| Objective:The aim of this experiment is to report their change of mechanics,applicability or malar fat pad endure how much strength when sutures lift the malar fat pad.Meanwhile.To find the best suspension position, the amount suspension,the path of buried lead needle. These findings could be the theory for clinical application.Methods:1.Three fresh-frozen human cadaver heads were prepared.Putting five kinds of suspension sutures into the malar fat pad in different ways.For each suspension suture, a suture was positioned and set within the soft tissue of the cheek away from 15mm from the nasolabial line,the suspension suture out of tissue was attached to the hook tension adaptor on the digital pull-out dynamometer. The 5-mm (holding tension),10-mm,15-mm,20-mm tension and slippage tension,dissection tension,pull-out tension, breakage tension of each suture was recorded. Morphous of the fixation sites on the extracted sutures were examined with microscope.2. Two fresh-frozen human cadaver heads were prepared.Using buried lead method to elevate malar fat pad and using 2-0 black braid dacron as the suspension material.Then observing the best effect and finding the best point and amount of suspension.To analyze its reason by dissection.Results:1.Holding tension of bidirectional barbed polypropylene suture (2.4183±0.55510 N)was higher than other types of suspension sutures (p<0.05).Its breakage tension was (6.48767±1.20011 N) and the other tensions were unmeasured. The slippage tension of bidirectional barbed siliastic suture was 1.5667±0.24122 N,its pull-out tension was 1.8417±0.45736 N and the other tensions were unmeasured.There were no difference in 5-mm,10-mm,15-mm tension when non-barbed sutures hanged malar fat pad (p>0.05),but they have difference between 15-mm and 20-mm tension (p<0.05).The average of 5-mm tension was 1.3083±0.70598 N,10-mm tension was 3.2833±2.02590 N,15-mm tension was 5.5627±1.80527 N. An average tension of 55 newton was applied before rupture of the suture (nylon suture). In none of the cases did the suture pull through the malar fat pad. About 60% of barbs of bidirectional barbed polypropylene sutures demonstrated retroversion, bending, curling, or stripping away from the suture body after extraction.The distance of distal end of sutures became long.The morphous of bidirectional barbed siliastic suture didn't change anything.The broken ends of other sutures became thin or breakage.2.We found the best effect.It consistently softened the nasolabial fold, reshaped the malar eminence, rejuvenated the lower eyelid,and recovered the young profile. The suspension point is that the junct of a vertical line dropped from the lateral canthus and a transverse line drawn through the superior border of the ala nasi.The interval of tissue was 1 to 1.5 cm.. Accoding to our anatomy view, the supporting fascial septa within the malar fat pad extend from the superficial musculoa-poneurotic system (SMAS) to the overlying dermis of the cheek skin, the malar fat pad was fibrosis. The path of buried lead needle was subcutaneous fat, it can avoid facial nerver and blood vessel.Conclusion:1.Polypropylene barbed suture and siliastic barbed suture provided support by barb.They were fit for patients whose tissue sagged slightly.2.Buried lead method was fit for patients whose tissue sagged,because it can provide moderate and stable elevate by hanging sag tissue in a ring way.3.Non-barbed suture draged malar fat pad at different distance with different tension.These findings could be the basis for the choice of suture.4.Malar fat pad was firm, suspension suture can elevate the malar fat pad successfully.The results could be the theory for addressing the descent of midface that accompany aging.5.Using buried lead method to elevate malar fat pad for improving midface was a simplified,safe,effective method. It could rejuvenate the nasolabial folds,labiomental folds, infraorbital hollows, and midface.It appeared to be a straightforward, and effective means of rendering a youthful midface. |
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