METHOD OF EXTENDED THREE-LEVEL LIFTING OF SOFT TISSUES OF FACE AND NECK Russian patent published in 2024 - IPC A61B17/00 A61B17/03 

FIELD: medicine; plastic surgery.

SUBSTANCE: mobilization of the skin-fat flap of the neck is performed through incisions around the earlobe within the following boundaries: below — 1 cm below the lowest ring of Venus, laterally — to the conditional vertical line below the earlobe, above — to the edge of the lower jaw, liposuction of areas of local adiposis of the neck, making a skin incision in the submental groove 3 cm long. Then, dissection of the platysma is performed along the midline from the cervical-mental angle to the apex of the chin and its mobilization laterally to the angle of the mandible, resection of the subplatysmal fat, the anterior belly of the digastric muscle and submandibular glands, transverse dissection of the platysma starting from the midline of the cervical-mental angle to the lateral angle of the lower jaw, excision of excess platysma when comparing its medial edges. Then the medial edges of the platysma are sutured with separate interrupted sutures, the skin in the submental groove is sutured with an intradermal continuous suture, a skin incision is made in the temporal region, starting 1 cm below the level of the eyebrow tail and continuing down the hairline, in the preauricular region — along the natural border between skin of the face and the auricle, bending around the tragus in front, in the retroauricular area — in the postauricular fold to the level of the lower leg of the antihelix and bending around, continuing down the hairline, mobilization of the skin-fat flap in the postauricular area, in the lower and middle third of the face, reaching 1 cm further than the conventional line running from the lateral corner of the eye to the angle of the mandible, and to the lower ring of Venus on the neck. A SMAS incision is made from the lateral corner of the eye to the corner of the mandible, mobilize the skin and SMAS with a single flap in the plane located under the SMAS. The SMAS is mobilized in the premasseteric space to the level of the marionette crease and down subplatysmal to 5 cm below the edge of the mandible. The platysma is cut off from the sternocleidomastoid muscle along the fascial fusions, and the SMAS is mobilized in the infraorbital region above the orbicularis oculi muscle to the lateral edge of the nose. The spaces formed as a result of mobilization of the SMAS are connected when the SMAS is mobilized in the middle zone of the face, where the dissection is carried out more superficially in relation to the zygomatic major and minor muscles and ends in the nasolabial fold medially. A single flap consisting of skin and SMAS is obtained. An incision 5 mm long is made on the deep fascia of the face in the projection of the Bichat lump, and the Bichat lump is resected through this incision. An interrupted suture is applied, capturing the deep fascia of the face in the incision area and suturing it to the fixed SMAS in the superolateral vector in the projection of a conventional line from the lateral corner of the eye to the angle of the lower jaw. A plication lift of the deep fascia of the face is performed parallel to the conventional line from the lateral corner of the eye to the angle of the lower jaw along its entire length, redistributing a single flap consisting of skin and SMAS in the superolateral vector. Interrupted sutures are applied, capturing the displaced SMAS and suturing it to the fixed SMAS immediately in front of the auricle at the level of the zygomatic arch. Excision of excess SMAS in front of the auricle and application of separate interrupted sutures with fixation of SMAS to the underlying soft tissues, lateral platysmal myotomy from the earlobe to the angle of the lower jaw, lateral platysmaplasty — suturing of the platysma to the mastoid process in the postauricular area with separate interrupted sutures, straightening of the skin-fat flap, identification and excision of excess skin in the parotid areas, application of intradermal interrupted sutures and external separate U-shaped sutures are performed.

EFFECT: permanent elimination of age-related changes in the face, i.e. nasolabial folds, marionette folds, jowls with minimal tension on the skin seams, replenishing the volume of the middle zone of the face, obtaining a harmonious transition from the cheekbone to the cheek area, forming a clear cervico-mental angle and oval of the face.

1 cl, 13 dwg, 1 ex