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Erschienen in: European Journal of Plastic Surgery 2/2019

12.09.2018 | Original Paper

Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles

verfasst von: Nader Gomaa Elmelegy, Ahmed M. Hegazy

Erschienen in: European Journal of Plastic Surgery | Ausgabe 2/2019

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Abstract

Background

Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment.

Methods

Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis.

Results

The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery.

Conclusions

The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results.
Level of Evidence: Level IV, therapeutic study.
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Literatur
1.
Zurück zum Zitat Fink B, Grammer K, Thornhill R (2001) Human (Homo sapiens) facial attractiveness in relation to skin texture and color. J Comp Psychol 115(1):92–99CrossRefPubMed Fink B, Grammer K, Thornhill R (2001) Human (Homo sapiens) facial attractiveness in relation to skin texture and color. J Comp Psychol 115(1):92–99CrossRefPubMed
2.
3.
Zurück zum Zitat Kligman AM, Zheng P, Lavker RM (1985) The anatomy and pathogenesis of wrinkles. Br J Dermatol 113(1):37–42CrossRefPubMed Kligman AM, Zheng P, Lavker RM (1985) The anatomy and pathogenesis of wrinkles. Br J Dermatol 113(1):37–42CrossRefPubMed
4.
Zurück zum Zitat Robert L, Labat-Robert J, Robert AM (2012) Physiology of skin aging. Clin Plast Surg 39(1):1–8CrossRefPubMed Robert L, Labat-Robert J, Robert AM (2012) Physiology of skin aging. Clin Plast Surg 39(1):1–8CrossRefPubMed
5.
Zurück zum Zitat Dulguerov N, D’Souza A (2011) Update on treatment rationale and options for the aging face. Curr Opin Otolaryngol Head Neck Surg 19(4):269–275CrossRefPubMed Dulguerov N, D’Souza A (2011) Update on treatment rationale and options for the aging face. Curr Opin Otolaryngol Head Neck Surg 19(4):269–275CrossRefPubMed
6.
Zurück zum Zitat Luebberding S, Krugeer N, Kerscher M (2014) Quantification of age-related facial wrinkles in men and women using a three-dimensional fringe projection method and validated assessment scales. Dermatol Surg 40(1):22–32CrossRefPubMed Luebberding S, Krugeer N, Kerscher M (2014) Quantification of age-related facial wrinkles in men and women using a three-dimensional fringe projection method and validated assessment scales. Dermatol Surg 40(1):22–32CrossRefPubMed
7.
Zurück zum Zitat Callaghan TM, Wilhelm KP (2008) A review of ageing and an examination of clinical methods in the assessment of aging skin. Part I: cellular and molecular perspectives of skin aging. Int J Cosmet Sci 30(5):313–322CrossRefPubMed Callaghan TM, Wilhelm KP (2008) A review of ageing and an examination of clinical methods in the assessment of aging skin. Part I: cellular and molecular perspectives of skin aging. Int J Cosmet Sci 30(5):313–322CrossRefPubMed
8.
Zurück zum Zitat De Maio M, Rzany B (2007) Chap.5: the most common indications. In: De Maio M, Rzany B (eds) Botulinum toxin in aesthetic medicine. Springer Verlag, Berlin, pp 27–92CrossRef De Maio M, Rzany B (2007) Chap.5: the most common indications. In: De Maio M, Rzany B (eds) Botulinum toxin in aesthetic medicine. Springer Verlag, Berlin, pp 27–92CrossRef
9.
Zurück zum Zitat Nemoto M, Uchinuma E, Yamashina S (2002) Three-dimensional analysis of forehead wrinkles. Aesthetic Plast Surg 26(1):10–16 Nemoto M, Uchinuma E, Yamashina S (2002) Three-dimensional analysis of forehead wrinkles. Aesthetic Plast Surg 26(1):10–16
10.
Zurück zum Zitat Tsukahara K, Tamatsu Y, Sugawara Y, Shimada K (2011) The relationship between wrinkle depth and dermal thickness in the forehead and lateral canthal region. Arch Dermatol 147(7):822–828CrossRefPubMed Tsukahara K, Tamatsu Y, Sugawara Y, Shimada K (2011) The relationship between wrinkle depth and dermal thickness in the forehead and lateral canthal region. Arch Dermatol 147(7):822–828CrossRefPubMed
11.
Zurück zum Zitat Kaur M, Garg RK, Singla S (2015) Analysis of facial soft tissue changes with aging and their effects on facial morphology: a forensic perspective. Egypt J Forensic Sci 5:46–56CrossRef Kaur M, Garg RK, Singla S (2015) Analysis of facial soft tissue changes with aging and their effects on facial morphology: a forensic perspective. Egypt J Forensic Sci 5:46–56CrossRef
12.
Zurück zum Zitat Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871CrossRefPubMed Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871CrossRefPubMed
13.
Zurück zum Zitat Lemperle G, Holmes RE, Cohen SR, Lemperle SM (2001) A classification of facial wrinkles. Plast Reconstr Surg 108(6):1735–1750CrossRefPubMed Lemperle G, Holmes RE, Cohen SR, Lemperle SM (2001) A classification of facial wrinkles. Plast Reconstr Surg 108(6):1735–1750CrossRefPubMed
14.
Zurück zum Zitat Seckel BR (2010) Ch.12: facial danger zone 2. Ch.34: facial danger zone 5. In: Seckel BR (ed) Facial danger zones, avoiding nerve injury in facial plastic surgery. Thieme, New York, pp 12–34 Seckel BR (2010) Ch.12: facial danger zone 2. Ch.34: facial danger zone 5. In: Seckel BR (ed) Facial danger zones, avoiding nerve injury in facial plastic surgery. Thieme, New York, pp 12–34
15.
Zurück zum Zitat Pitanguy I, Ramos AS (1966) The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 38(4):352–356CrossRefPubMed Pitanguy I, Ramos AS (1966) The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg 38(4):352–356CrossRefPubMed
16.
Zurück zum Zitat Bernstein L, Nelson RH (1984) Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 110(3):177–183CrossRefPubMed Bernstein L, Nelson RH (1984) Surgical anatomy of the extraparotid distribution of the facial nerve. Arch Otolaryngol 110(3):177–183CrossRefPubMed
17.
Zurück zum Zitat Klein JA (1993) Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 95(3):1085–1098CrossRef Klein JA (1993) Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg 95(3):1085–1098CrossRef
18.
Zurück zum Zitat Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed
19.
Zurück zum Zitat Wong CH, Mendelson BC (2015) Ch.65: facial anatomy and aging. In: Farhadieh RD, Bulstrode NW, Cugno S (eds) Plastic and reconstructive surgery approaches and techniques. Wiley, Chichester, pp 923–947 Wong CH, Mendelson BC (2015) Ch.65: facial anatomy and aging. In: Farhadieh RD, Bulstrode NW, Cugno S (eds) Plastic and reconstructive surgery approaches and techniques. Wiley, Chichester, pp 923–947
20.
Zurück zum Zitat Timothy J, Marten TJ, Marten DE (2015) Chap.67: forehead lift. In: Farhadieh RD, Bulstrode NW, Cugno S (eds) Plastic and reconstructive surgery approaches and techniques. Wiley, Chichester, pp 948–966 Timothy J, Marten TJ, Marten DE (2015) Chap.67: forehead lift. In: Farhadieh RD, Bulstrode NW, Cugno S (eds) Plastic and reconstructive surgery approaches and techniques. Wiley, Chichester, pp 948–966
21.
Zurück zum Zitat Sulamanidze MA, Salti G, Mascetti M, Sulamanidze GM (2000) Wire scalpel for surgical correction of soft tissue contour defects by subcutaneous dissection. Dermatol Surg 26(2):146–150CrossRefPubMed Sulamanidze MA, Salti G, Mascetti M, Sulamanidze GM (2000) Wire scalpel for surgical correction of soft tissue contour defects by subcutaneous dissection. Dermatol Surg 26(2):146–150CrossRefPubMed
22.
Zurück zum Zitat Moriarty KC (2004) Chap.8: treatment of forehead wrinkles. In: Moriarty KC (ed) Botulinum toxin in facial rejuvenation. Mosby, Elsevier, London, pp 65–84CrossRef Moriarty KC (2004) Chap.8: treatment of forehead wrinkles. In: Moriarty KC (ed) Botulinum toxin in facial rejuvenation. Mosby, Elsevier, London, pp 65–84CrossRef
23.
Zurück zum Zitat Torres S, Hamilton M, Sanches E, Starovatova P, Gubanova E, Reshetnikova T (2014) Neutralizing antibodies to botulinum toxin type A in aesthetic medicine: five case reports. Clin Cosmet Investig Dermatol 7:11–17PubMed Torres S, Hamilton M, Sanches E, Starovatova P, Gubanova E, Reshetnikova T (2014) Neutralizing antibodies to botulinum toxin type A in aesthetic medicine: five case reports. Clin Cosmet Investig Dermatol 7:11–17PubMed
Metadaten
Titel
Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles
verfasst von
Nader Gomaa Elmelegy
Ahmed M. Hegazy
Publikationsdatum
12.09.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Plastic Surgery / Ausgabe 2/2019
Print ISSN: 0930-343X
Elektronische ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-018-1453-9

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