July27Unitedkingdom  2021 

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Abstract Volume: 3 Issue: 1 ISSN:

Ponytail Thread Lift for Mid-Face Rejuvenation

Ibrahim A Ashary*


Corresponding Author: Ibrahim A Ashary, MD., Mawada Barakia, BDS.


Copy Right: © 2021 Ibrahim A Ashary. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Received Date: June 28, 2021

Published date: July 01, 2021


Abstract

Background: The aging process is regarded as a natural biological phenomenon in the human body, leading to atrophy of the soft tissue and loss of tonicity and congenital structural integrity1

As a minimally invasive facial rejuvenation operation, thread lift has become progressively common globally. The initial excitement was frequently accompanied by disappointment as we learned more about the restricted longevity of minimally invasive procedures and complications arising from different previous suture models.4

In this study, we present our experience with the ponytail thread lifting method, which is a combination of classical thread lifting and Dr. Ashary’s ponytail modification, that addressed the issue of thread lifting durability based on Patient satisfaction which has been proven to be the predominant factor in determining aesthetic surgery success.5

Material and Method: Between September 2016 and September 2017, 70 patients between the ages of 39 and 68 (average age, 52 years) underwent a ponytail thread lift performed by the author. Each patient signed informed consent.

Patients were asked to finish a standardized study instantly after surgery, follow-up and two years after surgery. The questionnaire is an outcome reported by the patient to assess results among patients with midface area facial aesthetics.

Results: After surgery, all patients reported an enhancement in their appearance, and cheek elevation on Follow-up patients was asked about their facial appearance satisfaction, and all patients were pleased with their appearance.

94.29% of patients rated their appearance as natural and all patients reported that they’ve noticed a positive change in their quality of life.

57.14% reported that people made positive remarks about the operation.

When patients were asked about how many years of favorable effect did the surgery have on their appearance, 40% reported they look 10 years younger, 35.71% reported they look 15 years younger and 24.29% reported they look 20 years younger.

97.17% expressed satisfaction with the choice to undergo surgery two years after the surgery, Only 4.29 % reported they believed their face would look better if they didn't have a thread lift.

Conclusion The ponytail thread lift technique has proven to be efficient and more durable even two years after surgery, and a great step in the way of preparation for the permanent facelift procedure.

Patients who responded in this study were extremely satisfied with their choice to undergo the procedure.

 

Ponytail Thread Lift for Mid-Face Rejuvenation

Background

The aging process is considered to be a natural biological phenomenon occurring in the human body, resulting in soft tissue atrophy and loss of tonicity and congenital structural integrity. (1)

The facial plastic surgeon has several methods available to influence a beneficial shift about the midface. (2)

Comprehension of the anatomy of this area is paramount in rejuvenating the aging midface. The relationship of the malar pad with the zygomaticus major / minor muscles and the SOOF are key aspects to understanding the aging midface, Location and knowledge of the significance of the frontozygomatic ligament, understanding how superficial facial expression muscles use SMAS to form facial fiber links to the dermis that enable midface animation, and, Finally, the investment by SMAS in the midface of the superficial facial expression muscles and the malar pad. The first anatomical point is that the malar pad overlaps the zygomaticus muscle and the SOOF, The frontozygomatic ligament emerges from a thickening of the SMAS that secures the midface right above the lateral attachment of the zygomaticus muscle. The surgeon must release this ligament to successfully rejuvenate the midface during surgery, as the inability to do so will prevent the lateral and superior movement of the malar pad during surgery. The significance of understanding that the superficial facial expression muscles in the midface use the SMAS to attach to the dermis, which makes it possible to animate this region, clarifies why lifting this region in a subperiosteal plane will have little impact on enhancing the depth of the nasolabial fold since lifting in this plane moves all superficial structures around the same, yielding no net alteration of the superficial aging anatomy. (3)

Thread lift has become increasingly popular worldwide as a minimally invasive facial rejuvenation procedure. The initial excitement was often followed by disappointment as we learned more about the limited longevity of minimally invasive procedures and complications resulting from various suture designs of the past. (4)

Patient satisfaction has been proven to be the predominant factor in determining aesthetic surgery success. (5)


Material and Method 

Between September 2016 and September 2017, 70 patients, aged between 39 and 68 years (average age, 52 years), underwent a ponytail thread lift performed by the author. 

Patients were 67 females and 3 males. Informed consent was signed by each patient.

To assess results among facial aesthetic patients, all patients were asked to finish a standardized study instantly after surgery, follow-up and two years after surgery. The questionnaire is an outcome reported by the patient to assess results among patients with facial aesthetics. In the first survey, patients were asked about their satisfaction with their overall appearance.

In the second survey, patients were asked about psychological well-being, social function, early life impact and aging appraisal.

And in the third survey patients were asked about their satisfaction with the decision to undergo surgery and the outcome of the procedure.

Figure.1: procedure illustration.

Figure.2, Anchorage.

Operative Procedure

Marking the face before the procedure is very helpful. When marking the face, the patient is asked to move in the opposite direction with the operator’s hand and pollex while holding the entire buccal region to measure the amount of fascia, muscles, and skin that need to be pulled. Just below the pollex in one of the obliques of the hand that was previously marked, three dots are placed successively to mark your exit point. In the temporal region of the head, the hair is glided aside for the incision. The scalp is incised 1-1.2cm with a blade 15 to pave way for the exit of the needle. From the dotted marked points, the needle is inserted until it reached the incision area. 

When the eye of the needle is visible, the thread is inserted (silk 0) and pulled the other end of the thread that was inserted and when the two ends of the symmetrical sutures are grasped, the shank is pulled off the needle until it reaches the entry point at about 0.4mm, and the needle is re-inserted to anchor the sutures in. finally a pull exerted and symmetry of the cheek and the amount of tissue pulled vertically is evaluated. Also, the area is homogenously re-positioned and an appropriate facial profile is evaluated. Once everything is sure, the threads in the temporalis where the incision was made are anchored.

Figure.3  Drawing

Figure.4 Anaesthesia

Figure.5 Incision

Figure.6 Technique


Results

All patients reported an improvement of their face appearance immediately after surgery as a result of the Ponytail thread lift.

On Follow-up patients were asked about their facial appearance satisfaction, and all patients were pleased with their appearance.

94.29% of patients rated their appearance as natural and none thought that their normal appearance was unfavorably changed in any manner. All patients reported that they’ve noticed a positive change in their quality of life.

When patients were asked whether others noticed that they had undergone surgery, 57.14% reported that people made positive remarks about the operation

When patients were asked about how many years of favorable effect did the surgery have on their appearance, 40% reported they look 10 years younger, 35.71% reported they look 15 years younger and 24.29% reported they look 20 years younger. 

97.17% reported satisfaction with the decision to undergo surgery when patients were asked about their satisfaction two years after the surgery, and only 4.29% reported that they believe that their face would still look better if they had not had a thread lift.  

Fig.7.a before ponytail thread lifting, frontal view Fig.7.b after ponytail thread lifting, frontal view

Fig.8.a before ponytail thread lifting, left side view Fig.8.b after ponytail thread lifting, left side view

Fig.9.a before ponytail thread lifting, right side view Fig.9.b after ponytail thread lifting, right side view

Fig.10.a before ponytail thread lifting, neck view Fig.10.b after ponytail thread lifting, neck view    

(Please go through the attached pdf to view all images)


Conclusion 

The ponytail thread lift technique has proven to be efficient and more durable even two years after surgery, and a great step way of preparation for the permanent facelift procedure, Patients who responded in this study were extremely satisfied with their decision to undergo a thread lifting and the outcomes and quality of life following the procedure.

 

References

1.Kazinnikova OG, Adamian AA. “Age-specific changes in facial and cervical tissues: a review”. Ann Plast Recontr Aesthetic Surg 2000;1: 52–61

2. Weinzweig, J., 2010. “Plastic Surgery Secrets plus E-Book”. Elsevier Health Sciences

3. Freeman, M.S., 2003. “Rejuvenation of the midface”. Facial plastic surgery, 19(02), pp.223-236

4. Paul MD. “Barbed sutures in aesthetic plastic surgery: evolution of thought and process”. Aesthet Surg J2013;33(3 suppl):S17–31

5. Alsarraf R, Larrabee WF, Jr, Anderson S, Murakami CS, Johnson CM., “Jr Measuring cosmetic facial plastic surgery outcomes: A pilot study”. Arch Facial Plast Surg. 2001;3:198–201

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