58. Lifting of marionette’s wrinkles with 4 elastic sutures and removal of the pre-auricular skin

In more ptotic faces, the elastic lifting of the marionette’s wrinkles is done through an 8 mm incision behind both lobes. In this case, two isosceles triangles are implanted. The marionette elastic wrinkle lifting is usually performed after the elastic MACS lift or the elastic cheek lift. The preauricular skin in excess is removed. During the procedure, elastic lifting of the neck with one elastic thread or elastic lifting of the neck with three elastic threads and four safety pins can be carried out through the same incisions behind the earlobes. This last procedure is particularly indicated in patients with very aged neck skin. As is known, the skin of the cheek and neck are not dissected; the tissues are simply repositioned. This new lifting, 3 sutures 4 pins, reduces the vertical wrinkles and the low horizontal wrinkles of the neck without causing unnecessary trophic damage to the tissues.

59. Elastic lifting of the lower lip

This patient asked us to correct the detachment and drooping of her lower lip, the outcome of maxillofacial surgery performed years earlier to reduce the length of her face. During the maxillofacial operation, her chin was reduced and reinforced with a metallic plate, which caused the tissues of the chin to lose their adherence. This loss of adherence caused the lip to sag and droop. This can easily be corrected by implanting an elastic thread (Elasticum EP4), to suspend the lower lip to the two fasciae of Loré. Elastic lifting of the lower lip can also be carried out to reduce the visibility of the lower teeth. As is known, the elastic thread is impalpable and, once colonised by connective cells, is transformed into a natural "ligament".

10. Phlebotherapy of telangiectasias and micro-telangiectasias with the two-syringe technique

TRAP, Three-dimensional Regenerative Ambulatory Phlebotherapy, it is the only rational treatment for varicose disease, the most frequent disease on the planet. The regenerative solution, 3% sodium salicylate is injected into the superficial circulation and reaches the deep veins. This solution strengthens and narrows the most dilated and dilatable veins, restoring their continence. TRAP treats hemodynamic hypertension. As the venous circulation in the lower limbs is three-dimensional, the treatment must be three-dimensional. By contrast, sclerotherapy and phlebectomy are two-dimensional and are therefore not suitable for treating the venous circulation of the lower limbs. It is foolish to close or remove the visible dilated veins – which are the relief valves of hemodynamic hypertension – without being able to restore the continence of the non-visible perforating and communicating veins.
The video describes the technique for safely injecting the microtelangiectasias that cannot be injected with the 20ml syringe and 25G needle.

28. Elimination of lip wrinkles with mixed peeling while maintaining the integrity of a dermal nevus

Mixed timedsurgical peeling is the method of choice for the elimination of deep lip wrinkles. This consists of pulsed timedsurgical de-epithelialisation followed by the application of a saturated solution of resorcin for one to two minutes. The patient wanted to keep the dermal nevus on her lip intact. We satisfied her. A single treatment session is sufficient to obtain a permanent result. Once the Timed apparatus has been set to the pulsed de-epithelialisation function and in the coagulation mode at a power of 2 Watt. The procedure is carried out by lightly touch the skin with the edge of the angle of 0,20 mm diameter EM 10 Yellow Electromaniple. On completion of de-epithelialisation, the saturated solution of resorcin is applied. The result of this standardised procedure is optimal; wrinkles are eliminated, and the skin is rejuvenated.
If the wrinkles on the lips are shallow, we inject intradermal cellular Adipofilling over the entire lip surface.

29. Elimination of the roughness of the lower eyelid with mixed peeling

Mixed peeling with de-epithelialization is the only technique in the world that can achieve the elimination of wrinkles and festoons from the lower eyelids with a standardized and safe treatment.
The areas where the wrinkles are visible are marked out. The preoperative design must include the crows' feet.
Local anesthesia is carried out by means of a 25 G cannula. On completion of local anesthesia, a saturated solution of resorcin diluted to 50% is prepared.
The Timed apparatus is programmed with the specific data for pulsed timedsurgical de-epithelialization: Direct Pulsed 4/9 hundredths of a second, Coag, 2 Watt. An EM10 Yellow electromaniple is used, the electrode of which is bent at an angle. The palpebral surface marked by the drawing has been de-epithelialized. The application time of the resorcin solution in this patient was 40 seconds. The result is the complete permanent disappearance of all roughness and eyelid festoons.

60. Elastic neck lift with three sutures and 4 safety pins

The patient had undergone a traditional face and neck lift elsewhere six months earlier. The face lift had sufficiently corrected the vertical ptosis of the cheeks. The neck still showed a double chin, a remarkable ptosis and vertical wrinkles. The inferior-anterior skin of the neck was visibly wrinkled. Since the vertical ptosis of the cheeks had been corrected, we were able to focus on restoring the aesthetics of the neck, using two surgical techniques: horizontal liposuction and neck lifting with three elastic sutures and four pins. After the liposuction, the first elastic suture is implanted in the center of the neck, through a hole made by a 16G needle. The two-tipped needle makes an elliptical figure with the elastic thread at the ends of which two pins are positioned. An 8 mm skin incision is now made behind both lobes. With a pair of scissors, a few cm² detachment is carried out on the Loré fascia where the Jano needle fixes the elastic thread. The two-tipped needle follows the design, partially exiting the respective hole, where it rotates forming a loop where a second pin is positioned. The two-tipped needle returns to where it entered by exiting the incision behind the lobe. A 3-0 polyester suture joins the three sutures by replacing the pins. The two ends of the elastic thread are pulled and knotted.