An Innovative Thread-looping Method for Facial Rejuvenation: Minimal Access Multiple Plane Suspension

Positional relationships of the origin and course of zygomaticus major with the nasal ala, tragus, philtrum, and lateral canthus for aesthetic treatments and surgeries

PURPOSE

The aim of this study was to characterize the origin and course of the zygomaticus major muscle (Zmj) with its topographic relationships with the nasal ala, tragus, philtrum, and lateral canthus.

METHODS

The Zmj was examined in 50 specimens of 25 embalmed adult Korean cadavers. Facial muscles were dissected to expose the origin and course of the Zmj in 48 specimens of 24 cadavers. The 25th cadaver was sectioned to obtain images of the Zmj.

RESULTS

The positional relationships of the Zmj origin with the nasal ala and the tragus were classified into three categories. A horizontal line through the center of the Zmj origin and the nasal ala passed through the tragus in 20 of 48 specimens (41.7%), the intertragic notch in 18 specimens (37.5%), and above the tragus in 10 specimens (20.8%). In a horizontal section of the head, the Zmj origin was located near the level of the nasal ala and tragus. In a coronal section of the head, the fibers of the Zmj arising at its origin were located close to the zygomatic bone, lateral to the zygomaticus minor muscle.

CONCLUSION

By combining dissection with the analysis of sectioned images and ultrasound images of the Zmj, this study has yielded positional information for easily predicting the location of the origin and the course of the Zmj and its related structures underlying the skin.

Stab access fascia suspension lift: A facelift technique without skin excision and visible scar

BACKGROUND

Traditional middle and lower facelifts are not suitable for patients with mild skin laxity or who wish to avoid incision scars.

OBJECTIVE

We present the stab access fascia suspension lift (SAFS-lift) technique, which does not require regular skin incisions, as a reliable surgical facelift strategy for the lower and middle face.

METHODS

From September 2020 to September 2021, 38 patients underwent SAFS-lift. SAFS-lift involved (1) incomplete subcutaneous undermining with hydrodissection-assisted tunneling; (2) complete subcutaneous undermining with a dissecting cannula in the zygomatic buccal groove area and hollow below zygomatic arch; and (3) maximal firm superficial musculoaponeurotic system suspension with polydioxanone barbed threads in loops. All patients evaluated the outcome according to the Global Aesthetic Improvement Scale. Four plastic surgeons evaluated postsurgery result with a five-point Likert scale (5 = excellent, 4 = good, 3 = fair, 2 = no change, and 1 = worse).

RESULTS

Thirty-six patients were successfully enrolled. The mean follow-up period was 14.72 ± 3.89 months. No patients showed visible scarring 6 months after surgery. The minor complication rate was 19.4%. They all subsided within 1-6 weeks without treatment. No infection, hematoma, seroma, or facial nerve injury was observed. Patients' outcome ratings were 4.22 ± 0.58 (3 months), 4.69 ± 0.46 (6 months), and 4.69 ± 0.54 (1 year). Surgeons' outcome scoring was 3.98 ± 0.95.

CONCLUSIONS

Stab access fascia suspension-lift is a predictable, effective, and safe facelift technique that can be performed without making noticeable incisions and resecting the skin.

Contemporary View On Thread Lifting: Histological And Anatomical Approaches

Currently, thread lifting in aesthetic facial rejuvenation is not the top priority, but nevertheless its popularity continues to gain momentum. In connection with increasing popularity, the number of issues related to thread lifting and its undesirable side effects also increases. In this publication, an analysis of Russian and international databases was carried out, including MedLine, PubMed, elibrary.ru, Wiley Online Library, Web of Science, over the period from 2010 to 2020 (10 years). In the search, the following keywords were used both in Russian and English: threads, thread lifting, rhytidoplasty, face rejuvenation, face lift, cog threads, Aptos, suture material. As a result, of all available publications, 51 articles were left for further analysis, on the basis of which the nuances of thread classification, histological changes in tissues in response to thread implantation, along with anatomical basics and features during the procedure of thread lifting were analyzed. The effectiveness and duration of the thread lifting effect is still subject to debate. Hence, sometimes, it is possible to identify the duration of the effect in the same study ranging from 1 month to 2 years. Despite the long history of thread lifting, there are still unresolved issues that need to be covered.

Facial Thread Lifting Complications in China: Analysis and Treatment

Background:

Facial thread lifting technology has been applied for more than 30 years, with relatively few complications. In 2014, China approved polydioxanone thread (an absorbable barbed thread) for large-scale nonsurgical facial lifting. However, due to surgeons’ lack of overall experience, the complications of polydioxanone thread facelift have been relatively high.

Methods:

From April 2014 to January 2020, a total of 190 patients with postoperative complications of facelifts were treated after they underwent thread lifting in other hospitals. Of these, 189 patients were women and one was a man; the age of patients ranged from 28 to 62 years, with an average age of 37.4 years.

Results:

Patients were mainly treated in our outpatient clinic for the following complications: skin dimpling (77 cases, 40.5%); contour irregularity (32 cases, 16.8%); visible threads (31 cases, 16.3%); thread extrusion (10 cases, 5.3%); infection (17 cases, 8.9%); swelling (nine cases, 4.7%); incomplete facial paralysis (five cases, 2.6%); hyperpigmentation (four cases, 2.1%); hematoma (four cases, 2.1%); allergy (one case, 0.05%). Follow-up was scheduled 1–24 weeks after treatment.

Conclusions:

The most common complications of facial thread lifting are, in the following order, skin dimpling, contour irregularity, visible threads, and thread extrusion. The reasons for complications are mainly unfamiliarity with facial anatomy, unskilled surgical operation, and misunderstanding of the facial aesthetics of Asian women.

Percutaneous Thread Lift Facial Rejuvenation: Literature Review and Evidence-Based Analysis

PURPOSE

Interest in noninvasive facial rejuvenation procedures continues to grow. With the advent of the so-called lunch-time face-lift, suture suspension facial rejuvenation has gained prominence and much popularity largely patient driven rather than data driven. We have published a decade ago a review about this rejuvenation technique. Despite its popularity at that time, serious long-term studies and peer-reviewed data about longevity and patient satisfaction were lacking to our surprise. As 10 years have passed, we have conducted a new systematic PubMed database search limited to the last 10 years interval.

METHODS

The search identified 192 publications. After screening the titles and abstracts, 20 clinical and 2 experimental studies met the inclusion criteria and were selected for this review.

RESULTS

Though thread lift facial rejuvenation is considered to be a promising modality, no new evidence has been added to the literature to support its use.

CONCLUSION

Until evidence-based efficacy and robust data are objectively documented, patients requesting percutaneous facial rejuvenation must be well informed about adverse events, longevity of effect, and limited available data on efficacy.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aging Process of Lateral Facial Fat Compartments: A Retrospective Study

BACKGROUND

Since 2007, when the anatomy of facial fat compartment was described, an increasing number of studies on the aging process of the compartment of cadavers has emerged.

OBJECTIVES

The authors evaluated the aging changes of lateral facial fat compartments on the same person.

METHODS

Sixty-three patients were included in this retrospective study. All patients had magnetic resonance imaging scans with at least 4 years apart. The authors targeted the fat compartments of the superficial temporal, subcutaneous temporal, and buccal fat pad, comparing the data on different time points.

RESULTS

The thickness of the subcutaneous temporal fat did not change significantly. The 3 diameters of the superficial temporal fat compartment all became thinner on the axial view (P < 0.05). On the sagittal view, the superficial temporal fat elongated from 38.89 mm to 43.74 mm (P < 0.05). The buccal fat compartment also lengthened from 68.73 mm to 74.39 mm (P < 0.05) and had a positive correlation with follow-up duration only.

CONCLUSIONS

The study revealed the fat compartment change on the same person with time. The temporal hollow mainly originates from the thinner part of the superficial temporal fat. The descending of the buccal fat pad aggravates the labiomandibular fold. By understanding the aging process more fully, we can rejuvenate our patients more naturally.

The Surgical Anatomy and the Deep Plane Thread Lift of the Buccal Fat Pad

Background

Management of facial rejuvenation by the thread lift procedure has evolved over the past few years. The role of deep plane thread lift for buccal fat pad reposition was advocated. However, there are concerns about the risks and the feasibility of the deep plane thread lift. This study was designed to determine whether the deep plane thread lift could achieve effective aesthetic results and to investigate the possible risks of critical tissue injury through cadaveric studies.

Methods

Twelve fresh frozen cephalic specimens of 8 male and 4 female Asian body donors (mean age, 63.3 ± 8.0 years) were investigated. The deep plane thread lifts for reposition of the buccal fat pads were performed for all the left hemifaces. Cadaveric dissections were performed to investigate the moving distance of the buccal fat pad and to examine the surrounding tissue of the passage of the deep plane thread lift.

Results

The average moving distance of the buccal fat pads after the deep plane thread lift was 3.73 cm. The difference in moving distance of buccal fat pads between bilateral sides was statistically significant (P < 0.001). No injuries of the critical vessels or nerves were found after cadaveric dissection. The passage of the deep plane thread lift was evaluated.

Conclusion

The deep plane thread lift for reposition of the buccal fat pad is a safe, effective, and practical method.

Subjective Evaluation of the Results of Injectable Hyaluronic Acid Fillers for the Face

Background

Skin ageing is a physiological process, progressive and irreversible. Hyaluronic acid injection treatments are used to correct the signs of skin ageing.

Material and Methods

Hyaluronic acid was implanted in the area of the cheek and the forehead aesthetic units in 57 women, aged 35-55 years. Apart from the clinical observation, self-assessment of the therapeutic results was conducted. The "My skin" questionnaire was used for subjective evaluation of the treatment results.

Results

Mean wrinkle score in the pre-menopausal group changed after the treatment, from 3.2±0.6 to 1.1±0.3 and from 3.2±0.6 to 0.8±0.6 for the forehead and the cheek esthetic units, respectively. In the post-menopausal group, the score decreased from 3.8±0.4 to 1.7± 0.7 and from 3.2±0.617 to 0.8± 0.6 for the forehead and the cheek esthetic units, respectively. The changes were age-dependent. Improved appearance of the facial skin - higher satisfaction with skin tone and scent - was reported after hyaluronic acid injections. Higher subjective perception of improvement corresponded to older age, irrespectively of the menopausal status. Correlations between age and the effect of the treatment on maintaining proper skin hydration as well as between improved appearance of the forehead area and feelings of autonomy and well-being were found.

Conclusion

Hyaluronic acid injections significantly improved the subjective perception and overall assessment of the scent and appearance of the facial skin.