History of soft tissue lifting with threads

In the early 1990s, minimally invasive aesthetic surgery spun off from plastic and aesthetic surgery and is rapidly developing, which has become more accessible and democratic. This factor has allowed a multimillion-strong army of patients who want to eliminate the aesthetic manifestations of an aging face to more boldly make plans to go to a specialist to perform anti-aging interventions. Previously, most of them, for certain reasons, would never have dared to go to a surgeon for a FaceLift, so they were doomed to slow aging.

  

Sulamanidze Marlen Andreevich
plastic surgeon, Member of the Society of Plastic, Reconstructive and Aesthetic Surgeons of Russia, Georgia, IPRAS, Honorary Member of the National Society of Aesthetic Surgeons of France, Honorary President of the Japanese Liposuction Society, Member of the American Society of Dermatosurgeons

 

 

 

 

 

 

Sulamanidze Georgy Marlenovich
plastic surgeon, candidate of medical sciences, full member of the Russian Society of Plastic, Reconstructive and Aesthetic Surgeons, as well as the Japanese Society of Liposuction

 

 

 

 Sulamanidze Konstantin Marlenovich

plastic surgeon, dermatovenereologist, member of the International Society of Plastic, Reconstructive and Aesthetic Surgeons (IPRAS)

Today, patients have the opportunity to take advantage of the latest facial rejuvenation techniques. Among the numerous areas of minimally invasive aesthetic surgery, thread methods for correcting involutive and other deformities of the appearance began to occupy a worthy place, the interest of colleagues in these methods began to grow steadily, scientific publications began to appear on these topics in reputable periodicals, at congresses, symposiums, scientific conferences even began to allocate separate sessions…

Promotion of thread lifting methods

The first information in the scientific literature about the use of threads for lifting the soft tissues of the face and neck dates back to the mid-fifties of the last century, when BUTTKEWITZ demonstrated the image of the correction of "saggy labial fold" with a thread suture.

In 1970, Frenchman Rene Guillemain published an article describing a similar technique, later called THE CURL LIFT. He used a long Reverdin needle to guide and tighten the tendon to tighten the cheekbones, lower third of the face, or upper neck. Under local anesthesia, the suture was placed in the subcutaneous fat and firmly fixed to the dense structures both from above and below. This technique did not become widely used, although the results were quite satisfactory.

The book Mario Gonzales Ulloa describes a similar technique for lifting facial tissue using nylon threads.

In 2002, GH Sassaki and AT Cohen published a similar two-needle technique in Plastic and Reconstructive Surgery. They used it simultaneously with the classic FaceLift to improve and strengthen the result, and also independently during the closed procedure.

In 2003, Maximiliano Mendez Florez published an article in which he proposed a thread lift technique using a double-edged needle of his own design, as well as a special maneuver that simplifies the operation. The double-edged needle that Mendez introduced is similar to the needle used by drapers years ago. And needles with sharp tips on both sides, curved or straight, small or large, but centered, were often used in the past by general or plastic surgeons.

In 1982, Sergio Capurro, an Italian plastic surgeon, wrote about the double-edged needle in the journals "Revista Italiana de Cirugia Plastica" and "Plastic and Reconstructive Surgery".

In 1986, Japanese surgeons Akira Yahai, Osama Fukuda, and Sinichi Abayashi reported in the journal Plastic and Reconstructive Surgery their technique for using a curved double-edged center-attached needle.

Two double pointed needles have also been used by orthopedic surgeons (meniscal surgery) and plastic surgeons (cleft palate surgery).

Double-edged needles with nylon thread have been used for ligation of varicose veins as well as in cosmetic surgery for upper blepharoplasty, Koo Boo Chai began using this suture technique as early as 1952.

Jo Mathay in the Philippines often used subcutaneous sutures to narrow large nasal tips in his patients. Nikolai Serdev also described this technique a lot, the distinctive feature of which was the cannula of the original design, and there was a special way to conduct it under the skin. and presentations at various congresses and scientific conferences contributed to the dissemination of these methods.

Using threads with pull-up structures

Regardless of the development of surgical techniques

lifting with smooth threads, namely, all of the above methods were used, in plastic and aesthetic surgery, the direction of using threads with various tightening structures (protrusions, notches, cones, knots, etc.) e.).

The first information about them dates back to 1968, when German colleagues patented a thread with notches, with which they proposed to stitch the rupture of the Achilles tendon.

American surgeons suggested in 1997 to suture the edges of wounds with transverse single sutures using similar threads, but this method has not received practical distribution.

After 2 years, our method of wound closure with a continuous cosmetic suture with notched threads was patented, which in recent years has been increasingly used by surgeons of almost all specialties.

Surgeries to lift the soft tissues of the face and neck using notched threads for the purpose of rejuvenation were first proposed by us in 1998. The name Aptos (antiptosis) – so we called these threads - subsequently it was assigned to all products and technologies of minimally invasive lifting that were developed and put into practice by us.

History of the development of Aptos threads

The first experiments we did were with threads with protrusions that were directed in one direction and attached to a long needle.

Several threads were pulled subcutaneously through a small incision in the temple area, the lower residue of each thread, together with the needle, was cut off after it was brought to the skin surface, and the upper one, after moderate pulling, was sutured to the fascia of the temporal muscle.

In the same way, the soft tissues of the submandibular and cervical regions were pulled up with the upper end of the thread strengthened to the periosteum of the mastoid process. In an effort to minimize the traumatization of the intervention, for some time we used the method of passing threads with one-sided direction of the protrusions from the center through a small incision in different directions to the periphery and tying their ends together.

Soon, in the same 1998, this technique underwent some improvement: a needleless thread with converging protrusions was created, which was introduced under the skin with a guide needle, which made it possible to abandon the incision.

Such a thread, placed subcutaneously, was fixed in soft tissues due to protrusions converging towards its middle. Thus, it carried away the subcutaneous tissue, tightened and evenly distributed it along its length, which achieved the effect of tightening or obtaining a high contour of soft tissues.

In 2002, we again returned to the idea of ​​using a single product - a needle with a thread, however, the new suture material was distinguished by the presence of two needles, to the ends of which a single thread with converging protrusions was attached - Aptos Thread 2G.

This device doubled the shoulder of the thread, and hence the power and stability of the tightening. An important innovation in this case was also the fact that these needles were paired by temporary soldering in such a way that in this position their points formed a single whole. The implementation of the idea of ​​paired needles and the new technique of the operation made it possible to place the threads without skin incisions, through a puncture, without getting skin retractions at the place of the thread kink: both needles were injected into the skin with a single point, they were separated under the skin at the required depth, and only then they were inserted into different directions.

The next stage of our research was the creation of a double-edged needle with a smooth suture thread attached to the needle in its middle part - Aptos Needle.

Such a needle had the possibility of bilateral patency, which ensured its passage under the skin along a broken or elongated contour, subcutaneous stitching of soft tissues without skin retractions and obtaining an even tightened contour.

It should be noted that while inventing the specified suture material and developing methods for its use in surgical practice, we did not know that similar suture materials and methods of their application were previously used by colleagues. This is probably why the range of their use in operations not only in aesthetic, but also in plastic surgery turned out to be much wider. With the help of various modifications of the Aptos Needle, minimally invasive aesthetic operations have been developed for suturing the soft tissues of the midface, submandibular and cervical regions (2003), chin, elongated and stretched earlobes and ptotic breasts (2004).

Aptos Thread 2G and Aptos Needle have successfully combined the capabilities of our subsequent development - suture material and the Aptos Needle 2G method.

 

Aptos Needle 2G, like Aptos Thread 2G, had one thread with versatile projections converging to the middle and two needles, however, these needles are double-edged, and the thread is connected to them in the middle part, as in Aptos Needle. Just like the Aptos Thread 2G needles, the tips of the Aptos Needle 2G needles were fastened on one side with a temporary soldering and in this position formed one point. This made it possible to insert both needles under the skin through one puncture and separate them at the required depth. Thanks to the implementation of the original idea of ​​pairing two needles, operations are performed without incision and skin retractions.

Lifting when performing operations using the Aptos Needle 2G method is more powerful and stable due to subcutaneous turns of the needle and passing the thread with protrusions along the contour of the "pouch" or hook without violating the integrity of the protrusions and retractions of the skin.

Our approach to lifting kinetically active zones (wrinkles of "sadness", corners of the mouth) was radically different. rigid tightening in such cases was ineffective and led to a rapid recurrence of the deformity. To eliminate involutive changes in these areas, we used an elastic lift developed by us in 2003 with special threads. This is – a spiral thread made using a special technology from a special polypropylene that retains “memory” - Aptos Spring.

 

Since 2001, in parallel with the development of practical experience, special attention has been paid to the study and study of the anatomical, histological, functional and clinical aspects of the impact of threads on the body of laboratory animals and humans, as well as the analysis of complications and negative aspects.

We are particularly proud of our recent double-blind, placebo-controlled study on the effectiveness of Aptos thread lifts.

The study group included 32 patients who underwent thread lift with various Aptos methods on one side of the face, neck, chest, limbs, trunk, while the contralateral side was treated with placebo or another Aptos method. In the dynamics, the necessary observations were made (photographing, questioning, expert opinions, ultrasound, Doppler ...). After some time (different in each case) with repeated intervention, the symmetry was restored.

Experience has shown that Aptos thread lifts, especially needleless AptosThread, and methods of its application have proved to be the most successful and in demand among specialists. Their popularity was ensured by:

- simplicity, ease, cost-effectiveness, minimally invasiveness and low traumatism of procedures;
- reliability and sufficient long-term quality lifting;
- the possibility of combination with other interventions and a short rehabilitation period.

These circumstances have made it possible to develop Aptos ultra-minimal invasive products specifically for dermatologists: Aptos Elegance, ExcellenceVisage, NanoSring and NanoVitis.

ExcellenceVisage threads are made from a copolymer of polycaprolactone and lactic acid. This material, after being introduced into tissues, undergoes biodegradation by hydrolysis, and over time (within one and a half years), the threads completely dissolve. In their place, a fibrous cord remains, the formation of which is associated not only with the presence of a foreign body (thread), but also with the gradual release of micro-quantities of L-lactic acid during biodegradation, which stimulates neocollagenesis.

In order to minimize surgical trauma, cannulas with rounded, blunt ends are suggested for use. For the introduction of threads, a cannula 17 cm long is used, its thickness – 20G.

To reduce the trauma of the intervention itself, the thread is inserted under the skin only through the injection, without its injection. This technology makes it possible to fan-shaped, for example, on the face, 5 threads through one injection in the lateral part of the face, without punching out in its medial parts.

The list of references is in the editorial office of estet-portal.com.