I. Subcutaneous bruises and hematomas
Subcutaneous hematoma: mostly occurs around the eyes, around the mouth and under the face. Generally, it can be absorbed by itself in a week. Larger hematomas are removed promptly and bandaged with pressure.
Prevention: Improve preoperative examination.
No recent anticoagulants, blood expansion.
Tube and blood-activating drugs.
Thorough hemostasis during surgery.
Negative pressure drainage.
Compression bandage with elastic mesh.
Anticoagulant medication use.
Timely check-up.
Second, skin necrosis
Mainly the flap is peeled too thinly and damaged pulling the subdermal vascular network. Excessive skin excision and excessive suture tension may also result in skin necrosis at the suture line.
Prevention: correct peeling level.
Correct use of local anesthetic drugs.
Subcutaneous tension-reducing sutures.
Avoid infection of the incision.
III. Infection
Intraoperative attention to disinfection and aseptic operation. Postoperative injection of 3-5D antibiotics. Promptly change medication if thread infection occurs.
Prevention: Do preoperative check of blood sugar and HB.
Reasonable use of antimicrobials.
Strict disinfection and aseptic operation during surgery.
Avoid contamination of suture material.
Clean up the hematoma in a timely manner.
IV. Incisional dehiscence
Mostly occur at the scalp and ear root. Therefore, the removal of stitches with tension in the scalp should be delayed until 9-12 D. The removal of stitches at the root of the ear and behind the ear should also reach 7 D.
Prevention: Proper subcutaneous reduction of tension.
Reasonable debridement.
Avoid infection and hematoma.
Layered sutures.
V. Incision line baldness and scarring
This phenomenon occurs from time to time.
Prevention by.
1.Cutting in the scalp should be done obliquely in the direction of the hair follicle.
2. Do not be too shallow when stripping the temporal area and do not expose the hair follicle.
3. Do not put too much tension on the suture.
VI. Local sensory disturbance
Within 2 months after surgery, a considerable number of patients often experience numbness of the scalp and cheek skin, but they can gradually recover after the compensatory growth of peripheral nerves.
There are two forms of manifestation: one is nerve irritation symptoms, which are manifested as local tingling, tenderness or walking ant sensation and numbness. The second is the loss of local sensation or hypoesthesia after local peripheral nerve rupture. For example, the dullness, numbness and itching of the scalp are caused by the severance of the supraorbital nerve in the incision area.
Strengthen physical therapy, oral glutamate, vitamin B drugs.
VII. Nerve injury
The main reason: due to unclear anatomical level, unfamiliar with the direction of the nerve and improper operation.
Forehead debridement peeling should be carried out under the capitellar tendon membrane.
The bursa and supraorbital nerve are under direct vision, so they are not easily damaged.
For face and neck wrinkle removal, the temporal part is separated in the superficial layer of superficial temporal fascia, and the sharp separation is performed 15-20mm from the edge of the incision first, and then the blunt separation is used instead.
1. Separation of the top of the frontal in the subcutaneous fat layer is strictly prohibited
Because this layer in the forehead by thick vertical fiber bundle closely above the skin dermis, under the cap tendon membrane. If forced separation often secondary to skin necrosis, baldness, forehead numbness, scarring and other complications
2.The areas that need to be separated in the subcutaneous fat layer when removing wrinkles – temporal area, cheek area
The separation of the skin of the postauricular triangle must be in the subcutaneous fat layer, and it is strictly forbidden to peel off the fascia of the sternocleidomastoid muscle, otherwise it is easy to damage the large ear nerve immediately above the muscle, so that most of the sensation of the skin of the ear is lost.
Clinical manifestations of facial nerve injury.
The facial nerve is a mixed nerve, the main expression muscle.
Temporal branch: from the parotid gland above the penetration, through the zygomatic arch after the junction of the upper and middle 1/3 superficial to the temporal region, the distal end of the trunk has divided into (1) frontalis branch; (2) orbicularis oculi muscle, after the injury can not raise the eyebrows, frontal lines disappear.
Zygomatic muscle branch: after penetrating from the front of the parotid gland, it emerges superficially 3.0 cm in front of the ear screen. It travels parallel to the zygomatic arch. After the injury, the lower lid is turned out, the eyes cannot be closed, and the corners of the mouth are distorted to the healthy side.
Buccal branch: after injury, the nasolabial fold disappears, the lips cannot be opened, the corners of the mouth are distorted to the healthy side, and the cheeks cannot be puffed.
Mandibular rim branch: after damage, the movement of the ipsilateral lower lip is impaired, the lip is turned out, the corner of the mouth is distorted, and the mouth cannot be closed.
Cervical branch: not much attention is paid to the cervical branch clinically, and when this branch is damaged, it is not harmful.
Superficial musculotendinous system layer (SMAS layer)
Safe peeling range.
A longitudinal incision is made 1.0-1.5 cm in front of the ear screen to 5-6 cm below the angle of the mandible.
A transverse incision is made 1.0-1.5 cm below the zygomatic arch, reaching forward to the anterior border of the parotid gland.
VIII Postoperative left-right asymmetry
At the time of surgery, several marks should be made, such as the upper part of the auricular root and the frontal angle as fixed points, and when lifting and pulling tightly for segmental excision, pay attention to the consistent width of the skin on both sides. Then observe whether the left and right outer canthus angles are on the same level. If any skew is found, correct it immediately.
Take preoperative photos to observe the dynamic and static differences between the nasolabial folds of the cheeks and the corners of the eyes before surgery.
IX Vomiting
Prevention.
Avoid overdose of local anesthetic drugs.
Appropriate strength of pressure bandage.
Reasonable use of anti-vomiting drugs: Valium, VitB6, Gastrofacial, Ondansetron, Mannitol, etc.
Ten subcutaneous adhesions, uneven epidermis
Subcutaneous peeling should be at the same level, fat removal should be uniform, avoid hematoma or foci of infection, peeling should retain the appropriate thickness of subcutaneous fat, and cheek fascia suspension should be uniform.
XI Parotid duct compression or injury
Compression of the parotid ducts can lead to poor salivary drainage of the parotid glands and painful parotid rise. It is due to over tight sutures deep in the cheek or improper dressing wrapping after hand.
Twelve Wrinkle removal effect is not obvious
Patient’s reason: High expectation.
Reason of medical practitioner: insufficient level, depth and scope of separation fixation.
XIII Social factors other than surgery
Money influencing the surgical protocol and thus the surgical result.
Extrasurgical factors arising from interpersonal relationships.
Operative factors: excessive surgery, temptation to operate, improper screening and selection.
Patient factors.
Inappropriate physical therapy after patient discharge.
Excessive desire for perfection.
Psychopathy, menopause, marriage.
Loss of work.