Aging is a universal phenomenon and inevitable. Skin too ages just as other organs of the body. In addition to generic body aging, extrinsic factors such as sunlight (visible, ultraviolet, and infrared), smoking, and air pollution induce aging due to their direct impact along with ethnic skin characteristics, which are unique to individuals. In addition to these, age-related structural changes in the bones, ligaments, fat pads, muscles, and skin all add to the aged skin look. Neck region is a perfect example of how skin in an exposed area is affected by all the above factors, resulting in textural changes with wrinkled blotchy, loose, inelastic, sagging skin; increase in neck volume with platysmal bands and Venus rings; and/or blunting of the cervicomental angle.
In a recent study, 20 female patients with various signs of neck aging that attended a dermatology center were treated for neck rejuvenation using different types of threads. And here are some interesting findings:
The most common signs of the neck aging treated were wrinkling of the neck skin, textural changes, platysmal bands, and double chin. Five patients with double chin and obliteration of the cervicomental angle were initially treated with two sessions each of injection lipolysis with deoxycholate, followed by threads. Three patients with excessive cord-like platysmal banding were initially treated with botulinum toxin, followed by neck rejuvenation with threads. Choice of thread used was based on the primary indication.
Techniques: Neck Rejuvenation with Absorbable Threads
1) When just rejuvenation of the neck in terms of textural improvement was desired, monofilament or screw PDO threads were used, as these threads improve microcirculation and collagenosis and thus the texture of the skin and mild wrinkling is corrected.
2) When reduction in volume due to a double chin was desired, monofilament PDO threads were used in a crosshatch technique to aid in lipolysis, along with tightening the skin, thus attempting to restore the optimal cervicomental angle. A crosshatch technique was used where more surface area was required to give greater textural improvement and also as optimal vectors for double chin. (fig. A&B)
3) To improve sagging and severe wrinkling, more stretch in the horizontal plane was desired, and hence to redrape the skin. Barbed threads are used in this situation. A hammock technique was used to stretch the skin where laxity was more, and to give a good anchoring at the mastoid fascia. (fig. C)
Results: Neck Rejuvenation with Absorbable Threads
Fifteen cases were satisfied with their procedure, whereas one failed to respond due to severe platysmal laxity. Post-procedure bruising was seen in 11 cases and edema was observed in all as a sequela, which lasted for 48–72h. No other complications were observed.
Absorbable threads stimulate fibroblast, collagenization, and neo-angiogenesis, which improve the skin texture and laxity. Repeat sessions may be needed similar to other aesthetic procedures to achieve and maintain the desired result. They can thus be used for improving skin texture as well as wrinkling and laxity to achieve the ideal aesthetic appeal: skin of the neck and face to be in sync, with minimal discomfort or downtime.
Neck Rejuvenation with Thread Lift (Journal of Cutaneous and Aesthetic Surgery, Gulhima A., Saneep A.)
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