年龄相关软组织变化对自体鼻整形术后迟发性轮廓显现的潜在贡献：一篇叙述性综述

文献信息

中文摘要

背景与目的： 在原本成功的自体鼻整形术后数年，可能逐渐出现迟发性轮廓不规则，尤其是在鼻部皮肤较薄的患者中。薄皮肤鼻整形、自体移植物行为以及鼻部老化曾分别被研究，但它们之间可能的相互作用仍不明确。本综述审视关于鼻部软组织被覆年龄相关变化、薄鼻部皮肤、自体移植物行为及其对鼻整形长期结局潜在影响的现有证据。材料与方法：采用结构化叙述性综述，以PubMed为主要数据库，并补充检索Google Scholar和参考文献列表。四个预先设定的检索领域分别涉及薄鼻部皮肤、鼻部老化、自体移植物行为以及保留与遮盖技术。PubMed检索共识别出463条记录。去除重复并进行标题和摘要筛选后，保留205篇出版物供进一步评估。通过补充检索还识别出其他相关出版物。由于研究设计、手术技术、随访时长和结局评估存在差异，对证据进行了定性综合。结果：薄鼻部皮肤与鼻整形术后下方结构特征可见度增加相关。老化与皮肤厚度和弹性、软组织体积以及下方鼻部支架的变化相关。这些发现为软组织遮盖随时间变化提供了可能的基础，但缺乏将老化与迟发性移植物可见度直接联系起来的纵向证据。晚期轮廓变化也可能源于移植物翘曲或吸收、瘢痕重塑或原生鼻部支架的变化。保留与遮盖技术能否预防老化相关的迟发性轮廓可见度尚未得到确立。结论：鼻部软组织被覆的年龄相关变化可能促成鼻整形术后迟发性轮廓可见度。然而，缺乏直接纵向证据表明这些变化会增加原本稳定的自体移植物的可见度。因此，这一关系应被视为一种假说，而非已确立的因果机制。需要采用软组织厚度、移植物形态和外部鼻轮廓客观测量的前瞻性纵向研究来检验这一假说。

英文摘要

Background and Objectives: Delayed contour irregularities may become apparent years after otherwise successful autologous rhinoplasty, particularly in patients with thin nasal skin. Thin-skinned rhinoplasty, autologous graft behavior, and nasal aging have been studied individually, but their potential interaction remains unclear. This review examines current evidence on age-related changes in the nasal soft-tissue envelope, thin nasal skin, autologous graft behavior, and their potential effects on long-term rhinoplasty outcomes. Materials and Methods: A structured narrative review was conducted using PubMed as the primary database, with supplementary searches of Google Scholar and reference lists. Four predefined search domains addressed thin nasal skin, nasal aging, autologous graft behavior, and preservation and camouflage techniques. The PubMed searches identified 463 records. After duplicate removal and title and abstract screening, 205 publications were retained for further assessment. Additional relevant publications were identified through supplementary searches. Evidence was synthesized qualitatively because of differences in study design, surgical technique, follow-up duration, and outcome assessment. Results: Thin nasal skin is associated with increased visibility of underlying structural features after rhinoplasty. Aging is associated with changes in skin thickness and elasticity, soft-tissue volume, and the underlying nasal framework. These findings provide a possible basis for changes in soft-tissue camouflage over time, but direct longitudinal evidence linking aging to delayed graft visibility is lacking. Late contour changes may also result from graft warping or resorption, scar remodeling, or changes in the native nasal framework. The ability of preservation and camouflage techniques to prevent aging-related delayed contour visibility has not been established. Conclusions: Age-related changes in the nasal soft-tissue envelope may contribute to delayed contour visibility after rhinoplasty. However, direct longitudinal evidence showing that these changes increase the visibility of an otherwise stable autologous graft is lacking. This relationship should therefore be considered a hypothesis rather than an established causal mechanism. Prospective longitudinal studies using objective measurements of soft-tissue thickness, graft morphology, and external nasal contour are needed to test this hypothesis.