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Kim et al. Elasticum suspension

INTRODUCTION Table 1: Age distribution of patients
Age (years) Number
Most patients who desire to undergo facial rejuvenation 30-39 4
want their skin in the mandible and zygomatic regions 40-49 12
to be pulled cranially without a visible scar from the 50-59 15
[1]
facelift. In order to fulfil these goals, the S-lift followed 60-69 11
by minimal access cranial suspension (MACS) lift has 70-79 4
been developed and put into practice. [1-3] The MACS Total (53.9 ± 10.9) 46
lift requires a smaller incision, less dissection, and
less operating time than classical facelift operations. needle along the cervicomandibular angle, and the
Although it has the advantage of a shorter recovery elastic threads were looped around the contralateral
time, it nonetheless requires at least 2 or 3 weeks Lore’s fascia, but were not tied. The same needle
before patients can return to social activities. Recently, was passed along a 1.0 cm parallel line below the
the elastic facelift technique has been introduced. cervicomandibular angle. Returning to the initial Lore
Using a straight needle and elastic thread fixed at the fascia, the elastic thread was tied under maximum
midpoint of the needle, lower face lifts and neck lifts tension. During passage of the Jano needle, slight up-
have been performed. [4,5] The aim of this study is to and-down movements of the needle tip allowed the
characterize the effects of the elastic facelift procedure operator to ensure that the pathway of the needle was
using elasticum suspension on the cervical angle and not too superficial.
anthropometric distances.
In both elastic facelifts and elastic neck lifts, the excess
METHODS skin could be excised in order to prevent tissue from
getting jammed. Just after anchoring, patients were
Patients checked for skin dimples, and when present, filler or
A total of 46 patients (4 males, 42 females) were fat injections were performed [Figure 2].
operated on between July 2013 and May 2015. Their
mean age was 53.9 ± 10.9 years (range 33-79 years). Lateral photographs
Most of the patients were in their 40s (12), 50s (15), Lateral photographs were taken in the standard manner
and 60s (11) [Table 1]. preoperatively, 2 weeks and 6 months postoperatively.

Operative technique The patients sat 90 cm from the lens (EFS18-55 mm,
Preoperatively, a marking pen was used to indicate Canon EOS600D, Canon, Tokyo, Japan). Flashes
the points where the elastic thread was to be passed (FOMEX D400, Fomex, Seoul, Korea) on both sides
and turned toward the entry site of the thread; these were synchronized (Shutter speed: 1/100 s, ISO: 200).
points were located about 3.0 cm and 1.5 cm from
the preauricular fold, on and superior to a line running Anthropometric measurements
from below the earlobe to the lower part of the alar The preoperative and postoperative profile views were
nasi. For the neck lift, 2 lines were marked from the
earlobe junction. The 1st line was to a point near the
angle of the mandible, and the 2nd line inferior to the
1st for making a loop [Figure 1].

In order to perform an elastic facelift without skin
excision, two 4-5 mm incisions a few centimetres
apart were made in the sideburn area. Through blunt
dissection, the deep temporal fascia was approached.
®
An elastic thread (Elasticum EP3,5 USP 0 Jano
®
needle 115 mm, Korpo SRL, Genova, Italy) was
anchored to this fascia. In order to perform an elastic
neck lift without skin excision, a 1.0 cm incision was
made just in front of the earlobe. The elastic thread was Figure 1: Preoperative design. Red solid lines: skin incision; red
[6]
anchored to the tympanoparotid fascia (Lore’s fascia). dotted lines: extent of skin excision; blue area: extent of dissection;
white lines: passages and knots of Elasticum . Note the lowermost
®
The Jano needle was passed 5 mm under the skin point of elasticum suspension should be superior to the line from
below the earlobe to the lower part of the alar nasi to avoid the
surface, as determined by the depth mark of the parotid duct injury
Plastic and Aesthetic Research ¦ Volume 3 ¦ December 23, 2016 385