Thread correction of gravitational changes in facial oval

Svetlana Korkunda, Ph.D., Associate Professor of the Department of Combustiology, Reconstructive and Plastic Surgery of KhMAPO, certified Aptos trainer (Ukraine, Kharkov)

Assessment of the causes of ptosis and prospects for correction

Of course, the choice of methods for correcting cosmetic skin imperfections primarily determines the condition of the skin. Often, patients themselves come with a request to “tighten up like this” or “fill in here,” and a typical mistake of cosmetologists is to offer patients to “eliminate” only the symptoms of gravitational ptosis along the oval of the face or nasolabial folds.

The doctor’s main goal when developing an individual program for correcting age-related changes in the skin and, in particular, the shape of the face is to satisfy the patient’s wishes as much as possible.

Formation of nasolabial and buccal-mental folds, the so-called. jowls, nasolacrimal groove is due to the fact that due to changes in the quality of the connective tissue (both the dermis and the ligamentous apparatus) and the volumetric ratios of the components of the tissues of these areas of the face, the latter, to one degree or another, begin to descend downwards. Therefore, the main cause of gravitational ptosis of the tissues of the oval of the face and higher located areas is the movement of tissues downwards and, as a rule, somewhat medially. Accordingly, techniques that do not eliminate the cause of these changes cannot give a long-term and high-quality effect.

What you should pay attention to when treating a patient with manifestations of gravitational ptosis:

• there are no lower or upper limits on the age when it is already possible or too late to work with this problem;
• the leading point is the clinical condition of the tissues, namely turgor, skin quality, amount of skin (presence of excess skin), degree of mobility, amount of subcutaneous fat, etc.;
• anamnesis – general, cosmetic; possibly surgical;
• features of the facial skeleton – flat, wide, high cheekbones; angle of the lower jaw; dental status;
• the presence and severity of retraction of the temporal zone, nasolacrimal groove, buccal-mental and nasolabial folds (and wrinkles);
• symmetry of facial tissues (usually moderate asymmetry);
• the amount of subcutaneous fat in the submandibular zone (the more there is, the more pronounced the ptosis of the lower third will be).

An assessment of all the above factors will allow not only to make a correct diagnosis, but also to evaluate possible correction options and predict their effectiveness and duration. In any case, it is necessary to understand that working in each zone in isolation is not very promising. In medicine, full treatment results can be achieved only if there is a direct impact on the cause of the pathological process. The cause of drooping facial contours is a change in the shape, volume and location of fat compartments on the face and a deterioration in the quality of the skin in general. Accordingly, the direct movement of tissues upward and outward makes it possible to physically eliminate the cause of gravitational ptosis. This can be achieved through surgery (open or endoscopic) or thread lifting using long barbed threads.

Possible correction options

Surgical methods of treatment , including the so-called circular facelift, have a certain duration of effect, as well as such a feature as long-term preservation of the lateral areas of the face and a fairly rapid return of nasolabial folds, nasolacrimal groove, etc. That is, in The central part of the face again develops age-related changes. Endoscopic methods make it possible to correct the initial stages of gravitational ptosis in patients without excess skin or with minor manifestations thereof.

Reinforcing the deep tissues of the face with injection agents allows one to obtain a lifting effect in patients with barely beginning signs of gravitational ptosis, and this should be regarded rather as a therapeutic effect. Often, reinforcement is combined with the introduction of botulinum toxin preparations along the oval of the face. Volumetric modeling using supraperiosteal fillers makes it possible to compensate for volumetric changes and movements of fat compartments on the face, and this effect is also effective in the initial stages of gravitational ptosis. It is worth noting that the protocol for combining injection facial reinforcement and botulinum toxin has an average duration of effect of 6 months, which requires the patient to repeat these procedures within the appropriate time frame. And one of the requirements of modern patients with a long history of cosmetology is the desire to have a long-lasting effect and visit a specialist less often due to lack of time and limited opportunities for the rehabilitation period. That is, simply put, walk rarely, so that bruises are not noticeable, and the results last a long time.

Hardware techniques that allow you to change the amount of tissue (causing fibrosis) are also able to correct gravitational changes in facial tissue. They are not accompanied by the presence of hematomas, therefore they have a milder rehabilitation period.

The role of thread lifting in working with gravitational ptosis is quite promising, as it allows you to eliminate the cause of this condition, the technique is predictable based on the result and rehabilitation, and can be one of the links in a comprehensive treatment protocol.

Undoubtedly, the final version of the correction will depend on the initial clinical picture, the wishes of the patient, the clinical and aesthetic thinking of the doctor, and equipment.

Threadlifting procedure

The protocols of our clinic involve the following algorithm of actions:

1. examination and questioning of the patient, assessment of the quality of facial and body tissues;
2. the patient's wishes;
3. highlighting the leading problem - skin quality, the presence of excess skin, in which zone ptosis is more pronounced than it is accompanied by (nasolabial folds, nasolacrimal grooves, etc.);
4. we exclude the situation with the presence of large excess skin - this is a direct indication for surgical treatment;
5. We recommend working with the quality (health) of the skin - mesotherapy, redermalization, biorevitalization, plasma lifting, etc. This greatly increases the effectiveness of the final result and significantly optimizes the course of the post-procedure period, which, as is known, when working with long threads with notches has such features as swelling, facial unevenness and hematomas in the first days after implantation;
6. if necessary, botulinum toxin in the lower third of the face (along the oval);
7. actually carrying out thread lifting in order to eliminate or significantly reduce the severity of gravitational ptosis of both the middle and lower thirds of the face. We recommend that the patient undergo correction of both the middle and lower thirds of the face at the same time - this allows for a more pronounced result in both quality and duration of the effect. The choice of threads (biodegradable or non-absorbable) depends on the clinical situation and the wishes of the patient. But in any case, these will be long threads with notches and fixation at reference points;
8. special rehabilitation protocols using low-dose drugs;
9. a month after the placement of threads (on average) - a follow-up examination to determine the need for additional work using fillers to create a more aesthetic facial relief or correct the results of thread lifting.

NB! This protocol may include a medium peeling, a course of superficial peelings, and hardware technologies that affect the quality of the skin.

Thread lifting as a complex component

The main principle of working with gravitational ptosis of facial tissues is maximum impact on the cause of its formation. The role of thread lifting in this is quite high, as it allows you to move the tissues of the cheeks (zygomatic zone and oval of the face) to a higher and lateral position. Undoubtedly, the duration of the effect is not unlimited. This does not exclude the possibility of its repeated use in the future - if the patient is satisfied with the achieved result and the cost of achieving it (both financial and the course of the rehabilitation period). This technique cannot be positioned as a panacea - it is one of the components of a complex effect on the chronoaging of facial tissues, but due to its mechanism of action it has an etiopathogenetic effect.

A modern specialist in aesthetic medicine has a large arsenal of high-quality anti-aging techniques. And it is very important that with the increase in this arsenal, the doctor’s vision of the role of each technique in terms of its clinical application and combination with others also expands. And in the “fight” against gravitational ptosis, the one who professes the principles of clinical, and not just commercial medicine, will be successful.

First published: KOSMETIK international journal No. 3 (57) / 2014, pp. 42-44