RU2186529C2 - Method for correcting age alterations of facial and neck skin - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: it is conducted subcutaneous implantation of golden threads along the lower dermal edge by not capturing subcutaneous fiber. Additionally, one should conduct liposuctioning in submental area. A zone is defined as two concentric ellipses. A tunnel is performed from the middle of submental fold up to the middle of internal ellipse due to separating the skin and capturing the part of subcutaneous fatty fiber. An aspirator is inserted into the tunnel obtained to conduct the suction of fatty mass, firstly, under area of internal ellipse and then, under area between the two ellipses. At the same time, a deep liposuctioning is carried out in area of internal ellipse, and a surface liposuctioning - in area between the two ellipses. The method provides prolonged duration and stability of cosmetic effect and decreases the risk of postoperative complications. EFFECT: higher efficiency of correction. 2 ex, 2 dwg

Description

 The invention relates to medicine, more specifically to aesthetic surgery, and can be used to eliminate age-related changes in the soft tissues of the face and neck.

 Atrophy is the leading physiological process that characterizes the aging of soft tissues (skin with subcutaneous fatty tissue) of the face and neck.

 In its structure, the skin is a complex organ that performs various vital functions. The first feature of facial skin is its various thickness in various departments. In different people, this thickness varies widely. The second feature of facial skin is the content in it of a large number of blood vessels, sebaceous and sweat glands, nerve endings. Thanks to them and the active action of enzymes, vitamins and harmonics, active redox processes occur in the skin, which contribute to the fulfillment of the protective and other functions of the skin.

 The skin of all parts of the face has extensive vascularization due to the presence of a significant number of food sources and a dense intradermal network. Under the skin is fatty tissue, the amount and degree of development of which varies depending on gender and age.

 In the process of aging, focal, destructive changes in fibrous structures are observed, as well as collapse of collagen structures increasing with age. The number of cellular elements decreases, epidermal appendages change (sweat and sebaceous glands, hair follicles), changes occur in the vascular system of the skin (hyperelastosis, increased development of connective tissue, hypertrophy of muscle fibers, thickening of argyrophil membranes, etc.). These morphological disorders occur in different parts of the face and neck in different ways with the inherent features for each department.

 The main clinical manifestations of aging of the soft tissues of the face and neck - wrinkles and folds - are ambiguous in nature and mechanism of occurrence. Folds of facial skin are formed due to skin relaxation due to atrophy of its layers and subcutaneous formations. The mechanism of the formation of wrinkles proper is different: skin lacking elasticity gradually ceases to return to its original position, in which it was before muscle contraction, does not completely straighten, the interweaving of degenerated fibrous structures stabilizes the furrow, its depth and extent.

 Due to the upright posture of a person, all soft tissues of the body sag as they age. In the facial area, the action of external forces and processes occurring in the tissues causes unique clinical manifestations of facial aging for each person with various combinations of skin furrows (wrinkles) and sagging of stretched skin in the form of folds. The sagging of the chin area and the formation of a double chin especially changes and deforms the contour of the face.

 An urgent task of modern cosmetology is the development of effective low-traumatic methods for correcting age-related changes in the soft tissues of the face and neck.

 There are various methods for correcting age-related changes in the soft tissues of the face and body: lifting (circular skin tightening), dermabrasion, skin peeling with various chemicals, massage, etc.

 Known, for example, is a surgical method for correcting wrinkles of the face and neck by circular skin tightening, which consists in the following (Frishberg I.A. Cosmetic operations on the face. M., 1984, p. 182-185). A skin incision is made, starting in the temporal region in the form of a smooth rounding, going down to the earlobe, enveloping it, and continuing in the behind-the-ear fold. In this area, the incision is brought to the mastoid process, where the last bend on the neck is made. Next, skin detachment is carried out, the latter is pulled and the excess is excised.

 The disadvantages of this method are high invasiveness, a high risk of postoperative complications in the form of hematomas and cicatricial complications. In addition, a circular tightening provides mechanical stretching of wrinkles, but does not affect the structure and healing of the skin.

 Facial skin tension (lifting) has little effect on the chin area, where a double chin is formed as a result of sagging skin and the accumulation of fat. Sagging tissues in this area are due to skin relaxation, rigidity of the subcutaneous muscle and the accumulation of adipose tissue.

 According to some authors, from 30 to 60% of patients require operations on the chin area.

 A known method of correcting age-related changes in the skin in the chin area, including a horizontal skin incision along the natural chin fold, lipectomy and excision of excess skin (Frishberg I. A. Cosmetic surgery on the face. M., Medicine, 1984, p. 179-181).

 However, chin lipectomy can lead to a number of complications: recurrence of deformation, impression in the chin, cicatricial contractures and hypertrophy, which requires additional complex interventions to be eliminated.

 The closest to the claimed method - the prototype, is a method for correcting age-related changes in the skin of the face and neck by introducing liquid silicones under the skin (Rees T.D. Plast reconstr. Surg., 1977, v.l, p. 79).

The disadvantages of the method are:
- low efficiency, since silicone, due to the rapid migration into the surrounding tissue, a decrease in volume and "sagging", does not provide the duration and stability of the cosmetic effect;
- postoperative complications in the form of non-specific inflammatory processes and allergic reactions;
- the inability to restore the previous contour of the face and oval of the chin.

 An object of the invention is to increase the efficiency of the method and reduce postoperative complications.

 The stated technical problem is achieved by the fact that gold threads are implanted under the patient’s skin in combination with liposuction of the chin area.

 The proposed method is as follows.

 Previously, the surgical field is treated with an antiseptic and a line marker is applied, under which at the first stage of the operation implants from inert material will be inserted. As the latter, a gold thread is used together with a polyglycol thread, the main function of which is to withstand tension at the time of implantation and not allow a very fragile and thin gold thread to break.

 Marker lines are applied to those problem areas of the face and neck where there are wrinkles and a decrease in skin tone and elasticity is noted: the area of the cheeks, forehead, temporal region, chin, edge of the lower jaw, the front surface of the neck (Fig. 1 and 2). The lines are applied so that they slightly overlap the wrinkles, that is, before the start of the wrinkle and a little after the end of the wrinkle. The number of marker lines and, accordingly, the number of threads is determined by the individual characteristics of the patient's skin. In the chin area, the liposuction area is additionally marked with a marker by applying two concentric ellipses, while the internal ellipse is the actual zone for deep liposuction, and the external one is for soft surface liposuction in the transition zone to ensure a smooth transition of the liposuction zones and to exclude complications in the form of impressions in the chin area.

 Next, the first stage of the operation is performed - the implantation of gold threads under local anesthesia. Filaments are implanted in the direction of wrinkles and skin folds (and under them to fill them) or implanted in the form of a mesh to correct larger areas with small wrinkles or sagging. To do this, a special needle with a trihedral sharpening of the tip, which pulls two strands of gold - gold and polyglycolic, is introduced into the puncture site (the beginning of the marker line), is carried out along the lower edge of the dermis and brought out (puncture, end of the marker line). In order to prevent the ends of the threads from reaching the skin surface, during the injection, the tip of the thread is pressed with a finger, then the needle and thread are pulled with moderate force, forming a small fold, and when the puncture is made, the fabric is pressed around the outgoing tip of the thread with scissors and then cut. In this case, the atraumatic needle does not pierce, but spreads the tissue without injuring the skin, and both ends of the thread remain under the skin. It turns out like a subcutaneous stitch with gold thread.

To perform the operation, sterile kits of the Lorca Marine company are used, which include:
- 1 gold thread of high fineness (24 carats, 999.9), diameter 0.1 mm;
- 1 polyglycol thread (caliber 3/0 or 5/0 USP);
- 1 atraumatic needle (length 60 mm).

 The length of the threads is 25 cm. In one package there are 2 threads. As a rule, 2 packs (1 m) are required on the face, 0.5 m on the chin, and 0.5 m on the neck.

 The next step in the operation is to perform chin liposuction. They inject with a raspator in the middle of the natural transitional skin fold of the double chin, stupidly separate the skin with the capture of part of the subcutaneous fatty tissue in the form of a tunnel 2.5-3 mm wide to the middle of the internal ellipse, introduce a special aspirator with a needle with a diameter of 2.5 mm and three holes and suction the fat mass first under the zone of the internal ellipse, and then under the zone between two ellipses with visual and palpation control of the liposuction process (figure 2).

 At the end of the operation, sterile patch strips are placed on the implantation sites of gold threads for 12-24 hours, and the chin area is strengthened with elastic bandages for a week.

 The mechanism for correcting age-related changes in the skin of the face and neck is as follows.

 Upon implantation of gold and polyglycol filaments (hereinafter referred to as the "gold filament") in the subdermal space, a sharp activation of metabolic and regeneration processes around the implant begins. Polyglycol thread resolves after two months by hydrolysis to water. And around the golden thread, a protective shell of cellular elements forms - this causes an additional blood flow, tissues are enriched with oxygen and nutrients. Since the newly formed cells have a more organized structure and contain more moisture, collagen and elastin, the appearance of the skin is rejuvenated. Gold threads are so thin (thinner than a human hair) that they are not felt under the skin and do not interfere with facial movements.

 Thus, the effect of introducing gold threads is not a mechanical effect, but rejuvenation of the skin due to the granulomatous reaction, which increases the tone and elasticity of the skin. On the other hand, the evacuation of fat masses from the chin area allows you to restore the previous contour of the face and a clear oval of the chin.

 The determining significant differences of the proposed method in comparison with the prototype are the following.

 1. Gold threads are used as an implant for subcutaneous administration, which ensures the duration and stability of the cosmetic effect.

 Gold threads do not cause toxic or allergic reactions, they are chemically neutral and harmless to living tissues. Subcutaneous administration of gold threads stimulates the proliferation of fibroblasts in cells and promotes their production of collagen and elastin, resulting in the formation of elastic tissue, which creates a lifting effect and contributes to a significant increase in overall skin tone and elasticity.

 2. The introduction of gold threads is carried out strictly along the lower edge of the dermis, without capturing the subcutaneous tissue, which reduces postoperative complications and achieve a high cosmetic effect of skin rejuvenation.

 When gold threads are implanted above the optimal level (into the dermis), scarring and injury to blood vessels and nerve endings are possible, and below (into the subcutaneous tissue), the effectiveness of the method is reduced.

 3. In addition, liposuction of the chin area is performed by separating the skin together with part of the subcutaneous fat in the form of a tunnel from the middle of the chin fold to the middle of the previously defined marker zone in the form of two concentric ellipses, first introducing the aspirator into the received access and suctioning the fat masses under the inner ellipse zone, and then under the zone between these ellipses, which allows you to restore the correct contour of the face and chin.

 The combined use of hypodermic implantation of gold threads at the first stage of the operation and chin liposuction at the second allows you to get a qualitatively new, synergistic effect of face renewal due to the fact that the first ones start the mechanism of natural skin rejuvenation, and liposuction ensures the restoration of a clear oval of the chin and lost contour faces.

 Thus, the proposed method is an interconnected sequence of stages of the operation, contributing to the most complete correction of age-related changes in the skin of the face and neck.

 The invention is illustrated by the following examples of specific performance of the method.

 Example 1

 Patient T., 52 years old, was in the clinic about age-related changes in the skin of the face and neck.

 From the anamnesis: wrinkles appeared about 20 years ago.

 Objectively: the skin is dry, flaccid, flabby, with a yellowish tint. On the face and neck there are skin folds and wrinkles, deep nasolabial folds, sagging of the chin area. The contour of the face is changed due to the drooping cheeks (“bulldogs”) and the second chin.

 Correction of skin folds, wrinkles and double chin by the claimed method.

 The surgical field is treated with a 0.5% alcohol solution of chlorhexidine. Marked lines of the introduction of gold threads on the face, chin and neck. Local anesthesia with ultracaine was performed. Gold threads were implanted on the face by means of three horizontal and four vertical stitches both on the right and left sides of the face. For this, a special needle with a trihedral sharpening of the point into which a double thread (gold and polyglycol) is inserted, was inserted into the puncture site (beginning of the marker line), was carried out along the lower edge of the dermis and brought out (end of the marker line), and the thread was cut. It turned out like a subcutaneous stitch with a thread. Similarly, gold threads were implanted on the forehead: they held four vertical and three horizontal stitches to the right and left of the middle of the forehead. Three horizontal and five vertical stitches were made on the chin. Additionally, two stitches were held along the edge of the lower jaw using one thread (25 cm). Three horizontal and five vertical stitches were made on the neck. The skin was treated with a 3% solution of hydrogen peroxide, and then smeared with gentamicin ointment.

 The next stage of the operation was liposuction of the chin area. For this, the liposuction zone was outlined with a marker in the form of two concentric ellipses, injected with a raspator into the middle of the transitional skin fold of the double chin, the skin was separated with the capture of part of the subcutaneous fatty tissue in the form of a tunnel 2.5-3 mm wide to the middle of the internal ellipse, an aspirator with a needle with a diameter of 2.5 mm and three holes and began a deep suction of fat, first under the zone of the internal ellipse with visual and palpation control of the liposuction process, and then more superficial and softer - under one between two ellipses. The volume of sucked fat was 50 ml. A plate of a sterile patch was placed on the injection sites of gold threads, and the chin was fixed with elastic bandages for a week.

 Examination of the patient after 6 months: dryness and sagging of the skin disappeared, deep folds became less pronounced, wrinkles were smoothed out, and complexion improved. There is no second chin, a clear oval of the face has been outlined.

 Example 2

 Patient B., 47 years old, was in the clinic about premature aging of the skin of her face and neck.

 From the anamnesis: wrinkles appeared about 5 years ago.

 Objectively: the skin is dry, pale, atonic. The face is covered with a dense network of fine wrinkles, pronounced nasolabial folds, crow's feet at the outer corners of the eyes, sagging cheek skin of the bulldog and double chin.

 Correction of skin folds and wrinkles of the face and neck of the claimed method.

 The surgical field was treated with a 0.5% alcohol solution of chlorhexidine. Marked the lines under which the gold threads will be implanted (on the face, chin and neck). They performed local anesthesia with ultracain. Gold threads were implanted on the face by 4 horizontal and 4 vertical stitches in the cheek area, both to the right and to the left of the nose. In this case, the threads were carried out strictly along the lower edge of the dermis, so as not to injure the blood vessels and nerve endings and achieve the maximum cosmetic effect. On the forehead, 4 horizontal and 4 vertical stitches were made to the right and left of the middle of the forehead. On the chin, 3 horizontal and 5 vertical stitches were made. On the front surface of the neck, 3 horizontal and 5 vertical stitches were made. On the edge of the lower jaw, an additional 4 stitches were carried out using one thread (25 cm). The skin was treated with a 3% hydrogen peroxide solution and then oiled with Celestoderm cream. Plaster patches (except for the chin) were placed on the venues (jabs and punctures).

 The second stage of the operation was performed on chin liposuction analogously to example 1.

 A day later, the patch was removed, and the face and neck were treated with 3% hydrogen peroxide and Celestoderm cream, and the chin was left suspended on elastic bandages for another 6 days.

 Examination of the patient after 4 months: the general tone of the skin and its elasticity increased. Small wrinkles disappeared, skin folds on the forehead and neck decreased, the complexion improved. The woman began to look more youthful, the second chin disappeared, the previous regular contour of the face was restored.

Using the proposed method will allow, in comparison with the prototype:
- significantly reduce postoperative complications;
- to ensure the duration and stability of the cosmetic effect of skin rejuvenation, which lasts up to 10 years;
- to carry out a gradual and natural rejuvenation of the skin due to the body's own reserves in response to the implantation of gold threads;
- renew the face due to complex skin rejuvenation and restoration of the correct face contour.

Claims (1)

 A method for correcting age-related changes in the skin of the face and neck, including subcutaneous implantation of gold threads, characterized in that the implantation of the threads is carried out along the lower edge of the dermis without capturing the subcutaneous tissue, while liposuction is additionally carried out in the chin area, for which a zone is previously outlined in the form of two concentric ellipses, perform a tunnel from the middle of the chin fold to the middle of the internal ellipse by separating the skin with the capture of part of the subcutaneous fat, in which they introduce an aspirator and suction the fat mass first under the zone of the internal ellipse, and then under the zone between the two ellipses, while deep liposuction is performed in the zone of the internal ellipse, and surface liposuction is performed in the zone between the two ellipses.

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