Patent RU-2766524-C1 (RU)
Title: Method for surgical correction of age-related changes of facial soft tissues
Inventor: Vasilev Maksim Nikolaevich
IPC: A61B17/00
Filed: 2021-06-17
Granted: 2022-03-15
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, namely to aesthetic plastic surgery. Skin is marked for identification of facial spaces by marking three horizontal lines: first line starts from the place of attachment of the earlobe to the cheek, then goes 1 cm above the edge of the lower jaw and continues to the chin, second line starts from the lower point of the tragus and continues to the angle of the mouth, third line starts from upper point of tragus and extends to wing of nose. Pre-chewing space is located between the first and second lines, the free cheek space is located between the second and third lines, the pre-malar space is located above the third line. Then, facial soft tissues are hydraulically dissected; skin is incised within a temple length of 2 cm along a hairline, then along an auricle, along an inner surface of a tragus, around a lobe and in a postaural fold by 4 cm. Further, the skin is detached along 5 cm from the skin incision with the obligatory dissection of masseteric cutaneous ligaments. Then, on the SMAS layer exposed after the cutaneous detachment, to facilitate identification of facial spaces, three extended horizontal lines are marked, similar to lines on the skin: first line from the point of attachment of the earlobe to the cheek, then 1 cm above the edge of the lower jaw to the border of the skin detachment in the direction of the chin, second line from lower point of tragus, then to border of skin detachment in direction of mouth angle, third line from upper point of tragus, then to border of skin detachment in direction of wing of nose. Additionally, an oblique line is marked on the open after the skin detachment layer SMAS, which starts at the top from point located 1 cm outwards from the outer corner of eye and 1.5 cm vertically downwards, at the bottom the oblique line continues to the projection of the angle of the lower jaw. From the beginning and from the end of this oblique line, two horizontal lines 1 cm long are additionally marked in the medial direction on the SMAS layer exposed after the cutaneous detachment. Layer of SMAS is dissected along the oblique line and two horizontal lines each 1 cm long. Two SMAS flaps are formed — fixed proximal and rectangular movable distal. Then the rectangular movable distal flap SMAS is exfoliated for 2 cm by entering the face spaces: pre-chewing space, space of free cheek and pre-malar space, guided by three previously marked, on open after cutaneous detachment layer SMAS, extended horizontal lines. After entering these three face spaces, all vertical ligaments between these spaces are transected. Rectangle is then cut from the edge of the rectangular movable distal flap SMAS so that the top and bottom are 1 cm 2 , protruding sections of the movable distal flap SMAS. As a result, a movable U-shaped distal flap of SMAS is formed. Further, 0.5*0.5 cm windows are formed in the preauricular region at distance of 1 cm medially from the skin incision line in the fixed proximal flap: at the tragus, in the projection of the zygomatic arch and in the temporal region above the projection of the zygomatic arch by 1 cm. Nylon 3.0 fixation sutures are delivered through these windows so that the knots turn out to be screwed in. Nylon 3.0 fixation suture is delivered as follows: 0.5*0.5 cm SMAS proximal flap is punctured through each formed window, from the inside to the outside, in the lateral direction, then the movable distal U-shaped flap of the SMAS is stitched from the inside to the outside at distance of 1.5 cm from its free edge, then the movable distal U-shaped flap of the SMAS is stitched from the outside to the inside at distance of 1.5 cm from its free edge, distance between these pricks on the movable distal U-shaped flap of SMAS is 0.5 cm and then stuck into the formed window in the fixed proximal flap of SMAS 0.5*0.5 cm, stitching from the outside to the inside in the medial direction. Distance between the pricks on the fixed proximal flap of SMAS is 0.5 cm. All three nylon 3.0 fixation sutures are thus delivered through the movable distal U-shaped flap of the SMAS in the pre-chewing, pre-malar and free cheek space. Pre-chewing area is fixed with nylon 3.0 suture in the area of the formed window with size of 0.5*0.5 in the fixed proximal flap of the SMAS at the tragus, free cheek area is fixed with nylon 3.0 thread in the area of the formed window with size of 0.5*0.5 in the fixed proximal flap of the SMAS at the zygomatic arch, pre-malar region is fixed with nylon 3.0 suture in the area of the formed window sized 0.5*0.5 in the fixed proximal flap SMAS at temporal fascia 1 cm above the zygomatic arch. After pulling up the movable distal U-shaped flap SMAS, nylon 3.0 fixation sutures are tightened and tied. Then, to close formed nylon 3.0 fixation suture knots, three formed windows are interrupted sutured with vicryl 4.0 suture in the fixed proximal flap SMAS above nylon 3.0 fixation suture knots. Further, the free edge of the movable distal U-shaped flap of the SMAS is sutured with the fixed proximal flap SMAS with a continuous blanket suture of PDS 3.0 suture, in such a way that in the zygomatic region and in the region of the angle of the lower jaw, an overlap is formed, by the type of duplication, protruding by 1 cm 2  sections of movable distal U-shaped flap SMAS, on the fixed proximal flap SMAS, and in the cheek area the movable distal U-shaped flap of SMAS is sutured with the fixed proximal flap SMAS "edge to edge". Similar manipulations are performed on the other side of the face. That is followed by distributing, tightening and excising the excess skin-fat flap on both sides of the face, draining with rubber graduates in postaural zones and applying intradermal sutures on the incisions. 
     EFFECT: method makes it possible to effectively eliminate "flews", to correct facial contours, to smooth labial-chin and nasolabial folds, as well as to correct a zygomatic zone; to obtain a stable result of the operation and inconspicuousness of the formed skin scars; to form a natural young face relief with volume in the area of cheekbones and jaw angles. 
     1 cl, 18 dwg, 1 ex