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Case Report

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J Cosmet Med 2021; 5(1): 36-39

Published online June 30, 2021

https://doi.org/10.25056/JCM.2021.5.1.36

Outcome of mid- and lower face lifting using bidirectional cone sutures at 6 months and 1 year

Phoebe Kar Wai Lam , MBChB (Otago), MRCS (Edin), MSc PD (Cardiff) , James Yui Lam , MBBS (HK), MRCSED, PGDIPCLINDERM , Alvin Kar Wai Lee , MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), Ms Clin Derm (Cardiff), Ms PD (Cardiff) , Clyde Wang Lung Luk , MBBS, MSc, FCOHK, FCSHK , Paul Man Kei Tam , MBBS (HKU), MRCP (UK), FHKAM, FHKCP, DDME (CUHK), DPD , Cheuk Hung Lee , MBBS (HK), FHKAM (MED), FHKCP, MSc PD (Cardiff), MRCP (UK), DPD (Wales), Dip Derm (Glasgow), PG Dip Clin Derm (London), MRCP (London), Grad Dip Derm (NUS), Dip Med (CUHK)

Association of Doctors in Aesthetic Medicine, Hong Kong

Correspondence to :
Phoebe Kar Wai Lam
E-mail: myperfectskinsolution@gmail.com

Received: May 24, 2021; Revised: June 8, 2021; Accepted: June 8, 2021

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Soft tissue ptosis occurs with age, leading to loss of facial volume. The facial retaining ligamentous system is an intricate network of fibrous tissues connecting the whole face, restraining soft tissues from gravitational forces, and opposing facial movements. With proper positioning and anchorage within the ligamentous grid and superficial fat repositioning, lifting the mid-face and adjacent areas (e.g., jowl) is likely to occur. We aimed to determine whether inserting 3 pairs of bidirectional cone sutures can effectively improve the nasolabial fold (mid-face) and jowl (lower face) in Asian patients with mild to moderate mid-face laxity at 6 months and 12 months. Ten healthy volunteers with mild to moderate facial laxity received 3 pairs of bidirectional cone threads, inserted in a straight parallel technique. Based on validated evaluation parameters: facial laxity rating scale (FLRS) and the wrinkle severity rating scale, a total of 7 independent reviewers, among which 3 assessed the change in mid-face laxity (nasolabial fold), and the other 4 reviewers evaluated the change in jowl or lower face contour based on FLRS at 6 months and 12 months. All reviewers were experienced esthetic doctors. According to the reviewers’ evaluation based on the validated parameters, there was a linear improvement in the mid-face laxity/nasolabial fold and lower face laxity/jawline contour self-reporting patients’ satisfaction at 6 months and 12 months compared to baseline in all 10 patients. There was continuous improvement in mid-face laxity and lower face laxity from baseline, 6 months, and 12 months after treatment. The evaluation results among the reviewers were similar, apart from reviewer 7. All patients gave their best rating at 12 months, and their satisfaction almost doubled compared to that before treatment.
Level of Evidence: Level IV, brief communication

Keywords: aging, fascia, ligaments, nasolabial fold, rhytidoplasty

Fig. 1.Clinical photo (central, top; right lateral, middle; left lateral, bottom) of patient taken at baseline line, 6 months, and 12 months.
  1. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989;83:11-6.
    Pubmed CrossRef
  2. Lorenc ZP, Goldberg D, Nestor M. Straight-line vector planning for optimal results with silhouette instalift in minimally invasive tissue repositioning for facial rejuvenation. J Drugs Dermatol 2018;17:786-93.
  3. Russo PR, Vercesi F, Migliorini L, Christen MO. Histological findings after insertion of PLLA sutures with bi-directional cones in humans: two years follow-up. J Plast Path Dermatol 2018;14:121-5.

Article

Case Report

J Cosmet Med 2021; 5(1): 36-39

Published online June 30, 2021 https://doi.org/10.25056/JCM.2021.5.1.36

Copyright © Korean Society of Korean Cosmetic Surgery.

Outcome of mid- and lower face lifting using bidirectional cone sutures at 6 months and 1 year

Phoebe Kar Wai Lam , MBChB (Otago), MRCS (Edin), MSc PD (Cardiff) , James Yui Lam , MBBS (HK), MRCSED, PGDIPCLINDERM , Alvin Kar Wai Lee , MBChB (CUHK), DCH (Sydney), Dip Derm (Glasgow), Ms Clin Derm (Cardiff), Ms PD (Cardiff) , Clyde Wang Lung Luk , MBBS, MSc, FCOHK, FCSHK , Paul Man Kei Tam , MBBS (HKU), MRCP (UK), FHKAM, FHKCP, DDME (CUHK), DPD , Cheuk Hung Lee , MBBS (HK), FHKAM (MED), FHKCP, MSc PD (Cardiff), MRCP (UK), DPD (Wales), Dip Derm (Glasgow), PG Dip Clin Derm (London), MRCP (London), Grad Dip Derm (NUS), Dip Med (CUHK)

Association of Doctors in Aesthetic Medicine, Hong Kong

Correspondence to:Phoebe Kar Wai Lam
E-mail: myperfectskinsolution@gmail.com

Received: May 24, 2021; Revised: June 8, 2021; Accepted: June 8, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Soft tissue ptosis occurs with age, leading to loss of facial volume. The facial retaining ligamentous system is an intricate network of fibrous tissues connecting the whole face, restraining soft tissues from gravitational forces, and opposing facial movements. With proper positioning and anchorage within the ligamentous grid and superficial fat repositioning, lifting the mid-face and adjacent areas (e.g., jowl) is likely to occur. We aimed to determine whether inserting 3 pairs of bidirectional cone sutures can effectively improve the nasolabial fold (mid-face) and jowl (lower face) in Asian patients with mild to moderate mid-face laxity at 6 months and 12 months. Ten healthy volunteers with mild to moderate facial laxity received 3 pairs of bidirectional cone threads, inserted in a straight parallel technique. Based on validated evaluation parameters: facial laxity rating scale (FLRS) and the wrinkle severity rating scale, a total of 7 independent reviewers, among which 3 assessed the change in mid-face laxity (nasolabial fold), and the other 4 reviewers evaluated the change in jowl or lower face contour based on FLRS at 6 months and 12 months. All reviewers were experienced esthetic doctors. According to the reviewers’ evaluation based on the validated parameters, there was a linear improvement in the mid-face laxity/nasolabial fold and lower face laxity/jawline contour self-reporting patients’ satisfaction at 6 months and 12 months compared to baseline in all 10 patients. There was continuous improvement in mid-face laxity and lower face laxity from baseline, 6 months, and 12 months after treatment. The evaluation results among the reviewers were similar, apart from reviewer 7. All patients gave their best rating at 12 months, and their satisfaction almost doubled compared to that before treatment.
Level of Evidence: Level IV, brief communication

Keywords: aging, fascia, ligaments, nasolabial fold, rhytidoplasty

Fig 1.

Figure 1.Clinical photo (central, top; right lateral, middle; left lateral, bottom) of patient taken at baseline line, 6 months, and 12 months.
Journal of Cosmetic Medicine 2021; 5: 36-39https://doi.org/10.25056/JCM.2021.5.1.36

References

  1. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989;83:11-6.
    Pubmed CrossRef
  2. Lorenc ZP, Goldberg D, Nestor M. Straight-line vector planning for optimal results with silhouette instalift in minimally invasive tissue repositioning for facial rejuvenation. J Drugs Dermatol 2018;17:786-93.
  3. Russo PR, Vercesi F, Migliorini L, Christen MO. Histological findings after insertion of PLLA sutures with bi-directional cones in humans: two years follow-up. J Plast Path Dermatol 2018;14:121-5.

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