Protocol for jawline correction and removal of excess, saggy skin in the submandibular area by using thread-lift techniques.

Preliminary stage

The Mezo-Radiyess procedure was carried out to the patient before the correction. It helped to create a framework and reinforce the area where the implantation of APTOS threads was planned.

Indication for application of thread-lift techniques:

• involution and age-related changes of the skin of face and body: mimic and gravitational wrinkles, Degree 3 and 4 (the Adamyan-Magomadov classification, 1997); loose and flabby soft tissues of eyebrows; excessive soft tissues of cheekbone, submental and neck areas;
• atrophic changes of the skin.

Materials & Equipment

1.    Manipulation room or operating theatre which meets the sanitary and hygienic requirements according to Sanitary rules and regulations 2.1.3.1375-03.

2.    Surgical table or operating couch.

3.    Standard set of sterile surgical instruments.

4.    Sterile dressing material.

Thread 2G method was chosen for the correction of the mental and Needle 2G - for submental areas.

Correction protocol

Before the procedure, the patient is photographed in 5 general positions (a frontal view, 2 oblique views and 2 lateral views) and marking of zones of intervention is carried out.

The marking is made with a medical marker. The use of water or stationery marker is excluded as the antiseptic solution will wash all the markings. In addition, skin irritation or an allergic reactions are possible. The marking is made in the sitting position, after which the patient is placed on a couch.

The infiltration anesthesia is often used. Anesthetic solution is injected along the marking. 1% lidocaine solution is used in combination with a solution of adrenaline or epinephrine. It takes 2-4 ml. per side.

During the correction, both needles are pierced by a single edge, they are separated under skin at the necessary depth and only then they are moved in the necessary directions.

To lift the mental area, the paired needles are inserted in the pretragal region. Then they are separated. One of the needles goes deeper to pick up the fascia, and then goes back to the hypodermic layer.

Further both needles with a thread are inserted along the intended direction. The needles are then brought out at pre-marked points - the edge of the jawline and the chin area. The thread should be tightened evenly on both sides to reach a small hyper correction.

Since the procedure implies invasive influence, as well as subcutaneous insertion of threads, all asepsis rules should be strictly followed.

The bending of the thread at the enter point is hidden under the skin. Light Lift Needle 2G also consists of two needles and one thread with bidirectional barbs. The needles have double sharp edges, and the thread is connected to them in the middle part. Once put together, needles create one sharp point. After insertion, separate them at the necessary depth. As in the case of Thread 2G, the technique of insertion of paired needles makes it possible to perform procedures without incisions and skin retractions.

For the procedure two needles are entered subcutaneously behind an ear lobe, at the edge of the mastoid area. Further one needle is inserted along the marking. If necessary it is brought out not completely, but turned subcutaneously and moved ahead to the other side.

The needle with thread is inserted in a subcutaneous adipose tissue on depth up to 5 mm, between a derma and platysma. An exit point - the opposite side of the face before an ear lobe. The second needle is also inserted parallel to the first one, crossing all submental area, from right to the left. According to marking another thread is inserted and fixed similarly on the other side.

The soft tissues of submaxillary area, implanted by threads, are tightened. Threads create necessary support in a type of a hammock. The ends of threads are cut off; the doctor must make sure they are not visible at the enter points. Folded skin in parotid area is sometimes observed. Finally,

the skin will be straightened within 2 - 3 weeks.

Light Lift Thread 2G consists of two needles. One thread with bidirectional barbs is attached to their ends. This invention increases the power of face lift and it becomes more stable.

After-treatment therapy

At the end of the procedure, the patient's face is cleaned with a solution of Chlorhexidine and ice is applied.

In the vertical position the doctor carefully examines the areas on which the correction was carried out. Pronounced asymmetry or retractions of skin are not allowed.

The moderated asymmetry, retractions, skin rashness, swelling and hyperemia of tissues are possible. After 7-10 days, these symptoms usually pass.

Light Lift Thread 2G allows cosmetologists to avoid skin incision and to minimize the risk of skin retraction.

Recommendations for the patient

1. Apply ice to the correction area within 24 hours after the procedure.

2. No hot drink for 2-3 days.

3. Limit the movements of facial muscles for a week.

4. No thermal and water procedures (sauna, solarium, swimming pool) and no fitness within 7 days.

5. No thermal effects in the implantation area for at least one month.

6. It is no recommended to massage application area within a week after the procedure. Deep massage is contraindicated

for a period of up to two months after the procedure.

Treatment effect

Soft tissues of the mental and submental areas are lifted; the

facial contours are improved. Excessive skin in the submtal area

is eliminated.

Dr. Albina Kajaia

the Head of Department of Dermatology and Cosmetology at the plastic and aesthetic surgery clinic Total Charm.