications: SMAS relaxation, such as SMAS lift back on the pull with tweezers, meet the lower loose skin improved, it should be the line SMAS folding.
2) SMAS turndown: In SMAS folding (or folding) process, you must first clamp and grip the SMAS lift it, back on the direction of advance, you can see facial flaps were hanging up, and to improve the situation of the nasolabial fold and chin. SMAS fold the same week also improved relaxation mouth. This reduces the tension of the skin of cheek.
relatively plentiful in the face or SMAS fold in patients with a round face, the cheek due to filling of postoperative facial more rounded feel of postoperative results. the face of patients with type suitable for thin SMAS fold, so that some of the face look more plump before the surgery, the postoperative results Good.
(2) SMAS partial nephrectomy: the subcutaneous tissue along the incision below the zygomatic prominence separate parts, starting here separated from the SMAS, forward to the tragus at, and continue down to the neck, which may be including the platysma platysma, including continuous or phase. and then in the temporalis muscle below the screen in front of the ear down to the mandibular (lower jaw away from the edge of at least 4cm) or neck level for a straight line incision, and then make a transverse incision at the top , and the formation of the SMAS flap off at the top of the fascia flap excision for the triangle, and then fixed up the silk suture the fascia.
4. subperiosteal dissection in the supraorbital margin, and lateral eyebrow zygomatic arch incision between the upper edge of the periosteum of about 1.5cm, with sub-periosteal stripping down in the subperiosteal incision, stripped to the outside inward and from the cheekbones and upper jaw anterior periosteum of the inferior orbital rim on the inner of pear-shaped hole edge, outer edge of the mandible ramus, issued the top of the gingival buccal sulcus.
5. platysma treatment
(1) platysma resection: If you want to neck angle of jaw further better should be at least 4cm from the edge of the mandible at the leading edge and trailing edge platysma resection, and then move forward platysma flap suture and re-grant.
(2) platysma in transverse cut: chin neck angle for those who disappeared, can be considered the top half of the platysma were rampant off, and then cut off the top of the suture to the chin, passes down the lower part of the wound after suture.
6. chin and neck too fat processing
(1) Liposuction: Liposuction surgery for suitable local fat and loose skin are more obvious who. liposuction, note the level of aspiration and to maintain the same level of suction, to avoid postoperative depression and other deformities.
(2) fat removal: application of liposuction for little effect may be considered by this method. submental area first to design a length of about 2 ~ 3cm the incision line, design line skin incision along the subcutaneous tissue, the skin peeling, so that the chin and neck fat exposure, excision of the fat, should pay attention to retain a thin layer of fatty tissue, the wound to stop bleeding completely, the tension and remove the chin redundant neck skin, subcutaneous tissue with silk sutures and the skin turn.
7. fixed, cut and sew first head of fixed coronal incision, removal of excess scalp tissue; the SMAS fixation suture after removal of excess skin should pay attention to the face and neck, the direction of stretch on the outside flap, flap tension, but great attention to avoid flap necrosis after surgery, and then followed with silk suture subcutaneous tissue and skin.
8. dressing, place the Oil yarn, flat yarn and pad, bandages wrapped line.
facial aging relative if the patient is not heavy, and did not want around the ear after surgery scar appeared, just before the upper temporal area and the ear forward, subcutaneous superficial fascia layer was separated and SMAS, SMAS, and proper removal of the skin, above the main pulling tight with subperiosteal dissection, but also very effective in the overall Department of younger.
(e) after treatment < br> (1) After antibiotic 3d, to prevent infection.
(2) to observe the situation of wound drainage, 24 ~ 48h dressing, removal of drainage or in drainage.
(3) 7d facial stitches, 10d remaining stitches will be removed.
(f) any surgical complications
there will be complications, face lift surgery is no exception. surgeon must be able to recognize this and be able to handle it. All face a common complication of rhytidectomy as follows:
1. Hematoma
(1) rate: hematoma, surgical face lift is the most common complication, occurred abroad, reported earlier was 4.2% (1975 years ago), from 1975 to 1980, the incidence decreased to 2%, which prohibits taking aspirin before surgery drugs, smoking, primarily with surgery and careful postoperative observation and so on. Although the hematoma Facial Rejuvenation roughly 70% of postoperative complications, but its consequences are not catastrophic, serious differential diagnosis and proper treatment can solve the problem, but after a disastrous problem is not recognized hematoma occurred and to give timely treatment.
(2) postoperative hematoma and clinical characteristics of the time: within 24h after surgery patients should be closely observed, especially after 6 ~ 8h. Most hematomas are occurring during this period, surgical physician should always be careful to take complaints and signs of patients change, such as pain (especially pain swelling, and more weight), anxiety, nausea, high blood pressure, etc. These symptoms and signs are likely to be caused by the hematoma; there other signs, such as everted lips, cheeks and neck become stiff inflation; change the color of oral mucosa.
(3) preventive measures
1) close observation of intraoperative attention to changes in blood pressure and avoid severe high blood pressure conditions (other than drugs, such as with epinephrine injection plus lidocaine). Once the significant increase in blood pressure, should identify the cause and take appropriate measures (such as administration of drugs) to control the ideal range inside.
2) pain in patients with intraoperative try not to make patients more relaxed and in the case of painless surgery. Most patients will begin in a few hours after surgery discomfort or pain, because at this time of narcotic drugs began to weaken the role, especially under local anesthesia.
3) patients in the careful operation, master detachment level, to avoid damage blood vessels and nerves to vascular injury or bleeding, ligation or coagulation time.
4) postoperative suction drainage tube placed and properly bandaged.
(4) measures: Postoperative hematoma and bleeding if found, should be dealt with immediately, if necessary, return to the operating room, the suture removal hematoma after removal, carefully check the bleeding site and give ligation to avoid the appearance of hematoma caused by flap tension is too large, resulting in the phenomenon of skin flap necrosis, infection-prone a hematoma, adverse wound healing.
2. Edema: no edema is very obvious, you can not give special treatment, surgery should not be wrapped too tight, too tight can cause poor blood flow and lymphatic flow and increased edema. after the patients head slightly, which will help venous return. Some people think that surgery After the (24 ~ 48h in) cold compress will reduce swelling.
3. seroma: flap seroma may occur, cheek common. generally does not require special treatment, usually takes 4 to 6 weeks are free absorption, absorption few wrinkles.
4. ecchymosis: Postoperative hematoma or any other reason there is extensive bleeding, in which case, understand the patient's medical history is very important; patients will provide you with a reference value history, such as prone to fall after the swollen, explained to the patient, in which case a few weeks will subside on their own, no need to worry about.
5. nerve injury
(1) sensory nerve damage: most likely to damage The nerve is the great auricular nerve. will set off the neck skin flap from the sternocleidomastoid muscle should operate carefully to avoid injury of the great auricular nerve; slender patients in the comparison even more so, this great auricular nerve in patients mostly close to and easily attached to the flap damage. auricular nerve is usually in the ear canal through the sternocleidomastoid muscle below the 6 to 7 in the abdomen, if during the separation process accidentally cut the nerve, immediately under the magnifying glass to repair and may restore its function. For the supply of the face and temporal dominance of superficial sensory nerve, setting off a neck flap to be cut off, do not need mind these nerve branches. Patients will have the feeling of being lost or changed ( for the separation region and the edge of the ear lobe and the part). fairly can be restored within a short period of time, usually 3 to 4 months. it clear to the patient before surgery this. Only a very small number of patients did not return to normal.
(2) motor nerve injury: is easy to damage the motor nerve temporal branch facial nerve. Once the damage will be obvious signs of nerve damage, such as the damaged area can not be on the raised eyebrows and frown, and sagging eyebrows that ipsilateral the disappearance of forehead wrinkles. The reason may be surgery when electric cautery to stop bleeding condenser hemostatic suturing injured nerve ligation does not accidentally included, more often nerve stretch, almost all patients will be over time improvement over, the recovery of about 2 to 6 months. If this happens, and patients should discuss, tell the patient what happened and hope that happens (that is, expect it to recover to a certain extent and improvement). in its fully restored before, every 3 to 4 weeks to conduct an inspection. In thinner patients face lift surgery, buccal branch of the facial nerve may be injured. the last few years in the literature, often of the facial nerve reports of damage to the marginal mandibular branch, which usually occurs in those who are not experienced surgeon, especially to try to extensive dissection and SMAS platysma surgery. mandibular branch from the mandibular angle mandibular at least 4cm, surgeon decided to platysma separation line, at least 4cm should be stripped from the mandibular to avoid injury of the marginal mandibular branch.
(3) spinal nerve injury: spinal accessory nerve injury can cause muscle atrophy, usually posterior neck dissection during the extensive damage to the nerve when the easy. spinal nerve is usually in the sternocleidomastoid piercing, incision should be chosen far away from the back of the neck of the fine to avoid nerve damage.
6. scar: Although surgery operation is very careful, very careful post-operative treatment, but still a small number of patients with poor wound healing occurs, and obvious scar; scar tissue after surgery or several weeks months will not only become larger and larger, and there could be scar hyperplasia. This situation can easily occur in darker skin person, or a ruddy, freckled person. When the scar, the scar can be taken glucocorticoids within the injection drug method, which can lead to scar contraction, no scar surgery again; began within days of injection may reduce the scar of red, itching and discomfort. However, the scar corticosteroid injection medicines should be careful, because some patients atrophic scar in the future there are yellow crystals. If you later want to make a scar surgery, attention should be sutured.
7. skin necrosis: The main reason is the incision tension is. This may be caused by hematoma, superficial infection, more common reason is that in the case of larger suture tension can be related to long-term heavy smoking, which may be generated from blood circulation distal causes . Postoperative dressing is also a result of excessive pressure ...
