RU2845954C1 - Method for combined fan two-plane ultrasonic mobilization of facial soft tissues and an ultrasonic probe for its implementation - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: group of inventions relates to reconstructive plastic surgery and can be used for combined fan two-plane ultrasonic mobilization of facial soft tissues. Temporal-parauricular approach is performed, and a cutaneous-subcutaneous flap is formed. SMAS cutaneous-subcutaneous flap is detached at the level of a superficial fascia by combined mechanical and ultrasonic exposure. Probe tube is moved from the borders of the lower jaw and a zygomatic arch to the medial parts of the face; fat cell membranes are destructed in a combination with collagen coagulation in the connective stroma of subcutaneous fat and derma. That is followed by a traction and suture fixation of the tissues; the excess skin is removed; the wound is closed in layers, and the skin is covered with a cosmetic suture.

EFFECT: group of inventions allows to lift the middle face zone, to eliminate sagging and to improve the total tissue tone due to the combined ultrasonic and mechanical effect and a set of surgical techniques.

3 cl, 3 ex

Description

The group of inventions relates to reconstructive plastic surgery.

A method of surgical correction of age-related changes in the soft tissues of the lateral surfaces of the face is known, which includes tissue dissection in the temporal, parotid, chewing or postauricular areas, peeling off the skin-fat flap and dissection of the superficial muscular-aponeurotic system (SMAS) with separation of the fascial flap from it. Then the SMAS flap is pulled laterally upward, excess tissue is excised and fixed with interrupted sutures to the periosteum of the zygomatic arch, the posterior edge of the SMAS incision, and also to the mastoid process in the postauricular area. The skin-fat flap is also pulled up laterally, excess tissue is excised, and the flap is fixed to the back of the incision in the temporal, parotid-chewing and postauricular regions (A.E. Belousov et al. Plastic reconstructive and aesthetic surgery. St. Petersburg: Gipokrat Publishing House, 1998).

The disadvantage of the known method is the possible reduction in the cosmetic effect of the operation associated with dissection under the SMAS in a limited area without separating the fascial adhesions.

Systems and methods for cosmetic ultrasonic treatment, in particular of skin, are known, including in various embodiments skin treatment at two or more depths, for example, in the superficial muscular-aponeurotic system SMAS. The SMAS treatment system may comprise a hand probe, a removable transducer module and a control module (description of the invention to patent RU 2785827 C2, 12/14/2022).

The ultrasound systems and methods of ultrasound skin treatment described in RU 2785827 improve the cosmetic effect of the surgery, but only provide ultrasound treatment of the SMAS.

The method of ultrasonic treatment of SMAS known from RU 2785827 can be considered a prototype for the method of combined fan-shaped two-plane ultrasonic mobilization of soft tissues of the face, however, the system for implementing the known method, which can contain a hand probe, a removable transducer module and a control module, does not provide a combined mechanical and ultrasonic effect on tissues and is not a prototype of an ultrasonic probe that has no analogues.

The task, which the group of inventions is aimed at solving, is to create a method for deep SMAS lifting of soft tissues of the face, including the treatment of SMAS with mechanical and ultrasound exposure, and, accordingly, a tool that allows for the implementation of such a method.

The technical result of the group of inventions is expressed in obtaining an improved cosmetic effect and in reducing the trauma of combined fan-shaped two-plane ultrasound mobilization of soft tissues of the face.

The essence of the invention according to the first independent claim is expressed in a set of essential features, in which the method of combined fan-shaped two-plane ultrasound mobilization of soft tissues of the face, including ultrasound treatment of the SMAS layer, differs from the closest analogue in that, under general anesthesia, a temporo-parauricular approach is performed and a cutaneous-subcutaneous flap is formed, wherein the SMAS cutaneous-subcutaneous flap is detached at the level of the superficial fascia by combined mechanical and ultrasound exposure in the frequency range of 8-12 Hz, fan-shaped reciprocal movements of an ultrasound probe with a diameter of 2.5-3.2 mm with rounded working edges made for detaching the SMAS and located along the round end of the elongated probe tube in the cross-section, which is moved in the subcutaneous layer in directions diverging from the incision in a space limited by anatomical boundaries preliminarily established by visual and tactile landmarks, while the extended tube is moved from the main lines of tension to the medial parts of the face, the destruction of the membranes of fat cells with simultaneous coagulation of collagen in the connective tissue stroma of the subcutaneous fat tissue and dermis is carried out for 5-20 minutes, the ultrasound probe is removed, traction and suture fixation of the tissues are carried out, excess skin is removed, the wound is sutured layer by layer, and the skin is closed with a cosmetic suture.

The essence of the invention according to the second independent claim is expressed in the fact that the ultrasound probe for implementing the method comprises a handle and an elongated tube with a diameter of 2.5-3.2 with rounded end working edges located along the contour of the cross-section of the tube, wherein the end working edges are designed for detachment of the SMAS, and the handle is provided with an internal lock for connection to the ultrasound generator.

In special cases of execution or use, the ultrasonic probe contains an elongated metal tube.

The technical result of the group of inventions is ensured by the fact that the SMAS skin-subcutaneous flap is detached at the level of the superficial fascia using combined mechanical and ultrasonic action. The combined action on the facial tissues is provided by an ultrasonic probe with end working edges located along the circumference of the end of the elongated tube. The end rounded working edges made for SMAS detachment do not have sharp elements capable of injuring tissues. The diameter of the elongated tube from 2.5 to 3.2 mm is determined by the transmission of ultrasonic pulses in the frequency range of 8-12 Hz, generated for combined mechanical and ultrasonic action on the soft tissues of the face.

The pulse mode with different energies allows to adapt the parameters to each patient's face depending on the volume of fat deposits and the condition of the tissues, and provides a more accurate and satisfactory result. In the pulse mode, energy is supplied in portions, which allows for better control over the intensity of the effect on the tissues and ensures a uniform effect on the tissues. The pulse mode frequency is 8-12 Hz (preferably 10 Hz). Due to the periodic action of ultrasound waves, physical impact on vascular and nerve structures is excluded, which contributes to a more gentle treatment and reduced tissue trauma. In addition, the risk of adverse effects such as skin necrosis or unwanted lipolysis in the deep layers is excluded, which makes the procedure safer for patients. The pulse mode with different energies allows to adapt the parameters to different faces depending on the volume of fat deposits and the condition of the tissues, which helps to achieve a more accurate result. The general principle of the pulse mode is to alternate periods of ultrasound exposure and rest, which increases the overall efficiency and safety of the procedure, allowing the surgeon to individualize the approach for each patient.

The combined fanning dual-plane ultrasound soft tissue mobilization technique begins with penetration along strategic facial lines such as the mandibular border and zygomatic arch, releasing and tightening the SMAS layer in key areas, creating initial tension and eliminating sagging. Fanning movements are then used to mobilize the SMAS in more detail. The surgeon carefully moves from the main tension lines to the medial parts of the face, trying to evenly distribute the tension and improve the contours. For example, such sectoral fanning movements can be performed along the midface to the corners of the mouth, nasolabial fold and to the upper part of the cheekbones. An important aspect of the combined technique is the ability to adapt the mobilization to the individual characteristics and tissue condition of the patient. The surgeon can pay more attention to certain areas, which ensures optimal results. The mobilization is performed in two layers, subcutaneously and under the SMAS (suprafascial layer and subfascial layer).

The achievement of the technical result provided by the group of inventions, including a method of combined fan-shaped two-plane ultrasonic mobilization of soft tissues of the face and an ultrasonic probe that is specially designed to implement the method, is confirmed by the following examples.

Example 1:

Patient A., 45 years old, complained of pronounced signs of age-related changes in the face, including sagging skin in the middle and lower third of the face, as well as the formation of a double chin.

History: 2 births, postmenopausal hormone therapy, no chronic diseases. Height - 165 cm, weight - 60 kg.

Based on the examination, analysis of anatomical features, including the condition of subcutaneous structures, and ultrasound data of soft tissues, such as the thickness of the SMAS layer and the degree of decrease in its density, a diagnosis was made: age-related changes in the middle and lower third of the face (gravitational ptosis grade 2).

The patient underwent surgery to lift the middle and lower third of the face using ultrasound SMAS detachment technique.

Progress of the operation:

The operation was performed under general anesthesia. The incision was made through the temporal-parauricular approach: in the area of the hair growth border, enveloping the anterior edge of the auricle and continuing behind the earlobe. The skin-subcutaneous flap was exfoliated at the level of the superficial fascia.

For SMAS detachment, an ultrasound probe with a 2.5 mm diameter rod connected to a VASER device with an operating frequency of 10 Hz was used. The probe was inserted through minimal accesses, manipulations were performed in a fan-shaped manner with strict observance of anatomical boundaries.

After mobilization of the SMAS layer, tissue traction was performed in the posterior-superior direction with fixation with sutures. Excess skin was removed, the wound was sutured layer by layer. The skin was closed with a cosmetic suture. The operation was completed by applying a sterile dressing.

Result: Improvement of facial contours and elimination of age-related changes, without visible traces of intervention.

Example 2:

Patient B., 52 years old, complained of sagging skin on the neck and irregular contour of the lower jaw.

History: arterial hypertension (under medication control), no chronic diseases. Height - 172 cm, weight - 75 kg.

Based on the examination and analysis of complaints, the diagnosis was: age-related changes in the face and neck (gravitational ptosis grade 3).

Progress of the operation:

The operation was performed under general anesthesia. The temporo-parauricular approach was performed. The incision was along the anterior edge of the auricle and to the posterior surface of the ear, which minimized the visibility of scars. The cutaneous-subcutaneous flap was detached. For SMAS detachment, an ultrasound probe with a rod of 2.9 mm in diameter, connected to the VASER device with an operating frequency of 10 Hz, was used. The probe was inserted through minimal accesses, manipulations were performed in a fan-shaped manner with strict observance of the anatomical boundaries.

In the neck area, tissue mobilization was performed through a separate access under the chin.

The probe was used for cavitation action on the SMAS layer, providing soft detachment and reducing tissue trauma. After tissue mobilization, traction was performed in the lateral-posterior direction, excess skin was removed. Strong sutures were used to fix the SMAS, ensuring the stability of the result.

The wound was sutured layer by layer, drains were installed. The operation was completed by applying a sterile bandage.

Result: Clear contour of the lower jaw, elimination of sagging skin of the neck, restoration of harmonious proportions of the face.

Example 3:

Patient V., 40 years old, complained of loss of elasticity of facial skin and the appearance of wrinkles in the cheek and cheekbone area.

History: 3 births, no chronic diseases, no allergies. Height - 168 cm, weight - 58 kg.

Based on the results of the examination and analysis of diagnostic data, the diagnosis was: age-related changes in the face (gravitational ptosis grade 1).

Progress of the operation:

Under general anesthesia, a temporo-parauricular approach was performed. After the incision, the cutaneous-subcutaneous flap was detached at the level of the superficial fascia. For SMAS detachment, an ultrasound probe with a rod of 3.2 mm in diameter was used, connected to the VASER device with an operating frequency of 10 Hz, which allowed for precise tissue detachment without damaging the facial nerves.

Tissue traction was performed in the posterior-upper direction, the cheekbone line was emphasized, excess skin was removed. Cosmetic sutures were applied. The result was controlled during the manipulations using visual and tactile reference points.

Result: Tightened middle area of the face, elimination of sagging skin, improvement of overall tissue tone.

Claims (3)

1. A method for combined fan-shaped two-plane ultrasound mobilization of facial soft tissues, including ultrasound treatment of the SMAS layer, characterized in that under general anesthesia, a temporo-parauricular approach is performed and a cutaneous-subcutaneous flap is formed, wherein the SMAS cutaneous-subcutaneous flap is detached at the level of the superficial fascia by combined mechanical and ultrasound exposure in the frequency range of 8-12 Hz, fan-shaped reciprocal movements of an ultrasound probe with a diameter of 2.5-3.2 mm with rounded working edges made for SMAS detachment and located along the round cross-sectional end of the probe tube, which is moved in the subcutaneous layer in directions diverging from the incision in a space limited by anatomical boundaries previously established by visual and tactile landmarks, wherein the probe tube is moved from the boundaries of the lower jaw and zygomatic arcs to the medial parts of the face, destruction of the membranes of fat cells with simultaneous coagulation of collagen in the connective tissue stroma of the subcutaneous fat and dermis is carried out for 5-20 minutes, the ultrasound probe is removed, traction and suture fixation of the tissues are carried out, excess skin is removed, the wound is sutured layer by layer, and the skin is closed with a cosmetic suture. 2. An ultrasonic probe for implementing the method according to item 1, comprising a handle and a tube with a diameter of 2.5-3.2 mm with rounded end working edges located along the contour of the cross-section of the tube, wherein the end working edges are designed for detachment of the SMAS, and the handle is provided with an internal retainer for connection to an ultrasound generator. 3. An ultrasonic probe according to item 2, characterized in that the tube is made of metal.