61. Elastic neck lift with three threads and four safety pins
KEYWORDS:Elastic neck lift, Neck lift with safety pins, Elastic MACS lift, Elasticum, Jano needle
The sagging skin of the neck is largely due to the ptosis of the cheeks, which we correct with the elastic MACS lifting. Once the vertical ptosis of the cheeks has been corrected, if a poorly shaped neck remains, we can perform an elastic neck lift with three threads and four safety pins. This new lifting technique gives the neck a pleasant shape. With aging, the profile of the cervico-mandibular angle is lost; vertical folds of skin and muscles form in the neck and, below these, horizontal wrinkles. In Elastic Plastic Surgery the skin of the cheeks and neck is never sectioned.
A vertical line is drawn in the center of the neck. Then two small lateral lines are drawn in correspondence with the vertical projection of the labial commissures; these small lines are drawn on the line representing the future cervico-mandibular fold. Between these two lines the first elastic thread will be implanted. At the ends, the traction loops will be created which will eliminate the vertical folds of the skin of the neck.
To draw the cervico-mandibular angle, the patient is made to bend the neck and the tissues over the angles of the mandible are pulled upward. This line runs outward to the angles of the mandible and reaches the fasciae of Loré. The return path of the elastic thread reaches the loop of the central elastic thread. The two side elastic threads are parallel and 1 cm apart, or just over 1 cm.
A local anesthetic is injected first behind the earlobe, then above the Loré band, along the path of the elastic threads, and finally in the areas where the excess fatty tissue is palpated. Horizontal liposuction is performed using a 2mm or 2.5mm diameter cannula and a 10ml syringe. Liposuction is performed through a small skin incision or a hole made by a 16G needle, which is dilated with the tip of a thin Klemmer. After neck liposuction, compression is needed for about two to three weeks.
The first central elastic thread (Elasticum EP 3.5, Korpo) is implanted. With a 16 G needle, a hole is made on each of the two small lines that correspond to the vertical projection of the labial commissures. A Klemmer with a fine tip is used to dilate and deepen the holes. The Jano Needle is inserted perpendicularly into the entry hole to a depth of just over 5mm. It then travels its course horizontally, partially exiting the hole drilled at the other end, where it is extracted up to the 5th depth notch. The tip is moved slightly to the side and the needle returns to the entry hole, where it is completely withdrawn. A safety pin is used to hold the thread out of the hole. The two ends of the elastic thread are knotted without traction. A second safety pin holds the elastic thread out of the hole.
The two lateral elastic threads are now implanted. The operator makes an 8mm incision behind the earlobe. Using scissors, she detaches the skin immediately above Loré's fascia and inserts a retractor. The Jano Needle enters the small incision and anchors the elastic thread tangentially to the Loré fascia. The needle is partially withdrawn up to the fifth depth notch; it then rotates and follows the predetermined path in the subcutaneous tissue, passing outside the angle of the mandible. Once the jaw has passed, the double-pointed needle is extracted up to the fifth depth notch; then it rotates and follows the previously drawn line, partially coming out of the hole. The elastic thread is withdrawn. As always, a Klemmer is attached to the end of the thread. The Jano Needle is now pulled out until just over 5mm is left in the tissue. It then tilts and changes direction to create the pulling loop. Once the loop has been created, the Jano Needle travels parallel to the previously implanted wire, in the direction of the mandibular angle. Here it is extracted up to the fifth depth notch and then reaches the preauricular region, where it partially emerges. The distance between the two elastic threads is never less than 1 cm. The tensile strength is determined by the tissues that are between the two threads. The Jano Needle is pulled out to the last depth notch; it then tilts and, with the aid of a retractor, comes out of the small incision behind the ear lobe.
A 3-0 polyester thread is passed through the loops of the core thread and side thread, which are held out of the skin by safety pins. Then the pins are removed and the polyester thread is knotted. The knot is pushed deep with a Klemmer. The two threads are now merged. The operator forcefully pulls the two ends of the elastic thread and then, with the aid of the retractor, knots them. The vertical crease disappears. The small incision behind the earlobe is closed with a rapidly absorbable thread.
The operator now makes an 8mm incision behind the contralateral earlobe. Using scissors, dissect the tissues immediately above Loré's fascia. He then inserts a retractor and anchors the elastic thread to Loré's fascia. The double-pointed needle is withdrawn to the fifth depth mark; it then inclines and emerges partially under the mandible, external to the mandibular angle. The Jano Needle is pulled out to the fifth depth notch; then it rotates and continues its path, partially coming out of the hole in the central wire. The elastic thread is withdrawn. The double-pointed needle is extracted until just over 5 mm remain in the tissues; it then tilts, creates the ring of traction, returns and exits externally to the mandibular angle. The Jano Needle is pulled out to the fifth depth notch; then rotates and emerges partially in the preauricular region. It is extracted again to the fifth depth mark, angled and withdrawn through the incision behind the earlobe. The two elastic threads are joined using a 3-0 polyester thread and the safety pins are removed. The knot is pushed deep into the tissue. Under the guidance of a retractor, the two ends of the elastic thread are vigorously pulled and knotted. The small incision behind the earlobe is closed with a rapidly absorbable thread. The procedure is finished. The fabrics have been repositioned and the neck has regained its youthful shape. Once colonized by the connective cells, the elastic thread will become a "ligament", making the result stable.
Capurro S. (2024). Elastic neck lift with three threads and four safety pins. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org.
How does elastic neck lifting work?
Traditional neck lifts often yield disappointing short- or long-term results that do not reflect the operator's efforts (extensive dissection and manipulation of the platysma). Obviously, a neck with a well-defined cervico-mandibular angle has a more esthetic appearance; this can be achieved by implanting elastic threads, without any dissection of the neck skin. The elastic thread is fixed to the fascia of Loré, not behind the ear in the mastoid region. This anterior fixation means that the patient does not experience the breathing difficulties or the feeling of oppression associated with the old techniques. Restoring the cervico-mandibular angle causes low horizontal neck wrinkles to disappear.
In elastic lifting procedures, the neck is not dissected. The excess skin covers the new cervico-mandibular angle. In this new elastic surgery technique, safety pins are used to connect the central thread to the two lateral threads, which eliminate the vertical folds of the neck skin.
Sagging neck skin is often caused by ptosis of the cheeks, and can be corrected by means of elastic MACS lifting alone. In patients with moderate ptosis of the face and neck, we normally perform elastic MACS lifting and simple elastic neck lifting, which consists of the implantation of a single elastic thread between the two fasciae of Loré. This thread is implanted through the same access used for the MACS lift, i.e. at the sideburn. In patients with severe ptosis of the face and neck, elastic MACS lifting and elastic neck lifting with three threads and four safety pins can be performed during the same session. Sometimes, however, this latter procedure is postponed, so as not to hinder the lifting of the cheeks.
The lower third of the face and the neck are closely connected. The elastic lifting of marionette wrinkles tractions the tissues on the mandibular arch. Excess preauricular tissues are removed. If necessary, the volume of the mandibular tissues can be enhanced by means of Adipofilling with small lobular fragments. If there is excess skin under the chin, it is surgically removed by creating a cutaneous and subcutaneous lozenge that stops at the cervico-mandibular angle.
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