Thread Lifting of the Nose: Fully Comprehensive Approach to the Technique.

Nose thread lifting is a relatively recent technique. It offers a chance to approach nose morphology defects without turning to surgery to obtain a temporary improvement. Nevertheless, it lacks standardization and it can therefore offer quite variable results and short durability. The authors' experience is presented here along with a recommended methodological approach to deliver reliable techniques for predictable results. Thread lifting techniques for nose reshaping by means of insertion of poly-L-lactic/poly-caprolactone threads are presented, based on principles of graft-based techniques, to obtain temporary morphological correction of selected nose deformities. Methods: A total of 553 patients underwent nose reshaping using poly-L-lactic/poly-caprolactone threads. Of the procedures, 471 were primary treatment, and 82 were secondary treatment after a previous rhinoplasty. The mean follow-up period was carried out through patient photographs and lasted 33.4 months (range 2-60 months). Clinical examinations and patient satisfaction surveys were done at 6 months and 1 year from thread lifting. Results: The Freiburg questionnaire survey (subjective Global Aesthetic Improvement Scale) allowed the authors to confirm a 95% satisfaction rate after 6 months, and 62% at 1 year after treatment. A flow chart based on the recorded results is presented to support operators in selecting the proper correction method to adopt, based on the different listed indications. Conclusions: Nose reshaping techniques with poly-L-lactic/poly-caprolactone threads are presented together with patients' treatment satisfaction. Standardization is based upon the authors' experience. Contraindications and encountered complications are discussed, so as to provide the readers with a complete "state-of-the art" presentation of these techniques. In the authors' experience, this is a reliable and safe approach to obtain temporary amelioration of selected nose defects via a nonsurgical and minimally invasive method.

Elimination of Aesthetic Deformations of the Midface Area Our Experience.

INTRODUCTION: The aesthetic manifestations of the aging process in the cheekbone, cheek and infraorbital areas are especially concerning for patients, so rejuvenating interventions in these areas are most in demand. OBJECTIVE: To introduce the experience of our clinic for aesthetic manipulation using Aptos (anti-ptosis) thread lifting methods in the midface area. METHODS: Among the surgical interventions that we used were Aptos thread lifting methods both in combination with lower blepharoplasty, and without it. At the same time, special attention was paid to the individual approach, trying to minimize invasiveness and, most importantly, trying to achieve the effect of moving subcutaneous soft tissues to a new, more advantageous position from an aesthetic point of view, with their fixation to dense structures. RESULTS: The results of application of the presented methods to lift the cheek-zygomatic and infraorbital regions using Aptos methods were studied. In the overwhelming majority of cases, the results satisfied both surgeons and patients. CONCLUSIONS: Aptos methods for lifting the midface soft tissues, which we used, are quite effective for rejuvenating the aging face. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Avoiding complications with Aptos sutures.

BACKGROUND: Over the past decade, several methods of minimally-invasive thread-mediated lifting have been widely adopted in aesthetic surgery. Early use of these methods met with great enthusiasm, and threadlifting was often performed without sufficient regard for proper indications, controls, or outcomes. Soon after, reports of early-relapse ptosis, complications, and other undesirable side effects began to appear in the literature. OBJECTIVES: The authors describe the current best practices associated with threadlifting to ensure proper use and improved results. METHODS: The authors retrospectively reviewed their collective case data, analyzing the results of 12,788 face and neck threadlift procedures in 6098 patients over 12.5 years. RESULTS: The data showed inconsistent results and early relapse of deformity with the Aptos Thread and Aptos Thread 2G methods. Complications included thread visibility, migration, and exposure; linear bleeding along the needle course; skin dimpling; hypocorrection and hypercorrection; transient paresthesias; and a small number of cases of injury to major vessels, nerve branches, and parotid capsule/duct. As new devices were developed and the indications for each technique refined, soft tissue suspension became more effective and durable, and the incidence of complications correspondingly decreased in the latter part of the series. CONCLUSIONS: Threadlifting is a relatively modern trend in aesthetic surgery that demands a similarly novel approach from surgeons. When performed properly, threadlifting is associated with minor and infrequent complications and is a helpful clinical alternative to traditional facial rejuvenation techniques.