Elimination of face and neck wrinkles
Treatment of premature wrinkling of the face should be general and local. The general is to improve the nutrition of the whole body, and the facial skin in particular, the normalization of the regime of work, rest and sleep. When dry skin shows the use of nutritious creams and masks according to the rules of cosmetology and dermatology.
Indications for surgical intervention should be based on the degree of clinical manifestations of face aging, the age of the patient, the nature of his profession, the general condition.
It is advisable to distinguish 3 degrees of facial aging: at 1 degree (weakening of the turgor of the skin and subcutaneous tissue, minor folds and furrows of the skin), indications for surgery are relative, it should be followed with a small skin detachment.
At the II and III degrees of aging (pronounced skin folds, subcutaneous tissue displacement downwards, deep furrows, eyebrows hanging over the eye, etc.), indications to the operation are absolute, while carrying out it requires detachment of large areas of the skin, strengthening of subcutaneous formations, excision excess areas of the skin and stretching the widely separated adjacent areas to close the wound surfaces that are formed. In all cases, one should strive to place the scars in unobtrusive places.
Since the surgery for wrinkles on the face is mainly performed by the elderly, they must be carefully examined before intervention . It is recommended to avoid operations in persons with unbalanced psychoemotional status, inadequately assessing the degree of their cosmetic deficiencies. Each patient should be informed about the nature, the plan of the forthcoming operation, possible complications, the timing of the effect of the operation, and the localization of scars. It is desirable to obtain consent to the operation of the spouse or spouse of the person being operated in order to prevent the possibility of presenting various kinds of claims. It is necessary to tell the patient that during the treatment he must take leave without preserving the content.
With wrinkles of the entire face and neck, different methods of operation are possible. Consider one of them. On the eve of the day of surgery, the methylene blue contours of the zigzag-shaped skin band, which is to be excised in the temporal region, ahead and behind the auricle, is outlined.
The upper -posterior border of this tape (abvgd) corresponds to the line of the first incision, which is applied from the border of the temporal and frontal regions, then along the border of the scalp in the temple and the auricle. Having rounded it, the line continues to the longitudinal median line of the mastoid process. From here the line of the future section leads to the rear and downwards (at an angle of 90 °) by 2.5-3 cm. Ahead of the upper-back line of the cut is painted with the front-bottom line (ajjd), whose length should be equal to the length of the first line. The length of both lines is determined by applying a silk thread to them. If one of them is longer, corresponding corrections are made to the planned plan of the cuts only by changing the distance between the lines. It is determined by collecting the skin with your fingers, depends on the degree of stretchability of the skin and is equal (in the middle part) 2-3 cm.
To the two lines of cuts converging at the ends, a transparent X-ray or thick cellophane film is applied, on which the contours of the skin band to be removed are drawn. Above and below its film is cut off. It turns out a template by which you can make a completely symmetrical excision of excess skin.
When planning lines of cuts in front of the hair in the area of the temple and the auricle, one should strive to ensure that as a result of the operation the maximum skin tension was created only in two areas: above the auricle and behind it - at the middle level. Due to this, the upper zone of tension provides smoothing of the nasolabial fold, folds in the temples and cheeks, and the lower zone - smoothing of the folds of the chin and upper neck.
In all other areas, the tension in the joints should be the lowest; otherwise the auricle can move forward and downward, the lobe can be pulled back, or a noticeable wide postoperative scar in front and behind the auricle can form.
With a significant decrease in the turgor of the subcutaneous tissue in the cheek and neck region, its subcutaneous strengthening is most effective, contributing to a longer postoperative cosmetic result, which is confirmed by both clinical data and measurements of the elasticity of the cheeks before and after the operation by vacuum-diagnostic method.
In the postoperative period, the patient is prescribed general and local rest (forbid smiling and turning his head to the sides); Inside - multivitamins, and intramuscularly - a complex of antibiotics to prevent suppuration in the wound.
The stitches are removed on the 10th-12th day to avoid stretching the weak and fragile scar.
After that, you should irradiate the scars with Bucca rays, limit head movements and reduce the facial muscles by 1.5-2 months.
Treatment of forehead and nose wrinkles
With wrinkles of the forehead and nose, simple excision of the fusiform part of the skin along the edge of the scalp or in the area of the bridge of the bridge of the nose gives only a short-term effect. After a while, most of the operated folds appear again.
In this case, two variants of the operation are used: with a cut above the border of the hair on the forehead and in the region of the scalp.
Before surgery on the scalp, having retreated 1.5-2 cm from its border with the forehead skin, a strip of skin is shaved, connecting the two temporal areas. The shaved area should have the shape of an elongated oval; its width depends on the degree of mobility of the forehead skin (from 2 to 4 cm), and the length is 20-25 cm. The hair left in front of the shaved area is braided into pigtails. In the future they will close postoperative scars.
During surgery, the patient's chin leads to the chest; The surgeon should be behind - at a bed of the patient.
The incision is made along the upper edge of the shaved strip from the temple to the temple through the entire thickness of the skin. Bleeding from the wound is stopped by pressing on the skin above the eyebrows.
The lower edge of the wound is grasped symmetrically by the clamps.
Cooper's blunt curved scissors or a curved rasper exfoliate the forehead skin from the tendon helmet and frontal abdomen of the occipitus-frontal muscle to the eyebrows and nose bridge, without damaging the vascular-neural bundles emerging from the supraorbital orifices.
Mobilized skin is pulled upward and dissected (between the clamps of each pair) until a fixed edge of the wound appears. Apply a seam between the central pair of clamps, and then between the side pairs. Excess skin between these major sutures is excised, the wound is sewn tightly and a pressure bandage is applied.
This technique allows not only to straighten the transverse furrows, but also to smooth the vertical folds on the bridge of the nose, reduce the folds of the eyelids and corners of the eyes.
The disadvantage of the method is an increase in the dermal part of the forehead. Therefore, in people with a high open forehead and bald patches, this method is not applicable. At them the line of dissection of the skin should be waved along the border of the hairline, ending the incisions in the scalp.
With a significant forehead baldness, it is recommended to use the Fomon-G operation. I. Pakovich, which produces a continuous superciliary incision, widely separates the skin to the middle of the crown, shifts the forehead's skin downwards, dissects its excess and impose blind seams on the skin edges of the wound.
To turn off the mechanism of forehead wrinkling, IA Frishberg (1971), modifying the operation according to Uchida (1965), cuts the forehead skin along the hair line or in the scalp region, exfoliates the skin above the frontal muscle and the tendon helmet; then dissecting them along the line of cutaneous incision and from its ends to the outer ends of the eyebrows reduces the muscle and tendon helmet to a new level. Due to this, the effect of the frontal abdomen of the forehead-frontal mouse on the forehead's skin is turned off, the threat of recurrence of folds in the forehead area is eliminated, but at the same time the ability of the mouse to raise the eyebrows remains.
Correction of lowered eyebrows
When correcting lowered eyebrows by the method of IA Frishberg (in contrast to the methods of Barnes, Fomon, Clarkson, involving the excision of the elliptic areas of the skin above the eyebrows), all soft tissues of the superciliary area are cut to the bone, the frontal abdomen of the occipitus and frontal muscle is dissected and the tissues eyebrows to the periosteum. Thanks to this, a more reliable fixation of the eyebrows is achieved,
This technique can be used in the case when you need to raise too low located eyebrows; and, if there is no need to eliminate both interbrown folds at the same time, a cut on the bridge of the nose is not necessary.
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Elimination of wrinkles of upper eyelids
The wrinkles of the eyelids are divided into two main types:
- folds only the skin of the eyelids;
- the swelling of the eyelids due to the shift of the subcutaneous tissue of the orbit in the thickness of the eyelid, which can be observed even in young patients with a weak ligamentous-muscular apparatus of the eyelids.
Anatomical tweezers grasp the fold of the skin in the place of its greatest sagging; Upper and lower folds are painted with the markings corresponding to the largest width of the excess skin area. From ethic points lead pines, converging at their ends at the outer and inner angles of the eyelids. In this case, an oval of irregular shape is obtained, the widest is closer to the outer edge of the eyelid.
By the time with the drawn oval, a transparent X-ray film was applied, the contours of the area of the skin to be excised were applied, the edges of the film were cut off and a template was obtained, suitable for applying contours (cuts) in another century.
If the folds on the upper eyelids are clearly asymmetric, the plan for the operation is planned for each century separately, i.e. Without the use of a plastic template (some authors do not resort to it even with symmetrical folds).
Excess skin is excised without ligating the vessels, since catgut nodules, slowly dissolving, will be visible under the thin (750-800 microns) skin of the eyelids.
Bleeding is stopped by temporarily pressing the bleeding surface or by dropping 1-2 drops of adrenaline rupture into the wound (1: 1000).
After a small detachment of the edges of the wound, a single continuous plastic seam is applied , which is removed after 3 days by pulling it beyond the outer end (the inner end of the thread should not be fixed by the knot during the suturing of the edges of the wound).
When mixing subcutaneous tissue after excision of excess skin, its upper edge is mobilized upward, exfoliate the circular eye muscle (under the supraorbital margin) and the thinned fascia, reveal and remove protruding lobules of fat. The edges of the muscle and fascia are brought together by thin catgut sutures, and the edges of the skin by a continuous seam made of polypropylene fiber.
Elimination of wrinkles of lower eyelids
The skin is cut 2-3 mm below the ciliary margin from the inner to the outer corner of the eye. Next, the incision is extended horizontally (one of the natural grooves) by 5-8 mm, grasping the lower edge of the skin with two holders and blunt scissors exfoliate the skin of the eyelid without damaging the circular muscle of the eye.
If fatty lobules protrude into the wound, the skin is peeled lower - further from the infraorbital margin. In the middle part of the wound, a finger is felt for the infraorbital margin, exfoliate the muscle and facies with blunt scissors, and find lobules of the subcutaneous tissue.
After additional light pressure on the eyeball, the tissue that emerges into the wound is removed from above. The muscle and fascia are stitched with catgut. If the muscle is flaccid and thin, it is sutured with several U-shaped catgut sutures in such a way as to invaginate a part of the muscle in the place of the removed fat and thus strengthen the muscular wall of the eyelid.
The exfoliated eyelid skin is stirred without tension upwards and outwards, dissecting the excess skin towards the outer top of the wound and laying the first knotty seam here.
Excess skin is cut off, bringing skin edges together without necessarily tensioning. You can apply a continuous seam to the skin with polypropylene fiber.
One-time elimination of wrinkles of both eyelids
Simultaneous elimination of wrinkles of both eyelids is best done by a method, the essence of which is reduced to a combination of the above-described methods of separate elimination of wrinkles and wrinkles on the upper and lower eyelids. In this case, a horn-shaped flap of the skin of both eyelids, connected in the lateral part by a bridge, is excised.
After operations on the eyelids, a light aseptic bandage is applied, fixed with narrow bands of adhesive plaster.
In the first hours after the operation and in the next 2-3 days, a cold is prescribed for the eyelid region. It is recommended to remove stitches on the 4th day.
Elimination of neck and chin wrinkles
Wrinkles of the neck and chin are effectively eliminated by an independent operation only in lean people with a well-movable skin, without significant subcutaneous tissue deposits. In this case, the incision is from the upper level of the tragus, around the lobe and continue behind the auricle to the border of the hair on the neck, then along this border.
Widely separating the skin, pull it up and back until the folds on the neck disappear. Dissect the edge of the skin towards the upper point of the wound and the back area, where the first seam is applied, capturing the tissue up to the periosteum of the mastoid process. Then the excess skin is cut off and knotty stitches are applied.
Elimination of wrinkles and sagging of cheeks
Wrinkles and sagging cheeks are often formed in relatively young people with no signs of baldness, bald patches. Therefore, they should use the technique of surgery with cuts above the border of the hair on the temples; while the hair in the region of the temples is plaited in a pigtail, a strip of skin is shaved 2-2.5 cm, a cut is made along the upper edge of the shaved area, which is continued downward in front of the auricle.
Peel the skin within the entire parotid region and up to the middle of the neck, grasp its edges with two clamps, pulling up and back.
Next, the skin is cut between the clamps, one knotty seam is applied, the excess skin is excised and a continuous seam is applied with a polyamide thread.
To eliminate pronounced persistent nasolabial grooves, LL Pavlyuk-Pavlyuchenko and VE Tapia (1989) recommend the use of the temporal fascia, along with the excision of excess subcutaneous tissue and skin, from which the transplant is inserted through the subcutaneous tunnel in the cheek area and is attached to the aponeurosis of the region of the nasolabial furrow.
Sequence of operations for facial wrinkles
If the entire face of the patient is covered with wrinkles and folds, at first they undertake a general operation - they eliminate wrinkles on the entire face and neck, then on the forehead. After this, there may be no need for surgery on the eyelids, since wrinkles in the eye and eyelid angles are simultaneously smoothed to a certain extent during the tightening of the forehead and cheek skin. If u need to take an operation, the amount of skin removed can be reduced.
Outcomes of operations for facial wrinkles
The duration of the effect of surgical intervention for facial wrinkles depends on the general condition of the patient, his psychoemotional mood, everyday conditions, family relationships, nutrition, constancy of body weight, etc.
Some patients have a good condition for 7-8 or more years, while another requires a second operation 2-3 years later.
The more flabby and agile skin on the face was before surgery, the better and longer the results of the operation. Since in young patients the process of reducing skin elasticity is still ongoing, the effect of the operation is less resistant than in the elderly.
When the keloid scar appears, the effect of the operation is reduced to zero. It can be prevented by exposure to soft X-rays (Bucca) in a dose of 10-15 Gy. The appearance of hypertrophic, atrophic and keloid scars is facilitated by the trauma of the flap during the operation, the tightening of the displaced flaps, the use of coarse suture material, and the prolonged stitching in the suture channels.