1、美容文饰严重并发症及其预防处理第四军医大学西京医院 林茂昌摘要 ： 美容文饰术（眉眼唇文饰术）貌似简单，实则有一定难度。是一项技性很强的工作，做得好给求美者增添美感，作得不好，则适得其反，甚至丑容、毁容目前由于美容文饰术广泛开展，加之一些不具备文饰技术的人员盲目参加此项工作，造成文饰并发症及丑容、毁容的事例屡有发生。本文对临床中常见的文饰严重并发症进行分析，并对其预防和处理予以介绍、讨论作者认为，只要认真规范地开展文饰美容工作，其严重并发症是完全可以预防和量减少发生的。关键词：文饰；并发症：丑容、毁容；预防处理；近年来由于美容文饰术广泛开展，加之一些不具备文饰技术的人员盲目的参加于此项美容工作
2、，造成文饰并发症及丑容、毁容的事例屡屡发生，值得引起重视。一、文饰术常见并发症及其原因目前临床中常见文饰并发症主要有以下几种：1. 感染 2. 交叉感染3. 过敏反应4. 眼部损伤5. 脱色、洇色6. 各种不良、怪异、失败文饰文饰术后出现并发症和失败的原因多种多样，概括的分析，主要有以下几个方面:1. 文饰美容师责任心不够，缺乏职业道德。2. 文饰美容师缺乏医学基本知识.如不了解文饰部位局部解剖、缺乏无菌技术观念、不熟悉文饰规范操作程序等。3. 文饰美容师缺乏应有的审美观和色彩常识。4. 文饰操作技术不熟练，粗疏、失误。5. 文饰器具质量低劣，使用不合色料。二、文饰术严重并发症预防和处理限于篇
3、幅以下主要谈谈上述并发症中前五项的预防和处理（一）局部感染表现：局部创面红肿、渗液、分泌物多或有脓点，毛囊炎等。预防：术前、术中严格按无菌操作进行，术毕时应清洁创面、涂抗生素软膏，术后定期随访，注意创面清洁卫生。处理：一旦发生感染，创面应每天清洁换药；口服或肌注抗生素，严重者应静滴给药，直到愈全（二）交叉感染由于肝炎、爱滋病等病毒可以通过创面渗液、血液、泪液、唾液等传播，因此若不注意，易造成潜在性、医源性交叉感染。预防:（1）严格消毒文饰器具，为了防止乙肝，爱滋病毒交叉感染，应选择具有杀灭病毒的新型消毒液浸泡器具或采用高压消毒等有效方法进行器具消毒。（2）严格按每人一针、一套、一杯的操作要求，
4、杜绝多人共用一套器具。处理：一旦发生、发现有交叉感染迹象或症状应及时请专科医师处理。（三）过敏反应文饰过程中麻药、消毒液、文饰液的应用，均有导致过敏反应的可能。过敏反应可分为延迟性和即刻性反应。即刻反应，当用药后，立即发生极严重的类似中毒的现象，如：突然惊厥、昏迷休克、呼吸心跳骤停而死亡。这种类型在文饰麻醉 用药时应特别警惕注意。以往有文献报道。在 1%地卡因液点眼致过敏性休克以及应用奴佛卡因、利多卡因行局麻时引起过敏性休克。延迟性反应，术后局部出现过敏性皮炎：表现为文饰区红肿，水泡，糜烂，渗液结痂，脱屑或者局部组织粗糙，增厚等，若处理不当可并发感染，后果严重。此种类型有一定潜伏期，接触后数小
5、时或数天后出现反应，文饰术中以对文饰液发生过敏者多见。预防：术前详细询问受术者有否过敏史；杜绝使用伪劣、过期药品和文饰液。处理：（1）严重过敏反应应立即给予脱敏药物，如钙剂、异丙嗪、可的松类激素药物肌注或静滴；吸氧。若出现过敏性休克应行抗休克治疗，如呼吸心跳停止则按心脏复苏方法原则迅速抢救，并立即请急救医师处理。（2）一般过敏反应：1 全身应用抗过敏、抗感染类药物。2 局部可应用止痒、消炎抗敏、消肿类药物。如果出现轻度红斑、丘疹、少量水泡无渗液时，可用炉甘石洗剂，激素类乳膏或霜剂。若有明显糜烂渗液，可用 3%硼酸液或庆地液敷，待渗液明显减少后可换成激素类霜或膏类制剂外用。（4）眼部损伤文饰术中
6、导致眼部损伤主要有以下几种：1. 飞针误伤眼球因文饰机速度快、纹针尖锐、如安装不牢、造成飞针或操作失误（尤其在纹眼线时），可导致角膜、眼球刺伤、甚至失明，应特别警惕预防。因此操作前应检查文针是否安放牢固，并应在他处试行开机，稳定后再正式文饰。文饰时应精力集中，文针应始终避开角膜或眼球。若一旦不幸发生误伤眼球，应立即请眼科医师处理。2. 过敏性结膜炎文线过程中有时应用地卡因或抗生素眼液会导致过敏性结膜炎。出现睑球结膜充血、分泌物多、眼痒、畏光溢泪等过敏症状。处理：（1） 及时应用生理盐水冲洗结膜囊。（2） 局部点用可的松眼液、眼膏。（3） 口服扑尔敏等抗过敏药物。（4） 静推葡萄糖酸钙液。3.
7、角膜损伤主要发生在文线：一种是机械性角膜损伤，如：文针不小心刺伤或不恰当擦伤造成角膜损伤，应及时处理，预防感染，否则会遗留角膜斑翳、影响视力。另一中是用表面麻药方法不当或浓度较大，造成角膜上皮剥脱甚至感染。常常在应用地卡因液表麻时发生：（1）0.51%地卡因滴液 23 次，35 分钟后即可发生表麻作用，维持约 2030 分钟，临床应用比较安全。（2）若滴用次数，过多或应用大于 1%浓度地卡因液，可使角膜上皮水肿、剥脱甚至中毒。一般表现为畏光多泪、角膜水肿、混浊、荧光素染色阳性。因此文眼线时应尽量少用 1%地卡因液直接点眼，最好用 1%地卡因棉片敷于睑部、避免麻药接触角膜。禁用大于 1%浓度地卡
8、因液点眼。一旦发生角膜损伤，应及时用抗生素眼液滴眼，防止感染，晚睡时涂眼膏，以促进角膜上皮恢复。4. 其它眼部损伤常见有以下几种：（1）文饰时，局部注射麻醉药导致暂时性上睑下垂。（2）文眼线时损伤下泪点，导致溢泪。（3）文线时感染导致睑缘疤痕，引起睑缘形态改变。（4）文线时损伤睫毛，导致睫毛乱生。（五）文饰后疤痕形成1. 文饰术后若局部感染处理不当极易造成局部疤痕形成。2. 不良文饰用药液、电灼或激光等方法褪色处理不当形成疤痕。处理：（1）疤痕面积小、轻、早期可对症处理：1. 局部应用激素类软膏、疤痕贴、疤痕霜等。2. 局部加压包扎（弹性绷带）。3. 疤痕内注射药物。4. 理疗：（2）疤痕面积
9、大、厚、经对症治疗无效时，只能采用手术切除方法进行治疗（略）（六）文饰其它并发症如：各种不良、怪异、失败文饰、各种形态脱色、洇色等。此类并发症因文献中介绍较多，本文不在赘述。参考文献：1. 林茂昌等主编，现代眉眼唇美容文饰学，西安.世界图书出版公司，19992. 孙玉萍主编，文饰美容技术，北京学苑出版社，1999 3. 林茂昌主编，现代眼部整形美容学， 西安.世界图书出版公司.1999Serious Complications and pretreatment of a polished beauty treatment Lin Maochang, Xi Jing hospital of th
10、e fourth medical officer universityAbstract：A polished beauty treatment (polish eyebrow-eye-lip) seems very simple. But in fact, it is surely difficult, requiring a lot of technique. A successful one will give pursers a sense of beauty, however, a bad one will lead to the Opposite side, even uglify
11、and disfigure appearance.At present, for the rapid development of the polished beauty treatment, in addition some unskilled people are blind to join in the job, the cases involving the complications of it and uglifying and disfiguring appearance frequently happen.The text makes an analysis of the co
12、mmon polished complications during clinical practice, introducing and discussing its prevention and treatment . In the authors opinion, as long as the work is careful and standard, complications can be completely prevented, even reduce its happening as possible. Key Words: polish; complications; ugl
13、ifying and disfiguring appearance; pretreatment.In recent years, for the rapid development of the polished beauty treatment, in addition some unskilled people are blind to join in the job, the cases involving the complications of it and uglifying and disfiguring appearance frequently happen. Its wor
14、thwhile paying too much attention.I. The common complications of polishing and its causes:At present, during the clinical practice, the common complications of polishing mainly about these types as following:1. Infection.2. Cross Infection.3. Allergic reaction.4. Injury of the eye.5. Decoloration an
15、d diffusion of coloring matter.6. Varieties of harmful strange unsuccessful polish.After the beauty treatment, the causes of complications and failure are various, the main aspects as follows:1. The beauticians dont have enough responsibility, lacking occupation morality.2. The beauticians lack of b
16、asic medical knowledge, such as not knowing the part of the topography, lacking the notions of aseptic technique, and are not familiar with the standard operation sequence of polish.3. The beauticians lack their own aesthetic view and general knowledge of color.4. Not familiar with the technique of
17、polishing, causing carelessness and mistake.5. Bad quality of instrument and ineligible color material.II. Serious complications of prevention and treatment of the polish For the limited space, here mainly discussing the first five prevention and treatment following:(1) Local infectionManifestation:
18、 The local surface of wound is red and swollen, exudated, and has too much secretion Or may has pustule, folliculitis etc.Prevention: Before and during the operation, strictly according to aseptic manipulation . At the end of it, clearing the surface of the wound , applying the ointment of antibioti
19、con. After it visiting the beauticians regularly, keeping the surface of wound clean and hygienic. Treatment: Once infected , clean the surface of wound and change bandage everyday. Take orally orInject antibiotic. The serious case needs intravenous drip, till complete recovery.(2) Cross InfectionBe
20、cause of the virus of hepatitis and AIDS circulated by oozing, blood, tear and spit of the surf-Ace of wound. If paying no attention to it, an incubative iatrogenic cross infection easily caused.Prevention: Strictly sterlize the instrument to prevent the cross infection of virus of hepatitisB and AI
21、DS, and choose the new sterilizer which has an ability to kill the virus, or the high-pressure Ways , or to some effective ways. Act in strict accordance with the rules that everyone should have his own needle, set and cup.Forbid many people to share one.(3) Allergic reaction During the process of u
22、sing anaesthetic , sterilizer solution and the polished solution , its Possible to contribute to the allergic reaction. It can be divided into two reactionsthe delaying One and the immediate one .The immediate reaction , after taking medicine ,instantly appearing a serious symptom similar to The tox
23、icosis, such as a sudden convulsions, coma, shock,a death out of suddenly stopping breathing and hearts beating. When applying an anaesthetic in those situations, extra attention is needed. ItHas reported in a document that during a local anesthetic, using 1% of dicaine for eyedrop, and novo-Caine l
24、idocaine can contribute to allergic shock.The delaying reaction , after the treatment, showing an allergic dermatitis, manifested as, with The area of polish red and swollen, odema, erosion , exudation, scab, desquamation, or with the local Tissue tough and becoming thick. A poor treatment can cause
25、 infection with serious results. This kind Reaction has a certain incubation period. After touching, the symptoms will develop a few days or yearsLater. People who are sensitive to the polished solution are more available.Prevention: before the treatment, ask the person operated on whether they have
26、 been sensitive to somethingForbid using poor quality and overdue medicine and the polished solution.Treatment: (1) Serious allergic reactionUse desensitizer instantly, such as calcium, phenergan, injecting and dripping hormone like cortisone oxygenInhalation. Once allergic shock caused, turn to the
27、 treatment of antishock, for example, quickly giving an emergency treatment according to the principle laid down on the treatment of recovery of heart if breath and heart stop beating, and turn to a firstaid physician immediately.(2) General allergic reaction 1 Use an anti-allergic and anti-infectiv
28、e medicine in the whole body.2 The medicine could be used for relieving itching ,diminishing inflammation,anti-allergic and detumescence in the local part Using calamine lotion ,hormone like ointment ,cream to treat a slight erythema,papule ,or little bubble without oozing.Using 3%of boric acid solu
29、tion or Qingdi solution for wet dressing to obvious oozing erosion ,after a clear decrease of exudation,it can be changed into hormone like cream and ointment for external use .（4）Injuring of the eyeDuring the polish ,the kinds of injure of the eye as follows:1. The needles injure the eyeball by mis
30、take For the speed of the machine is quick ,the needle is sharp ,if not firmly fixed ,the mistake made by the needle or operation will contribute to the stab of the cornea and eyeball ,even blind eyes .So more preventions are extremely necessary .(especially treatment on the line of the eyes.) Befor
31、e an operation ,checking that the needle is fixed firmly ,for the first step ,trying it out on other parts until it is firm enough to begin .During the process of the treatment ,concentrating on it and make sure that the needles avoid the cornea and eyeball all the time.Once unfortunately injured th
32、e eyeball ,turning to the Oculist as soon as possible.2. Allergic conjunctivitisDuring the process of the polish ,allergic conjunctivitis will attack ,for the usage of dicaine or antibiotic eye drop .As a result, the palpebral conjunctiva are full of blood ,secretion ,the itch of the eye ,photophobi
33、a and tears will overflow.Treatment: (1) Wash the conjunctival sac by using the physiological saline in time.(2) Put cortisone or ointment in the local parts .(3) Take the anti-allergic drug ,such as chlorpheniramine.VI. Applying for an intravenous calcium gluconate injection3. Injuring of the corne
34、aMainly during operating on the lines of the eyes .One is about the injury of the cornea mechanically ,such as a careless stable or not properly scrap the eyes .Once injured ,treat it immediately to prevent infection ,otherwise ,corneal macula is left over and will influence the eyesight The other i
35、s that a wrongly treatment or a heavy density when applying an anesthetic on the superficial anesthesia can cause the epithelium of cornea to peel off ,even be infected .It more available when using dicaine solution to apply a superficial anesthesia.(1).0.5-1%of the dicaine for dropping two or three
36、 times ,after three or five minutes ,it will work .It is safe to clinical practice for twenty or thirty minutes.(2).Dropping too much or providing more than 1% of the dicaine solution will make the epithelium of cornea ,oedema ,peel off or even toxicosis.Generally ,manifested as photophobia ,too muc
37、h tears ,an oedema of cornea ,bleary-eye ,fluorescein staining for positive .So during the treatment ,use 1% dicaine solution as less as possible .The best way is to use 1% of dicaine of piece of cotton to apply on the limbus palpebralisAnd to prevent the cornea from anesthetic .Forbid using more th
38、an 1% dicaine solution to drop .Once injured the cornea ,use the antibiotic eyedrop to prevent infection .Apply the ointment before going to bed so that the epithe-telium of cornea recovers quickly .3. Injury of other parts of the eyes .Common case:(1) . During the polish ,injecting a local anesthet
39、ic cause temporary blepharoptosis .(2) (29 .During polishing the lines of the eyes ,injuring lower lacrimal will cause the tears to overflow .(3) During polishing the lines of the eyes ,infection cause a scar onm the limbus palpebralis and change the shape of it .(4) During polishing the lines of th
40、e eyes ,injuring the eyelash and cause it to grow irregularly .V. Cicatrization after polishing .1.Poorly treated the local infection after the polish will easily cause local cicatrisation .2.As for the harmful polish in the treatment of fading ,using the medical solution ,electrotherapy or laser co
41、ntribute to cicatrisation .Treatment :(1) .As for the early slight small size scar one 1.Applying the kind of hormone ,such as,kind of ointment ,applying a scared plaster and cream in the local part2.Bind up by pressure in the local part (elastobandage)3.Inject the medical solution to the inner of t
42、he scar .4.Physiotherapy .(2).As for the think ,big size and ineffective one after suiting the remedy to the case ,only to the resection .VI. Other complications of polish Such as :all kinds of harmful ,strange ,unsuccessful polish ,all different shapes of decoloration and diffusion of coloring matt
43、er .For these kinds of complications are largely introduced in many documents .It is unnecessary to go into detail. Reference Documents:1 Chief editor :Lin Maochang ,modern eyebrow-eye-lip cosmetology of polishing ,Xian ,world library Publishing company ,19992,Chief editor :Sun Yuping ,the technique of cosmetogy of publishing ,Beijing Xueyuan publishing company 19993,Chief editor :modern plastic surgery on the eyes of cosmetics Xian world library publishing company ,1997
