The diagnostic techniques that have allowed a better understanding of the changes that facial soft tissue undergoes and lead to the appearance of aged, have let new working methods and protocols to provide solutions that require the skin aging.
The “yarn-suspensions” are stitches specially designed to be implanted in the subcutaneous tissues. They are inserted into the connective framework tissues and recalibrating raising areas that shows ptosis (drooping gravitational tissues) and therefore restoring the contours and lifting up facial structures.
The aging face suspension with “tined stiches” or “tines and stiches” or” yarn suspension “or “Fit” or “Featherlift” or “Contour Thread” or “jaw sutures” or “russian wires” that all these forms are usually found in the literature, offers the promise of a minimally invasive technique with few adverse effects.
The suspension to counterbalance the facial decline can be done with prosthetic materials such as stitches.
The facial suspension with stitches, although not a new idea, has gained prominence with the appearance of the so-called quick facial lift (lifting).
This procedure consists in passing stitches beneath the skin of the face and neck to counterbalance the decline and laxity of tissues, which avoids large incisions, significantly detachment and a substantial recovery time after surgery.
In the last decade, the support abilities of the suspension facial sutures, has increased, by the addition of the polypropylene (thermoplastic polymer) tines sutures. These stiches are described in the literature as Aptos Threads (Aptos, Moscow, Russia), Isse Endo Progressive Face Lift Sutures, Contour Threads (Surgical Specialties Corp., Reading, Pa.) and Happy Lift.
The use of sutures in the face suspension has been practiced with conventional sutures both to correct facial paralysis or for cosmetic lifting of the malar fat pads areas, in order to increase the volume of the medium-half facial region.
The “yarn-suspension” exercises their function through the extensions of the yarn that is anchored in the tissues and maintaining them pulled in a certain direction. Its unique design allows after implantation, their tines open, to penetrate into the tissues around it, while because of the different direction of those extensions, it ensures a balance of power.
Depending upon the orientation of the wheel-shaped tines, the yarns may be divided in:
Bidirectional: With its wheel tines converging or diverging, depending on the orientation of these. At the same time, these may be permanent yarns (fit yarns) or reabsorbable yarn (Happy Lift Revitalization)
One Way or secured: normally it needs to be fixed for a lifting effect.
Under dermal antiptosis yarns of suspension of Sulamanidze.
In the 90s, the Russian surgeon Sulamanidze began perfecting a non-absorbable surgical string with a double row of tiny spines like two pins of grain, one above the other, which gave the yarn the characteristic of self-sustained when inserted into the tissue
Finally, the improvement and development in the art of lifting by yarns, has been the use of permanent or Aptos ® yarns with lengths greater so far than usual, ie, 30 cm. This variety has been designed especially to use in lifting the neck area, arms and inner thighs.
Being the yarn longest and inserting them, therefore, a greater number of extensions, these yarns can hold a heavier pressure and are, therefore, particularly suitable in areas such as the neck where the tissues are subjected to a more intense effect of gravity. The pressure exercise is proportional to the number of yarns.
In the same decade, the plastic surgeon Nikolay Serdev, began using a blunt smooth yarn, characterized by a short elastic bristle that is inserted into the tissue with a knot to create a “bag of snuff.” This suture would increase the volume and firming the tissue. The suture described by Serdev opened a very important door to lift and to fix the tissues of the face or other parts of the body.
This methodology has proven useful in cheeks, chin, buttocks and breasts.
Dr. Rafael Spagnuolo uses this technique with nonabsorbable yarns obtaining excellent straining results and in the reaffirmation of the oval face.
There are a wide range of yarns now; we have only mentioned those used most frequently and those of proven effectiveness.
Indications and contraindications.
The advantage of the mini-invasive cosmetic surgery on the face and neck with yarn tensioner are many, we can summarize them in the following points.
• Minimally invasive surgery under local anesthesia.
• Outpatient procedure that does not require hospitalization.
• Possibility of further sessions of treatment.
• Possibility to reverse the procedure without scarring as the yarn tensioner is removed easily.
• Relatively long duration of the result.
• No real complications.
• Replenishment of the anatomical structure.
• Control over the aging process.
The most important indications
• Patients with significant public activity.
• Patients who request it explicitly.
• Patients who reject traditional surgery.
• Patients who reject scars.
• Patients at risk of producing keloids, (a scar resulting of an overgrowth of granulation tissue)
• Patients with initial or not very advanced flaccidity.
For whom this treatment is suitable?
International practice suggests that the best candidates for the minimally invasive technique with yarns lift, are men and women between 35 and 65 years old with mild to moderate sagging tissues that want to improve their appearance for a more youthful and natural face and fundamentally those who want to prevent nursing, complications from surgery and scars.