摘要
目的探讨采用双平面技术注射交联透明质酸钠凝胶改善面颊部凹陷伴中下面部轻中度皮肤松弛的效果和安全性。方法回顾性收集2023年2月至2024年1月梅奥整形外科医院(济南)收治的具有面颊部凹陷伴中下面部轻中度皮肤松弛的患者资料。治疗方案均采用双平面技术注射交联透明质酸钠凝胶,进针点位于耳屏前1~2 cm,进针后采用23 G钝针在面颊凹陷部的皮下脂肪浅层与皮下深层脂肪室2个平面进行扇形注射,并于颧弓下缘予适量的皮下注射以弱化突出的颧弓。单侧注射总剂量1.5~3.5 ml。注射过程中密切观察患者皮肤状态,注射后轻按压。术前、术后即刻、术后6个月分别采集患者图像,由盲测研究员采用面部松弛分级量表(FLRS)和中面部容积量表(MMVS)评价患者面部松弛及丰满度,量表评级或评分越高,代表面部越松弛或者丰满度越差,术后较术前评级或评分降低1级(分)即为有效,降低≥2级(分)为显著有效。由患者采用全球美学改善量表(GAIS)自评治疗前后的面部改善效果,满分5分,得分越高表明改善越明显。采用自制量表调查患者满意度及效果持久性。记录患者并发症情况。采用SPSS 26.0统计软件进行数据分析,计量资料数据用±s表示,同一患者术后即刻与术后6个月GAIS评分比较采用配对样本t检验;计数资料用例数(%)表示。结果共纳入80例女性患者,年龄30~50岁,均获得6个月以上随访。FLRS评价显示,与术前相比,术后即刻全部患者均评价为有效(69例,86.3%)或者显著有效(11例,13.8%);与术后即刻相比,术后6个月有74例(92.5%)患者评级无变化,6例(7.5%)患者评级升高1级,即治疗效果有所减弱。患者右、左侧MMVS评分显示,与术前相比,术后即刻全部患者均获得有效(右侧:55例,68.8%;左侧:69例,86.2%)或者显著有效(右侧:25例,31.2%;左侧:11例,13.8%)的改善效果;与术后即刻相比,术后6个月右、左侧分别有70例(87.5%)、77例(96.2%)患者评分无变化,其他12例患者(13侧)评分较术后即刻增加1分,提示治疗效果稍有减弱。治疗后所有患者均认为面部美观情况较治疗前改善,疗程结束即刻患者GAIS评分为(4.5±0.5)分,治疗后6个月为(4.4±0.5)分,差异无统计学意义(t=1.08,P=0.280)。术后即刻患者满意度(非常满意+满意)为97.5%(78/80)。72例(90.0%)患者表示愿意接受二次治疗。疗程结束后6个月,患者对治疗改善效果和维持效果的满意度(非常满意+满意)为98.8%(79/80),68例(85.0%)患者认为"治疗改善效果能够维持6个月"。术后即刻1例患者出现注射区域轻度泛红及轻微肿胀反应,冰敷后缓解。无其他不良反应。结论采用双平面技术注射交联透明质酸钠凝胶能够安全有效地改善面颊部凹陷,缓解中下面部轻中度皮肤松弛状态,治疗效果能够维持6个月左右。
ObjectiveTo explore the efficacy and safety of restylane volyme cross-linked sodium hyaluronate gel injection via dual-plane technique for cheek depression and mild to moderate skin laxity in the mid-lower face.MethodsThe data of patients with cheek concavity accompanied by mild to moderate skin laxity in the mid-lower face treated at Jinan MeiAo Plastic Surgery Hospital from February 2023 to January 2024 were retrospectively collected.The treatment was injection of cross-linked sodium hyaluronate gel via double-plane technique,with needle insertion points located 1-2 cm anterior to the tragus.After insertion,a 23 G blunt needle was used to fanwise inject the subcutaneous fat(superficial layer)and the subcutaneous(deep layer)fat compartments in the concave area of the cheek,and a suitable amount of subcutaneous injection was administered below the zygomatic arch to soften the prominent zygomatic arch and achieve natural smoothness of the filling area.The total volume injected per side ranged from 1.5 to 3.5 ml.The patient’s skin condition was closely observed during the injection process,followed by gentle compression after injection.Patient images were collected preoperatively,immediately postoperatively,and at 6 months postoperatively.Blind evaluator used the facial laxity rating scale(FLRS)and medicis midface volume scale(MMVS)to evaluate the improvement in facial laxity and fullness.A higher rating/score of the scale indicates greater laxity or worse fullness of the face,and a decrease of 1 grade/point postoperatively compared to preoperative status was considered effective,while a decrease of≥2 grades/points was considered significantly effective.Patients used the global aesthetic improvement scale(GAIS)to self-assess the improvement in facial appearance before and after treatment,with a maximum score of 5 points indicating the most noticeable improvement.Patient satisfaction and effect durability were investigated using a self-made satisfaction scale.The occurrence of patient complications was recorded.Data were analyzed using SPSS 26.0 statistical software,with measurement data expressed as Mean±SD,and paired t-tests used for comparison of GAIS scores immediately postoperatively and at 6 months postoperatively within the same patient.Categorical data were presented as cases(%).ResultsA total of 80 female patients aged 30 to 50 years were included,all of whom were followed up for over 6 months.The FLRS grades showed that compared with preoperative status,all patients immediately postoperatively were rated as effective(69 cases,86.3%)or significantly effective(11 cases,13.8%).Compared with immediately postoperatively,74 cases(92.5%)had no change in rating at 6 months postoperatively,while 6 cases(7.5%)experienced a 1-grade increase,indicating a slight reduction in treatment efficacy.The MMVS scores of the right and left facial sides of patients showed that compared with preoperative status,all patients immediately postoperatively achieved effective(right side:55 cases,68.8%;left side:69 cases,86.2%)or significantly effective(right side:25 cases,31.2%;left side:11 cases,13.8%)improvement in facial fullness.Compared with immediately postoperatively,at 6 months postoperatively,right side of 70 cases(87.5%)and left side of 77 cases(96.2%)had no change in grading,the other 12 patients(13 sides)increased by 1 point,indicating that the treatment effect was slightly weakened.All patients believed that their facial appearance improved after treatment,with GAIS scores of 4.5±0.5 immediately after treatment,while of 4.4±0.5 at 6 months postoperatively,the difference was not statistically significant(t=1.08,P=0.280).The satisfaction rate(very satisfied+satisfied)immediately postoperatively was 97.5%(78/80).Seventy-two(90.0%)cases expressed willingness to undergo secondary treatment.At 6 months post-treatment,the satisfaction rate(very satisfied+satisfied)with treatment improvement and maintenance was 98.8%(79/80).Sixty-eight(85.0%)cases believed the treatment improvement effect could be maintained for about 6 months.One patient experienced mild redness and slight swelling in the injection area immediately postoperatively,which subsided after icing.No other obvious adverse reaction occurred.ConclusionThe use of double-plane technique injection of cross-linked sodium hyaluronate gel can safely and effectively improve cheek concavity,alleviate mild to moderate skin laxity in the mid-lower face,and maintain treatment efficacy for approximately 6 months.
作者
王东
刘洋
来庆兰
陈光宇
Wang Dong;Liu Yang;Lai Qinglan;Chen Guangyu(Department of Cosmetic Surgery,Jinan MeiAo Plastic Surgery Hospital,Jinan 250000,China;Department of Dermatology,Hangzhou Xueran Medical Beauty Clinic,Hangzhou 311121,China;Cosmetic Injection Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)
出处
《中华整形外科杂志》
CSCD
北大核心
2024年第4期419-427,共9页
Chinese Journal of Plastic Surgery
关键词
透明质酸
交联型透明质酸
双平面注射技术
面颊凹陷
面部皮肤松弛
Hyaluronic acid
Cross-linked hyaluronic acid
Dual-plane injection technique
Cheek depression
Facial skin laxity
作者简介
通信作者:陈光宇,Email:423686203@qq.com。
