手術[4]脂肪吸引＋スレッドリフト フェイスラインのたるみに対する脂肪吸引とスレッドリフトの併用治療

Tips for Combined Liposuction and Threed Lift Treatment for Aging Facial Skin Sagging

はじめに

　顎下部では，加齢とともに脂肪の蓄積やフェイスライン上にある皮膚の下垂およびそれに伴うシワの増加などが見られ，cervicomental angle （以下，CMA）の増大と下顎輪郭の不明瞭化を引き起こすことが知られている 1）。そしてそれらが進行した場合には，フェイスやネックリフトの手術を行ったとしても，皮膚および皮下組織の弛緩によるシワやたるみを修正することは非常に難しい。

　顎下から頸部にかけての若さの指標としては，①下顎骨の下縁が明瞭であること，②甲状軟骨の形が見えること，③胸鎖乳突筋の前縁が明瞭であること，④CMAが105～120°であることの4項目が提唱されている 1）。そのため加齢変化を起こした顎下や頸部に対し，これらの4項目を視覚的になるべく明確化する治療を行うことが，患者満足度を上げるうえで重要となる（図1）。

　これらに対し当院では，局所麻酔下における脂肪吸引と糸による吊り上げ術（スレッドリフト）を組み合わせた治療法（以下，サクションリフト）を行っている。

　本稿では，その手技の要点と注意点および良好な結果を得るための工夫について述べる。

　With aging, the submental area shows adipose tissue accumulation, facial line and skin sagging, and associated wrinkle growth. n advanced cases, wrinkles and laxity due to skin and subcutaneous tissue laxity are very intractable, even if a face-neck lift is performed. Signs of aging in the submental and neck region include the formation of skin wrinkles due to the effects of sunlight, skin laxity, and the accumulation of subcutaneous fat under the chin, all of which are known to cause an increased cervicomental angle (CMA) and an obscured mandibular contour.

　Since liposuction or a face-neck lift alone may result in residual submental skin laxity, we offer a combination of liposuction under local anesthesia and the insertion of a sufficient amount of thread lift (we call this type of treatment a suction lift), which is very effective and less invasive than face-neck lift surgery. It is easy to express the important points in the youth index mentioned above with this combination, and it results in a longer duration of CMA improvement.

　When performing a suction lift, it is important to remove fat tissue evenly to ensure the clear appearance of the mandible shape. The number of threads used is adjusted according to the distance from the tip of the patientʼs mandible to the base of the neck and the extent of liposuction.

　We use two to four BNLS Ultimate Lifting threads and TESSLIFT threads under the chin.

　For the cheek area, we recommend the insertion of four to ten TESSLIFT threads. These threads are placed for the fat hanging at the face line to be fully lifted and then secured headward, and the scar of liposuction under the chin is formed along the shape of the mandible.

　A suction lift is a highly effective and satisfying procedure for individuals with a sufficient amount of subcutaneous fat and thin skin. Conversely, for those with a low subcutaneous fat volume and thick dermis, the skin sagging is difficult to pull up even when combined with a thread lift, making it less effective than the face-neck lift surgery.

　In addition, since the suction-lift procedureʼs effect of preventing skin sagging of the face line is very significant, this treatment is indicated for young patients who wish to prevent future skin sagging of the face line and under the chin, even if the CMA is not large. This is a good indication to prevent fat gain and laxity of the submental skin of the subcutaneous area around the chin.