English

58. Lifting marionette wrinkles with 2 or 4 elastic threads and removal of the preauricular skin

KEYWORDS: marionette wrinkles, Elasticum thread, elastic face-lifting

Marionette wrinkles can be corrected by exerting oblique traction by means of the elastic thread mounted on the atraumatic two-tipped needle. An elastic thread is now implanted to exert traction perpendicularly to the marionette wrinkles. A 1 cm incision is made behind the lobe of the ear and the skin above the fascia of Loré is dissected. A retractor is inserted. The two-tipped needle, which has been inserted into the cavity, partially emerges from the preauricular skin. It is then rotated and inclined so as to anchor the elastic thread to the fascia of Loré. The Jano needle now follows the preoperative design. The retractor is inserted into the dissected cavity and the two-tipped needle travels in the direction of the small entry incision.
The elastic thread is placed under tension and knotted. The skin incision is sutured.
The contralateral side is now treated.
In patients with very evident marionette wrinkles and an excess of skin, the two-tipped needle is used to implant elastic threads in both sides of the face in such a way as to create two suspension triangles. The excess preauricular skin is removed. As always, the apex of the first Isosceles triangle is close to the defect. The second triangle raises the excess skin toward the preauricular region, where it will be removed. Normally, patients who undergo elastic lifting of marionette wrinkles have already undergone elastic lifting of the cheeks or elastic MACS lifting.
Once local anesthesia has been carried out, a 1 mm incision is made behind the lobe of the ear. The tissues immediately above the fascia of Loré are dissected with scissors. A spreader is used to lift the dissected tissues. The two-tipped Jano needle penetrates superficially into the fascia of Loré, anchoring the elastic thread. The needle is partially extracted and then rotated in order to follow the preoperative design. The Jano needle partially emerges close to the marionette wrinkle; it then continues along its pathway, exiting through the entry incision. The elastic threads are placed under tension and knotted.
We now create the second triangle, which raises the excess skin toward the preauricular region, where it is removed. Removal of the preauricular skin completes the elastic lifting of marionette wrinkles in patients with evident esthetic defects. These Elastic Plastic Surgery procedures correct the edge of the jaw and restore the natural harmony of the face. Indeed, it should be borne in mind that the excess skin of the cheeks has repercussions on both the neck and the edge of the jaw. The vertical component of drooping of the inferior third of the face is corrected by treating the medial third by means of elastic lifting and, if the skin at the sideburns can be pinched between two fingers, by means of elastic MACS lifting. The elastic lifting of marionette wrinkles corrects the oblique slackness of the facial skin. If there is an excess, the preauricular skin is removed by means of minimal dissection.
From the two 1 cm skin incisions behind the earlobes, the elastic neck lift with 1 elastic suture or the elastic neck lift with 3 elastic sutures and 4 safety pins can be performed simultaneously. This last facelift is particularly suitable for more aged necks. As is known, the neck skin is not surgically dissected, the tissues are simply repositioned. With this new intervention, the vertical and low horizontal wrinkles of the neck are minimized without creating unnecessary trophic damage to the tissues.

Capurro S. (2023). Lifting of the marionette wrinkles with 2 or 4 sutures elastic and removal of the preauricular skin. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org.

FAQ

What other techniques can be used to improve this region of the face?

Botulinum toxin, fillers, Adipofilling, Adipolysis, facial gymnastics, Electroporo Cosmesis with subsequent application of resorcin, and daily application of bionic serums at home. Elastic neck lift without detachment of the tissues but only repositioning. with skin incision behind one lobe or both lobes.

What dissection is used to remove the excess skin?

The incision is the same as that used in traditional lifting. The skin that is to be removed is dissected. The edge of the skin is fixed to the cartilage of the ear with a long-duration absorbable thread.

POST-PUBLICATION REVIEW

Elastic lifting distends marionette wrinkles by exerting effective oblique traction near the defect. This elastic lifting procedure is performed in the absence of ptosis of the cheeks. If there is evident ptosis of the cheeks (i.e. the skin at the sideburn can be easily pinched), this must first be corrected by means of elastic MACS lifting. If there is less evident ptosis (the sideburn skin is difficult to pinch), we perform elastic lifting of the mandibular angle and, if deemed appropriate, of the cheeks through the same hole made with a 16 G needle. In elastic lifting of marionette wrinkles, if there is a lot of excess lateral skin, elastic threads are implanted in order to create two isosceles triangles on each side, and ample preauricular skin is removed (with fixation of the dermis to the auricular cartilage).
Elastic neck lifting also improves this region.
In the case of persistent sagging of the skin, the mandibular arch is enhanced by means of Adipofilling with small lobular fragments. If there is an excess of skin and subcutaneous tissue under the chin, a losange that extends to the cervico-mandibular angle is removed. (10/06/2024)