Preoperative images of a 60-year-old patient, who was a smoker. The patient wanted to improve the drooping skin of his neck and of the cervicomandibular angle as naturally as possible. He was looking for an ambulatory procedure which would involve minimal blunt dissection and leave no visible scars. This is the indication of choice for mini-invasive suspension by means of the elastic thread mounted on the Jano needle (straight, two-tipped needle). The structure of the thread can be seen in the inset.
First, the operative design is drawn on the skin. The purpose of the design is to guide both infiltration of the local anaesthetic (lidocaine and mepivacaine with epinefrine) and implantation of the “Elasticum” thread.
This patient suffered from lowering of the floor of the nostril, as is typical in labiopalatoschisis. To correct this defect, the nostril has to be raised by a third of its total height.
First, an area of the abdominal region is anaesthetised in order to carry out Adipofilling in the lip. A slight correction of the vermilion border is made.
The procedure to raise the floor of the nostril now begins. A N° 15 scalpel is used to make a small incision anterior to the inferior border of the nostril. The blade penetrates to the desired depth. Creation of a prosthetic pocket is now started by means of small round-tipped scissors. Blunt dissection is delicately performed beneath the scar, in the direction of the columella. Dissection extends to the lower portion of the columella. The operator’s assistant uses a finger to check the distance of the dissection from the mucosa. The pocket is now created under the wing of the nose. The operator keeps to the bony plane.
This patient requested an Elastic MACS lift (Minimal Access Cranial Suspension–lift) and an Elastic neck lift.
The new elastic thread (Elasticum®, Korpo srl) enables vertical face-lifting with minimal blunt dissection and neck-lifting without blunt dissection to be carried out simultaneously. This ambulatory procedure is performed under local anaesthesia.
The operation begins with liposuction of a small amount of fat from the submental region.
An incision is then made around the sideburn, which has previously been shaved back by 1 cm. The incision is undulated and forms a loop that extends to the preauricular region. In the area of the sideburn, the scalpel is inclined so as not to damage the hair bulbs. Blunt dissection, which is much less ample than in traditional MACS lift procedures, is carried out immediately beneath the hair bulbs. Blunt dissection is started with the scalpel and terminated with scissors.
This patient was 85 years old. Before elastic lifting of the neck is performed in elderly patients, the amount of excess adipose tissue in the neck and cheeks must be evaluated. This will be removed by means of liposuction. First, local anaesthesia with 1% lidocaine with epinephrine is carried out along the U-shaped incision in the lower half of the pavilion of each ear. The areas in which liposuction is to be performed are then anaesthetised with a dilute solution of anaesthetic. Anaesthesia is also carried out along the line of the cervico-mandibular angle, where the elastic thread will be implanted. After performing limited dissection of the skin around the ears (a little more than twice the skin that is to be removed), the operator begins liposuction.
After undergoing an elastic MACS lift of the cheeks, this patient also noted a marked improvement in the lateral cervical region. However, some excess skin remained in the central area of the neck. This defect can easily be corrected by means of elastic neck lifting; unlike traditional lifting techniques, this procedure does not require blunt dissection of the skin of the neck.