PEER-REVIEW | COMBINATIONAL AESTHETIC APPROACHES |
Thread facelift Thread lifting is frequently communicated as a minimal invasive alternative to surgical approaches for the improvement of skin laxity. Over the last 20 years, materials, instruments, and the method itself have been further developed and optimised. Several techniques are available including barbed (short) suture by Sulamanidze, Woffles (long) thread lifting, Waptos suture lifting, Isse unidirectional barbed-threads lifting, and silhouette lifting. Both, non-absorbable and absorbable sutures, with or without cogs, are in current use with similar aesthetic results46
. Based on current literature and communications
among experts, results vary widely with highly satisfactory results and mild side-effect profiles on the one side and a rather limited improvement with poor long-term sustainability and severe side-effects, such as palpable threads on the other47–49
.
Amelioration of localised fat deposits Injection lipolysis using multiple subcutaneous injections of phosphatidylcholine (PC) and deoxycholate (DC) to reduce adipose deposits in the abdomen and other areas had first been described in 2006. These derivatives of soya bean and bile extracts, respectively, had regulatory approval for certain applications, but neither had been formally approved for subcutaneous injection50
scientifically51 action50,52
. Although DC’s efficacy on cell lysis has been and clinically proven52
. , its unselective has been widely debated. When assessed at
various DC:PC ratios, PC demonstrates anti-lipolytic action, with the ability to reduce DC’s aggressiveness53 Published work, however, suggests that subcutaneous
injections of the lipolytic substances PC and DC lead to fat cell necrosis rather than apoptosis52 fibrosis50
, as well as . Long-term consequences of injecting a DC
Figure 5 (A) 37-year patient, who had undergone a number of different aesthetic filling procedures with various products of different companies for treatment of nasolabial folds and cheeks presented to the author’s department for further procedures. (B) Based on the severe masseter hypertrophy the author began with repeated BoNTA injections for 1 year, also waiting till abundant filler material had degraded before gently re-forming the malar contour and lips with hyaluronic acid
The very superficial light peels reach the stratum
corneum, superficial light peels affect the entire epidermis up to the basal layer, medium depth peels reach the upper reticular dermis, and deep peels are active up to the mid-reticular dermis. The latter two groups should be handled with caution, especially in dark skinned patients. Deep peels, like Baker- Gordon phenol peel, are contraindicated in skin types V and VI44
. Most frequently
observed complications include erythema, pain, itching and scaling, post-inflammatory hyper- and hypopigmentation, textural changes, skin atrophy, and photosensitivity as well as bacterial, viral, and fungal infections. Scarring is rare, but can occur after using deeper peels. Allergic reactions, forming of milia, acneiform eruptions, lines of demarcation, prolonged erythema, and toxicity after using resorcinol, salicylic acid or phenol may be occasionally seen44
50 ❚ . March 2015 |
prime-journal.com
formula into fat may also include necrobiosis of the adjacent reticular dermis, with death of adnexal glands, blood vessels, and nerves in the deep dermal layer54
.
When used in excess, skin contour irregularities have been reported54
which are essentially a result of the
product working too well. For this reason, only small amounts of the different compounds currently available (not FDA approved) should be injected, followed by repetitive treatments as required55
. Following this Thread lifting is
frequently communicated as a minimal invasive alternative to surgical approaches for the improvement of skin laxity.
protocol the procedure is usually tolerated well with minor and transient side-effects including reddening, swelling, and bruising at the injection sites, which may last for a week. In the majority of cases, the improvements begin to show after the swelling has resolved, with the optimal reduction of fat evident after about 6 to 8 weeks55
.
An increasing number of companies are investing in new lipodissolve products, such as Ghimas Spa, Italy; Lithera, California; and Kythera, Calabasas; the latter conducting rigorous clinical trials of a lipodissolve product called ATX-10156–58
.
Discussion For many years, the demand for aesthetic facial rejuvenation has been increasing. Improved understanding of the complex age-related alterations
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