04. Case report skin-scar revision and correction of chin ptosis by means of the elastic thread and two-tipped needle
KEYWORDS: chin lifting, elastic suture, two-tipped atraumatic needle.
This patient requested revision of a scar on the chin and, at the same time, correction of chin ptosis. The area of scarring is first designated. The pathway of the elastic thread (Elasticum®) is then drawn. Excision is started; the scar tissue is removed, while the deep dermis is preserved. The two-tipped Jano needle® is now inserted into the wound and the thread is fixed to the deep tissues of the chin. The tip of the needle emerges from the skin at the designated point. The needle is not extracted completely; the posterior tip remains in the tissues. Once the two-tipped needle has been extracted more than halfway, the elastic thread is pulled through. The posterior tip of the needle is then inserted to the required depth; the needle is rotated through 180° and continues to follow its predetermined route. When the tip of the needle again emerges from the skin, the elastic thread is pulled through, as before. A series of graduations on the shaft of the needle enable it to be extracted up to the depth required. The tip of the needle is again rotated and the needle follows the drawing, partially emerging at the predetermined point. The elastic thread is again pulled through. As before, the needle is extracted up to the required depth and then rotated through 180°. The elastic thread is fixed in the deep tissues of the chin. Finally, the two-tipped needle is withdrawn from the wound. To ensure that the Elasticum® thread has been correctly implanted, tension is applied to both ends. The thread is then knotted. Another elastic thread is implanted above the first one. After the small skin flap has been raised, the Jano needle® fixes the elastic thread in the deep tissues of the chin. The needle is again inserted into the wound and emerges on the line of the drawing; the elastic thread is pulled through, the needle is rotated, changes direction and re-emerges on the line; the needle is once again rotated and emerges from the wound. In this way, suspension of the chin is strengthened. Subcutaneous suturing is then carried out; this is completed by means of a few separate stitches. If there is no pre-existing scar on the chin, lifting can be carried out through a small incision under the chin.
Before and after elastic thread implant
Capurro S., Rava C. (2009): Case report: skin-scar revision and correction of chin ptosis by means of the elastic thread and two-tipped needle. CRPUB Medical Video Journal. Elastic Plastic Surgery section. http://www.crpub.org
Can Elasticum® thread be used to enhance the prominence of the chin?
Yes. In the video, we can see that the first circular suture has increased the prominence of the chin. The elastic thread, which is made of silicone, can also be utilised as a prosthetic implant; indeed, we have used it to raise the nasal floor in patients with labiopalatoschisis.
Elastic lifting of the chin – video publication (4) – has been successfully carried out several times in order to lift a drooping chin and/or make it more prominent. Where there are no skin scars, the 3 mm incision is made in the submental region. (30/07/15)