沈干医生的科普号

注射玻尿酸改善鼻尖下垂，看看病例，在注射后一年，玻尿酸基本吸收后，鼻尖改善依然维持，令人惊艳。 图片让大家可以看看鼻翼软骨的形态和位置（内侧脚、外侧脚），还有让鼻尖下垂的肌肉。倒数第二张显示注射的四个部位，有效改善鼻尖下垂。 Two slightly curved divergent lines of the ideal nasal dorsum in frontal view When a person smiles, the paired depressor septi nasi muscles pull the tip caudally at the same time as the levator labii superioris alaeque nasi muscles pull the alar base and lateral lip cephalically. This movement causes straightening of the alar rim. A deficient nasal spine leads to posterosuperior movement of the subnasale. Secondary effects include a midphiltrum crease and gummy smile

[cp]介绍一个比较有创意的提眉手术。 其实也算是小切口的额部拉皮手术。用剥离子在额头皮下剥离，使额部皮肤松弛，向头顶方向推拉，眉毛提升到理想位置，用经皮缝合，固定皮肤于新的位置。为了加强固定效果，可以全额头缝合，第二天拆除以防止缝线切割留下痕迹。病例随访的照片是分别手术后2年、19个月、3年4个月。效果不是昙花一现?，让人惊诧[哪吒开心][哪吒开心]，主要还是缝合固定手段 比较另类，但是效果不错。[/cp] 剥离子 先固定两针 类似止血网状缝合 多多益善，但是两天就拆除缝线，免得留下缝线痕迹

The determinants of when to proceed with ear reconstruction for microtia depend largely on the degree of physiologic development of the ear, the size and development of the costal cartilages, and the potential for peer pressure. In general, 85% of ear development is reached by the age of 3 years.3,23 Ear width will continue to increase through the age of 10 years. The costal cartilages are relatively small until the age of 5–6 years making them impractical for use in the fabrication of an ear framework prior to that time. The growth of the costal cartilages usually parallels the rate of growth of ear cartilage through adolescence. In fabricating a costal cartilage framework for total ear reconstruction, therefore, the size of the framework should be the same as that of the normal ear in older patients or slightly larger in younger patients.27,64,66 In the UnitedStates and Europe, most surgeons prefer to perform the ear reconstruction between the ages of 4 and 6 years, during preschool, completing the reconstruction prior to the child entering fifi rst grade. In Japan, Nagata永田 prefers to defer the ear reconstruction until the age of 10 years or later, when the chest wall is nearly fully developed and a trans-xiphoid circumference of 60 cm or greater has been achieved.25,41–45小耳再造的时机由耳和肋软骨的的发育状况决定，还有个考虑是同龄人给你施加的心理压力。一般来说，3岁耳就发育达到成人的85%，但是耳的宽度要继续生长到10岁。而肋软骨在5~6岁左右还是相对弱小，这个时间的肋软骨去构建耳廓是很勉强的。英美的医生耳再造的时间略早（可能是英美的孩子个体发育快），著名的耳再造大师日本医生Nagata永田（我2016年到他的医院访问学习过）的时间就倾向于10岁或更大些，我当时在他埼玉医院的病房所见到的基本是个头体格基本相似的孩子们。具体说来，经过剑突的胸围应该达到或超过60厘米。参考文献：41. Nagata SA. New method of total reconstruction of the auricle for microtia. Plast Reconstr Surg. 1993;92:187.42. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part I. Grafting the threedimensional costal cartilage framework for lobuletype microtia. Plast Reconstr Surg. 1994;93:221.43. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part II. Grafting the threedimensional threedimensional costal cartilage framework for conchatype microtia. Plast Reconstr Surg. 1994;93:231.44. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part III. Grafting the threedimensionalcostal cartilage framework for small concha-type microtia. Plast Reconstr Surg. 1994;93:243.45. Nagata S. Modififi cation of the stages in total reconstruction of the auricle: Part IV. Ear elevation for the constructed auricle. Plast Reconstr Surg. 1994;93:254.Nagata technique, second stage. Clinical case. () The design for incision lines and harvesting of the ultradelicate split-thickness scalp graft and temporoparietal fascia. () A crescent-shaped costal cartilage block is fabricated from the harvested fifi fth costal cartilage. () The constructed cartilage is undermined and elevated. The cartilage graft is wedged in the postauricular sulcus to create the posterior conchal wall. A temporal parietal fascial flfl ap is then transposed to provide soft tissue coverage over the postauricular surface. The wound is closed with an ultradelicate split-thickness scalp skin graft.二期手术掀起耳廓，需要切取颞浅筋膜和植皮，而且还需要再次取肋骨做耳廓支撑。创伤大，耳后遗留瘢痕。尤其没有颞浅筋膜作为备用的修复材料。这两个英国医生是我在伦敦Free Hospital访问过的耳再造整形医生永田Nagata 悟

乳房缩小提升，LEJOUR法

三年前做过鼻中隔软骨综合，鼻尖下旋，鼻背假体透光。给予肋软骨抬高鼻尖，腹肌肌肉膜包裹假体，鼻翼缩小，鼻翼缘软骨条插入。

二期结束，下一期耳垂转位，耳屏塑形

[cp]比较低平短的鼻子，充分解剖松解 ???[/cp]

[cp]不同方式的鼻翼缩窄，一是内切?U型缝合，二是外切。