Thread lifting: a minimally invasive surgical technique for long-standing facial paralysis

Eyebrow lifting using multidirectional absorbable thread

BACKGROUND

Thread lifting is a common procedure in minimally invasive esthetic techniques and can also be used to raise the drooping soft tissue of the forehead by vertically inserting threads into the forehead.

AIMS

This study aimed to examine the effect of forehead thread lifting on enhancing upper eyelid opening.

METHODS

Fifteen patients were included in this study, all of whom underwent eyebrow thread lifting with MINT LIFT® UP. Photographs of the patients were taken before, immediately after, and 1 and 12 weeks after surgery. Changes in the position of the eyebrows and eyelids were measured. The paired t-test was used to determine the statistical significance of differences.

RESULTS

At 1 week after surgery, the eyebrows were at a lower level compared with before surgery, and no significant changes in eye-opening were observed. However, at 12 weeks after surgery, the eyebrows and upper eyelids were both significantly elevated when compared to the preoperative state.

CONCLUSIONS

Eyebrow lifting can be performed using multidirectional thread lifting.

Finite element analysis of biomechanical interactions of a subcutaneous suspension suture and human face soft-tissue: a cadaver study

In order to study the local interactions between facial soft-tissues and a Silhouette Soft® suspension suture, a CE marked medical device designed for the repositioning of soft tissues in the face and the neck, Finite element simulations were run, in which a model of the suture was embedded in a three-layer Finite Element structure that accounts for the local mechanical organization of human facial soft tissues. A 2D axisymmetric model of the local interactions was designed in ANSYS, in which the geometry of the tissue, the boundary conditions and the applied loadings were considered to locally mimic those of human face soft tissue constrained by the suture in facial tissue repositioning. The Silhouette Soft suture is composed of a knotted thread and sliding cones that are anchored in the tissue. Hence, simulating these interactions requires special attention for an accurate modelling of contact mechanics. As tissue is modelled as a hyper-elastic material, the displacement of the facial soft tissue changes in a nonlinear way with the intensity of stress induced by the suture and the number of the cones. Our simulations show that for a 4-cone suture a displacement of 4.35 mm for a 2.0 N external loading and of 7.6 mm for 4.0 N. Increasing the number of cones led to the decrease in the equivalent local strain (around 20%) and stress (around 60%) applied to the tissue. The simulated displacements are in general agreement with experimental observations.

Medical Aesthetics - Current Trends and a Review of Its Applications

Medical aesthetics is the use of a procedure or product for a therapeutic indication which is conventionally used for aesthetics. Several medical conditions are now being treated with products, procedures or equipment that are conventionally used for aesthetic indications. This has widened the scope of treatment modalities available for dermatologists to treat various indications that fall outside the purview of aesthetic dermatology. The authors present aesthetic treatment modalities and procedures which can be used for medical aesthetics, their present-day status and usefulness in field of therapeutics with a review of published literature from "Medline" (via "PubMed"), "Cochrane," the Virtual Health Library, and Google Scholar.

The evolution of facial reanimation techniques

This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.

Efficacy and safety of thread embedding acupuncture for facial expression muscles atrophy after peripheral facial paralysis: study protocol for a randomized controlled trial

BACKGROUND

Facial expression muscles atrophy is one kind of sequelae after peripheral facial paralysis. It causes critical problems in facial appearance of patient as well as social and psychological problems. This study aims to evaluate the efficacy and safety of Thread-embedding acupuncture (TEA) for the management of facial expression muscles atrophy after peripheral facial paralysis.

METHODS

This is a patient-assessor blinded, randomized, sham-controlled trial. A total of fifty-six eligible patients will be randomly divided into TEA (n=28) and sham TEA (STEA) (n=28) groups. Both groups will receive TEA or STEA treatment at the frontal muscle and the depressor anguli oris muscle, at one predefined points once a week for eight weeks. Additionally, both groups will receive traditional acupuncture treatment at ten acupoints (GB20, LI4, LR3, GB12, ST7, SI18, LI20, BL2, SJ23, ST4) twice a week for eight weeks as a concurrent treatment. B-mode ultrasonography will be used to assess the changes in facial expression muscle thickness ratio of the affected/healthy side at baseline and at 10 weeks after screening, as the primary outcome. House-Brackmann Grade and lip mobility score will be measured and analyzed at baseline and 4, 8, 10, and 12 weeks after screening, as secondary outcomes.

DISCUSSION

The study will compare TEA with sham TEA to explore the feasibility for TEA in improving facial expression muscles atrophy after peripheral facial paralysis.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900027170. Registered on 3 November 2019, http://www.chictr.org.cn/edit.aspx?pid=45173&htm=4.

Use of Botulinum Toxin in Orofacial Clinical Practice

Introduction: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine’s release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT’s efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. Aim: This study’s aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT’s efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. Materials and methods: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. Results: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). Discussion: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

Suture Lifting: A Review of the Literature and Our Experiences

BACKGROUND

In the past 5 years, several absorbable sutures for use in minimally invasive suture lifts have appeared on the market. These newer sutures were preceded by several iterations of nonabsorbable counterparts, all of which were eventually removed from the market because of complications.

OBJECTIVE

This review will provide a history of suture lift experience, review the published evidence on the safety and efficacy of currently available absorbable suture lift materials, and detail the clinical experience of the authors using these products.

MATERIALS AND METHODS

A review of relevant clinical terms was performed on PUBMED and MEDLINE databases. All articles were reviewed, and further studies examined from citations of selected articles. Articles that focused on suture lifting using extensive dissection were excluded.

RESULTS

Twelve studies detailed the results of absorbable suture lifting largely through patient satisfaction surveys or retrospective chart review of cases. No randomized controlled studies were available.

CONCLUSION

Data on suture lifting are limited, with largely descriptive and retrospective case reports available in the literature entailed Oxford Centre evidence-based medicine Levels 2a to 5. Based on the available data, suture lifting appears to be safe and well tolerated, with patient satisfaction similar to or above that reported for other noninvasive lifting and tightening procedures. However, due to the lack of randomized controlled trials, the authors give the suture lifting Strength of Recommendation Level C. Further controlled studies are necessary to determine efficacy, longevity, and safety of this technology.