Published by : PROFESSIONAL MEDICAL PUBLICATIONS
|July - September 2006||
A non-aggressive forehead/brow lift with contour threads:
A case report and its application in Iran
Abdolazim Ghalambor1, Mohammad H. Pipelzadeh2
There are several advantages with use of contour threads in the face lifting technique These include no need for incision, so there is no scar lines, there is no damage to facial nerve, use of local anaesthesia is sufficient to produce analgesia, therefore it makes the procedure a very safe operation for elderly, diabetic and cardiopulmonary patients, and do not cause hair loss. In addition, the patients are awake and can chose the desired extent of final face lifting. We present the technique of use of contour threads and the outcome of a case of forehead/brow lifting in a 42 years old insulin-dependent diabetic single man who suffered from sagged eyebrows and many wrinkles on the lateral canthos of the eye. He did not have any cardiopulmonary or vascular disorders.
Key Words: Contouor threads, Non aggressive forehead lift.
Pak J Med Sci July - September 2006 Vol. 22 No. 3 320-322
1. Dr. Abdolazim Ghalambor
Department of Plastic Surgery
2. Dr. Mohammad H. Pipelzadeh
Department of Pharmacology
1-2: School of Medicine,
Ahwaz Jundishapur University of Medical Sciences,
Dr. Mohammad H. Pipelzadeh,
* Received for Publication: January 4, 2006
* Revision Received: March 11, 2006
* Revision Accepted: March 17, 2006
Face lift using Contour Threads™, the only FDA approved thread in United States, has become very popular all around the world and provides safe, effective and natural looking results. It can be employed for various face-lifting procedures in different parts of the face including the eye brow, cheek, nasolabial fold and double chin. Usually two contour threads are needed for each eye brow in brow lifting, three for nasolabial fold for each side and finally two for each side in double chin lifting. The number of threads used in each procedure is subject to change depending on the amount of lift and the patient’s skin.
Besides their need for general anaesthesia, classic face-lifting procedures can produce various complications that are minimised in contour thread lift technique. These complications can include remaining of scar line (bicornal incision), flap necrosis, hair loss and more importantly damage to frontal branch of facial nerve.1
This operation was completed in four stages. In the first stage, two points (A, B) were marked on one third of lateral and medial eyebrow area and further two points (X and Y) were marked at the hair margin approximately corresponding to points A and B. The fifth point (Z) was marked in the scalp area, forming a complete triangle with points X and Y, about 2 cm in the mid way between these points. A simplified drawing of these points is presented in Figure-1.
In the next stage, local anaesthesia was produced with subcutaneous injection of 2% lidocaine containing 1/100 000 epinephrine into entire marked path. In the third stage, two contour threads for each eyebrow were used. Both end of the 25-cm thread are attached to two needles to one end is a straight 17-cm long and the other end is a 26 mm half circular one as illustrated in the photograph (Figure-2). The straight needle was inserted, in a zig-zag manner in such a way that 5 zig-zags are covered for each brow lifting, starting from X point and ended in A, and the second thread connected similarly points Y to B. The ends of both threads, on the curved needle side, were sutured at the point Z and fixed on Gallia fascia and periostium.
In the last stage of operation, the other ends of the paired threads, on the straight needle side, were pulled out, the eyebrow was lifted as mush as was needed and the terminal ends were cut.
The sagged eyebrows were successfully lifted and the wrinkles around the eyes were completely removed and the results were satisfactory. Figure-3 A shows the sagged eyebrows and the wrinkles on the lateral canthos of both eyes before the operation, and Figure-3 B, C and D illustrate the lifting of eyebrows and removal of the wrinkles on the left and right lateral canthos respectively after the operation.
The desired amount of lifting was finally decided by the patient who was able to look into a mirror. The whole operation took an hour and the patient did not have any signs of bleeding or hematoma. The patient was discharged after two hours, acetaminophen 325mg three times a day was prescribed for relief of pain and instructed to apply an ice pack on the forehead regularly for the first six hours after surgery. Furthermore, he was instructed to hold his eye brows and keep his forehead fixed with his hands when coughing and sneezing for the next two weeks after the operation.
As ageing process begins, the changes to the facial structure appear as sagging, deep creases, folds and wrinkles. These changes usually begin in late thirties and persists up to late sixties, with average age of 45 to 50.2
Although application of this new technique does not replace conventional face-lift, it does provide a minimally invasive, less aggressive approach with low recovery time. The procedure employs specially designed threads made of clear polypropylene, a material that has been used in other medical procedures like heart and brain surgeries for years.3 Contour Threads™ are recently introduced new tools for repositioning sagged cheeks, lifting sagged eyebrows and readjusting asymmetric eye brows and face.4 The lift in this new technique is accomplished by a 10-cm barbed section located in middle of the thread, and adjusted that is strategically placed subcutaneously between the brow and the hairline. These special sutures have a needle system that inserts the thread in precise locations. The barbs then lift the sagged tissue and anchor it in a re-suspended more youthful location.
The Contour Threadlift™ approved by FDA in early 2005 is an answer to the vast demand for quick "lunch time" cosmetic surgeries in today’s world. Due to the minimal risks and ease of procedure, this method has become very popular all over the world. Today more than 285 surgeons in United States are using Contour Threadlift™ according to the manual.6 So far, the results of this technique have been very pleasing and natural looking. Because contour thread lifts are so new, plastic surgeons are not sure how long the results will last, though it is believed they can last seven to 10 years.5
In general both men and women who want a more youthful look yet not a full face lift procedure are good candidates. Ideal candidates are men and women in their thirties through sixties with mild drooping of the tissues of the brow, face and neck.1 Patient must be medically fit for this lift procedure. Patients with very thin and fragile skin who want a dramatic transformation and ones with heavy and jowly or thin faces are not good candidates for this procedure.
In this clinical work we explained the technique for forehead and eyebrows lifting in some detail, and showed that this technique is simple, effective and rapid with minimal complications. The outcome in our patient was satisfactory and compared well with other reported cases.5
1. Rees T.D, Aston S J, Thorne CHM. Blepharoplasty and fascialplasty including forehead-brow lift. In: McCarthy JG, May JW, Litter JW (eds). Plastic Sugery, Volume 3, W. B. Saunders Co., Philadelphia 1990; 2321-2414.
2. Aston SJ, Thorne CHM. Aesthetic sugery of the aging face. In: J. W. Smith, S J Aston (eds). Grabb and Smith Plastic Surgery 4th edition, Little Brown and Company, Boston 1991; 609-34.
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