Hypertrophy of the temporal muscle ( ) Temporal cavity ( ) Prominence of the zygomatic bone ( ) Op scar of the zygomatic bone ( ) Jaw surgery ( ) Sunken cheek ( ) Liposuction ( ) Acnescar ( ) Thread lifting / HIFU. After absorbable thread treatment became widespread, the authors collected patient feedback on the results of thread lifts.
Fixing Point
In addition, it is necessary to learn the clear meaning of the various terms used in the explanation of lifting. As such, if we start without clarifying the meaning of the words, confusion or curiosity may occur.
Direction
Among the key contents used in the book, the authors obtained some of them by experiencing actual lifting. Consequently, we think it is necessary to start our story after clarifying the definition and meaning of some important terms.
Hanging Point
The fixed type discussed here means forming a strong attachment point on the temporal fascia area. This is also why we talk about the attachment point first in this book.
Method of Making a Fixing Point
There is also a method of creating an attachment point with hard ligament tissue on the inside of the face. If you cause the dental floss to hang in the region of the true ligament, a hard attachment point can form.
Facial Anatomy for Non-surgical Thread Lifting
Layers of the Face
- Skin
- Superficial Fat
- Musculo-aponeurotic Layer/SMAS
- Deep Fat
- Deep Fascia
And the thickness of the dermis of Koreans is not much different from that of Caucasians. In the fourth layer of the face there are several spaces, between which the ligaments connect the periosteum/deep fascia to the skin.
Cadaveric Photo Series of Facial Layers
The part of parotidomasseteric fascia that covers the parotid gland is thicker than the part that covers the masseter area. The branches of the facial nerve emerging from the borders of the parotid gland are clearly visible.
Anatomical Structures that Could Be Damaged
- Blood Vessels
- Nerves
- Parotid Duct
Note the presence of the temporoparietal muscle in the same layer as the superficial temporal fascia. The parotid duct usually runs above the line connecting the tragus and the corner of the mouth.
Thread Lifting and Blood Vessels
Superficial Temporal Artery
Transverse Facial Artery
Injury to Facial Nerves
Facial Nerves in the Zygomatic Arch Area
Technique to Reduce Nerve Injuries
Knowing the depth of the main nerves and blood vessels based on the anatomy of the face is a prerequisite for a thread lift. We anticipate that additional studies on pinch anatomy will be conducted in the future.
Study Method
Result
Pinch Anatomy: Temple Area Inside the Hairline
Clipping after squeezing removed the subcutaneous fat layer and exposed the superficial temporal fascia. The entire fat layer was removed without damage to the artery, indicating that the pinch caused the separation of the subcutaneous fat layer and the superficial temporal fascia.
Pinch Anatomy: Temple Area
The left side of the tissue sample is the area where a gentle squeeze was performed and the right side is where a deep squeeze was applied. Only the subcutaneous fat layer was cut and there was no damage to the STA and STF on the left, but it can be seen that the STF was removed and the DTF was exposed on the right.
Pinch Anatomy: Zygomatic Arch Area
In the area where the muscles are seen through thin subcutaneous fat, there is no damage to the muscle. Superficial temporal fascia Superficial layer of deep temporal fascia Deep layer of deep temporal fascia.
Pinch Anatomy: Sub- zygomatic Arch Area
On the upper right side of the cut surface, the dermis and subcutaneous adipose tissue are cut obliquely. In the area where the subcutaneous fat layer exists to a certain extent, only a part of the subcutaneous fat layer is removed together with the skin when the incision is made after compression.
Pinch Anatomy: Cheek Area
At the bottom of the cut surface, the dermis and subcutaneous fat tissue are cut obliquely. In the area where there is a certain amount of subcutaneous fat, only a part of the subcutaneous fat layer is removed together with the skin during compression and cutting.
Pinch Anatomy: Lower Cheek Area
The buccal branches of the facial nerve can be seen traveling with the parotid canal. Therefore, the buccal and marginal mandibular branches of the facial nerve that travel deep to the SMAS are not damaged.
Areas Where Pinch Anatomy Is Important
- Temple Area Inside the Hairline
- Zygomatic Arch Area
The facial nerve runs beneath the superficial temporal fascia and cannot be lifted with gentle squeezing (Fig. 11.5). Squeezing can reduce the risk of damage to the superficial temporal vessel when making a puncture and anchoring a wire.
Understanding Absorbable Threads
Trend of Thread Lifting
- Distinction of Threads
- Current Trend
Teeth in different directions are made on one wire, and they have the function of collecting tissues to the center part of the bidirectional gears. It is manufactured by the molding method, at the same time pressing the body and gears of the wire.
Physical Characteristics of PDO
Functions of PDO
Tissue Changes After Inserting PDO Threads
Histologic Findings After PDO Thread Insertion
The myofibroblast is mainly clearly associated with a wound contracture in the wound healing process and is a cell that serves a key role in causing elasticity in the procedure area and tight skin after the skin regeneration procedure. Also, many eosinophils have been observed which show fibrosis-promoting effects in the wound healing process.
PLLA as a Suture Material
QT Lift (= VOV Lift, = BLUE ROSE Ⓡ FORTE)
- Features
- Advantages Determined by the Authors
In the case of QT lift (=VOV lift, = BLOU ROSEⓇ FORTE), which is a PDO wire in pressure form method, the important advantages are that it is strong and has a long duration. Also, since the gear is strong, a procedure with the binding method mentioned later is possible.
Silhouette Soft ®
- Features
- Advantages Determined by the Authors
It is known for the function of collagen formation by stimulating surrounding tissues. For example, it is useful for treatments such as collecting tissue under the eyes and lifting sagging lower cheeks by pushing up.
N-Cog Lift
- Features
- Advantages Determined by the Authors
It is also beneficial for procedures such as nose tip reshaping procedures, lowered neck lift, etc. Depending on the condition of doctors or patients, it is necessary to choose different techniques.
Finding the Vector (Simulation)
Because the direction and degree of subsidence varies from person to person, it is advisable to design accordingly. It is recommended that doctors try to pull the skin in different directions over the patient's face, and from it the key vector should be selected.
Marking Reference Lines
Meaning of ⓐ: At the point where this line and the hairline meet, the entry point can be marked for the nasolabial vector. Sufficient power can be obtained even if the hanging point is not located medially to the line.
Indicating Dangerous Areas
Meaning of ⓓ: When making an access point at the point where this reference line meets the hairline (d'), care must be taken to avoid damage to the superficial temporal artery (STA). The STA runs more laterally to the hairline between a' and d' in most cases and travels more medially to the hairline after it passes d'.
Anesthesia Using Dental Lidocaine
- Anesthesia Using the Dental Lidocaine
Anesthesia Using Cannulas
- Anesthesia Using Cannulas
Location of Entry Point
Number of Entry Points
Selection of Entry Point Tools
Cautions to Be Taken While Making Entry Point
Sterile Draping of Hairline
Various Techniques and Inserting Tools
- Disposable Cannula (Blunt/Sharp Cannula)
Once the gear wire is inserted into the tissues, the wire is immediately anchored so that only the cannula can be withdrawn. However, reversal is possible if only the proximal head of the cannula and wire is pressed with the thumb.
Thread Insertion After Cannula Insertion
During the withdrawal of the cannula, if any of the scars enter the tissue, further return is impossible. If the cannula is inserted to a depth that is not desired, it can be withdrawn and advanced again.
Temporal Anchoring (41 cm Long) U Pattern
Once the dental wire is inserted into the tissues, the wire is immediately anchored so that only the cannula can be withdrawn. Problems may occur if the insertion depth is not properly adjusted.) However, reversal is possible if only the proximal head of the cannula and the wire are pressed with the thumb. A surgical cannula must be inserted for each of the wires and then the wire must be inserted into a sheath.
Insertion Using a Thread with Needles at Both Ends
In such a case, the pinion will be anchored in an inappropriate place, and then the wire and cannula must be removed. This is a process that anchors the temporal area using a curved needle to insert long threads (the details of this procedure are discussed in 「Part 6-3 Technique for Attaching a Thread to the Temple」).
Removing Cannula
Cutting
- Cutting While Pulling the Thread
- Cutting While Pushing the Skin
Techniques for Various Types of Thread
Mono-thread Insertion
Namely, the effect of the mono-thread insertion is to fasten the hanging tissue inwards instead of pulling the tissue with direction. Ultimately, the effect of mono-thread insertion can be expected to be caused by the contraction of adipose tissue, the strengthening of fibrous connective tissue and the improvement of the dermal environment.
Difference in Changes from the Mono-thread Technique
Due to the effects of fat denaturation by monofilament insertion and effects of proliferation and contraction of fibrotic tissues, the size of the bulging fat decreases. It can be expected that the skin environment will improve due to the findings that the size of the capillaries increases.
Explanations About the Mechanism
- Method of the Mono-thread Technique: Neckline
- Mono-thread Technique: Inner Cheek
- Mono-thread Technique: Frontal Cheek
- Mono-thread Technique: Temples
The mechanism of procedures on the inner cheek using the PDO monowires is to use the effect of fat denaturation, fibrosis effect and tissue contraction effect of PDO. By inserting mono-threads in the area where the frontal cheek hangs over the nasolabial fold, conglutination of fibrotic tissue and contraction of fat cells can be expected.
Unidirectional Cog Thread
Spike
22.4, if the direction of gears cannot prevent the movement of the tissue from returning to the original position, pulled tissue will be slipped.
Zigzag Method
After the lifting procedure using bidirectional toothed threads, zigzag threads are sometimes additionally inserted to prevent side effects such as sagging.
Bi-directional Cog
- Understanding Bi-directional Cogs
- Experiment on Actual Bi-directional Cogs
The appearance after inserting the bidirectional serrated thread into the subcutaneous layer and pulling it in one direction can be seen. As previously mentioned, bidirectional serrations create lifting effects by repositioning tissue in the middle where there is no serration.
Mechanisms
It is advisable to distance at least two finger widths from the lateral canthus (arrows in Fig. 23.5). This can be prevented to some extent by designing the thread to pass two finger widths away from the lateral canthus.
Insertion Method
- Design
- Anesthesia Method
However, because the subcutaneous fat layer is not an area where the pain senses are well developed, pain is generally minimal when driving the subcutaneous fat layer, with the exception of a specific area (mainly the area that crosses the blood vessels). This sometimes involves injecting a small amount of lidocaine into the lane with a needle to numb it.
Entry Point and Anchoring
- Tools for Entry Points
- Anchoring Tools
- Depth and Direction of Anchoring Point
- Side Effects: Prevention and Treatments
In some cases, there is almost no bleeding after passing the needle, but significant bleeding does occur after the thread is placed on the needle and then anchored, resulting in swelling in the area of the entrance. After anchoring, instead of applying the wire right away, remove the temporary ring and check for bleeding where it passed.
Adequate Cannula for Long- Thread Insertion (17G)
- Method of Using Inner Guide Needle
- Method of Using Inner Guide Needle
Because the guide needle is longer than the bevel of the sleeve, when it enters the combined state, it can dam-. ages in the tissues are minimized. It penetrates the skin at the entry point using the sheath separated from the guide needle.
Cutting and Finishing
- Finishing (Pulling)
- Cutting
- Changes in the Skin Around
- Fine Wrinkles Around the Eyes
Because there is a bevel at the end of the sheath in the opposite direction of the handle, it is sharp. Skin penetration is performed at the entry point while the sheath and inner puncture needle are combined.
Mechanisms (Concept)
- Effect of Silhouette Soft®
- Exclusive Advantages of Silhouette Soft®
Characteristics
- Structure
- Ingredients
- Preparations for the Procedure
Bidirectional needle thread insertion method (Silhouette Soft®). two-way needle + two-way cones. The length of the space between the knots in the middle of the thread where a cone does not exist is 2 cm.
Method of the Procedure
- Designing
- Anesthesia
- Entry point
- Insertion
- Cutting and Finishing
If there is blood in the area where the needle and plastic join (Figure 24.8), proceed. Check how much blood got on the connecting part of the needle and the plastic.
Various Techniques
- Basic Technique 1: Straight Technique
- Basic Technique 2: Angle Technique
- Basic Technique 3: U Technique
- Post-mandibular Anchoring (PMA) Technique
- Various Combinations Using Two Threads
- Eyebrow Lifting
If the bevel of the needle passes upwards: Useful to exit through the opposite entry point. It should be more next to the zygomatic arch (the space between the zygomatic bone and the ear).
Useful Tips
This is mainly claimed within several days of the procedure; feeling cones along the route of the wire when touched in the initial phase is not problematic. If the route is acquired in the direction of the wire when making an entry point as in the second figure, indentations can be prevented (see Fig. 43.9).
Temporal Muscle Hypertrophy (or Trigonocephaly)
Temporal Hollowness
Zygomatic Bone Prominence
Sunken Cheek
Operation Scar: Zygomatic Bone Reduction Surgery,
Liposuction
Acne Scars
History of Lifting Procedure: Thread Lifting and HIFU
Since most patients do not want this, it is necessary to check it before the procedure showing the mirror and to keep 2FB (finger width) distance between the most medial wire and the lateral canthus. Even if it is explained to the patient that the asymmetry existed before, the patients do not accept it well.
Procedures for Each Area
Simple Fixing Method
When using the above dissection method, some effects can also be expected for those patients who have forehead tissue with strong conglutination.
X-Cross Method
After being tied by knot, with the function of the gear in the opposite direction, it has the function of preventing the drawn skin from sagging. There is only lifting effect if the drawn skin can ride above the insertion hole level.
Anchoring Method
In general, since the skin around the eyes and eyebrows is loose, it is important to lift the lateral part. When the lifting procedure is performed on the lateral side of the face, it is important to keep in mind and avoid damage to major arteries and nerves.
Summary of the Eye Area Lifting
- Lifting of the Eye Area
Anatomy of the Eye Area
- Anatomy
Techniques Which Can Be Used in the Eye Area
- Preconditioning by Dissection with Tumescent
- Method of Forming a Fixing Point
- Tying Method or Simple Cog Insertion Method
- X-Cross Method
This is a method that can be used on patients where eye wrinkles can be improved by a slight lifting of the skin around the eyes and temples).
Cautions
The lower cheek is an area where lowering of fats and laxity of fibrotic tissue is severe as aging progresses. For those whose skin in the lower cheek is loose or has too much fat that forms strong fix-.
Fascia Anchoring Method
For patients who have thin facial tissue coverage, satisfactory results can be achieved even with a simple flossing or bonding method. Dents may occur in the exit area where the thread exits and can be resolved by taking appropriate procedure.
Tying Method
X-Cross Method
Anchoring Method
Method of Fixing with Bi-Directional Cogs
The marionette line should be designed taking into account the treatment of the lower part of the cheek and jaw. If the sagging in the cheek area is severe, the effect of the corner technique or the L-shaped technique may be insufficient.
