شيخوخة الجلد وطرق تدبيرها

الدكتور نبيل نذير الوتار
أخصائي بالأمراض الجلدية والتناسلية والتجميل من فرنسا

في عام 1999 حصل العالم الروسي جراح التجميل الدكتور مارلين سولامانيدز على براءة اختراع عالمية لخيوط الابتوس وقد عمل سويا مع ابنه جورج لتحقيق تجديد شباب الوجه بطريقة غير جراحية .

وقد تمت ممارسة هذه الخيوط على العديد من المرضى وتبين إمكانية تحسين مظهر الوجه واعطاء عمر أصغر ب( 5-15 سنة ) وذلك حسب طبيعة الوجه ومهارة الجراح , وتعتمد الدراسة على خيوط الابتوس الروسية حيث توجد في الأسواق العديد من خيوط الابتوس التقليدية

خيوط الابتوس

كيفية عمل خيوط الابتوس :

الفكرة الأساسية بسيطة وتعتمد على الوزن الخفيف والمقاومة العالية لخيوط البولي برولين التي لها تصميم أسلاك شائكة ذكية قادرة على تثبيت نفسها بأنسجة الوجه التي يرغب بشدها وهي تعتمد على معرفة البنية التشريحية التي تتلو الاتجاه المناسب للحصول على المظهر الجديد المطلوب, وعندما يتحقق ذلك فستبقى صورة الوجه مثبتة على هذا الوضع لعدة سنوات , والعمل المدهش أن هذه الخيوط يمكنها أن تشد مع مرور الوقت للحصول على الشد المطلوب , ويمكن أن تحل هذه الطريقة محل عملية شد الوجه الجراحي متجنبين مخاطر الرض الجراحي والألم المديد والكلفه العالية

التقنية الجراحية :

بعد التعقيم الجيد نجري التخدير الموضعي بإبرة رفيعة بحقن الليدوكائين 1% مع الأدرينالين ويتم الحقن في مدخل ومخرج وضمن مسار الابرة الموجهة
توضع الابرة الموجهة تحت الجلد تحت الخط المعلم وبالعمق المناسب وتسحب للخارج في نقطة الخروج وندخل فيها خيوط الابتوس ضمن الابرة وعند سحب الابرة تتثبت أشواك الخيوط في الأنسجة المرنة المجاورة ويتثبت الخيط بحسب الشكل المرغوب
يمكن أن تشد نهايات الخيوط بحسب الرغبة مما يسمح بشد وتجميع الأنسجة المرنة ضمن منطقة عمل خيوط الابتوس و تقص نهايات الخيوط تحت سطح الجلد
وتحتاج الأنسجة المتهدلة إلى تعليم خاص للشد بحسب (الشكل -2)
فالشد الوجني الفموي يحتاج لثلاثة خيوط ابتوس تمر تحت الجلد في كل جانب خيط بطول 8.5سم وخيطين بطول 5 سم , الخيط الطويل يجب أن يمر بما فيه الكفاية ضمن النسيج الشحمي مثل وتر القوس حيث تحسن مظهر الانسجة المترهلة حول الفم وتعطي محيط مستدير للجلد
الخيط القصير يمش بشكل مواز مع الخيط الطويل حيث يقوم بدور الداعم له ليعطيه مظهرا أكثر تحدبا
الخيط العلوي يمر تحت الجلد على القوس المنحدر من منطقة الوجنة نحو الخد مؤدية لشد الجزء المتدلي من الجلد فوق الثلم الانفي الشفوي

تدلي الذقن : يعالج بخيطين من خيوط الابتوس بطول 8.5سم بعمق 1-2 ملم في كل جانب حيث يزرعوا في المنطقة بجانب الذقن حسب الشكل السابق وهذا ما يؤدي لتحسن محيط المنطقة تحت الذقن ولتحسن محيط الانسجة الرخوة من المنطقة تحت الوجنية .

طريقة زرع خيوط الابتوس

مخاطر العمل الجراحي :

مثل أي عمل جراحي أخر يشمل الجلد هنالك خطر كامن للإنتان والاحمرار والتكدم والتورم وتأخر الشفاء وكلها نادرة ولكن محتملة, مع إمكانية خروج الخيط من أحد رؤوسه وهي تترافق في حالة الجلد الرقيق جدا مع نقص في الخبرة الجراحية وكل الخيوط يمكن أن تستأصل خلال دقائق دون أية عواقب , ويمكن إضافة خيوط جديدة لإصلاح الشد بعد عدة سنين إن لزم الأمر , ويجب إعطاء مضادات الوذمة لتجنب التورم 3 أيام قبل بدء العمل الجراحي وثلاث حبات قبل بدء العمل الجراحي بساعتين
كما ويجب إعطاء الصادات الحيوية بعد العمل الجراحي

النتائج

تكون الفترة بعد العملية مباشرة هادئة ومن دون مشاكل
في 2.5% من الحالات تتمزق الخيوط نتيجة لضعف وحيد الجانب من الحواف وتظهر الخيوط على سطح الجلد وهذا ما يستدعي استئصالها وإعادة زرع خيوط ابتوس جديدة
زيادة الشد تحدث في 9.5% من المرضى ويمكن إصلاحها بالتدليك
و9.5% من المرضى يحدث لديهم كدمات على طول امتداد الخيط
ويحدث انخماص الجلد مكان دخول وخروج الخيط حدث في 14.6% من المرضى وهذه تصح تلقائيا او بواسطة تدخل جراحي بسيط
8.9% يحتاجون إلى إضافة خيوط جديدة في جانب واحد أو جانبين ومعظم الحالات أظهرت تحسنا ممتازا للأنسجة المتهدلة

مزيد من المعلومات

What Is Feather Lift (APTOS Thread Lift)?As we begin to age the tissue becomes weakened, we lose facial fat and the underlying support structure becomes lax and ptotic (sagging).  The areas to suffer this sagging is the cheeks, around the eyes, the brows, the jowls, and neck creating a longer, older looking face.  Younger patients suffer from cheek and brow ptosis, as well, often prompting them to seek procedure which may be designed for individuals in need of more invasive means.

There is now a less invasive procedure available which can lift, contour and suspend the sagging tissues of the face and neck.  The Feather Lift Procedure can provide quick and relatively bloodless lifting for patients who may need only little to moderate rejuvenation.  The Feather Lift is also been called the APTOS Lift, the APTOS Thread Lift and Suture Suspension Face Lift.  Feather Lift is Kolster Methods, Inc.'s (K.M.I.) name for using monofilament, polypropylene threads with cogs or barbs, called also APTOS® threads to lift the underlying tissue and contour the face.   Other thread manufacturers have coined the technique as the Silk Lift™, BPS® (Barbed Polypropylene Sutures) threads, and even the Russian Lift or Russian Threads.

Incidentally this procedure and the use of these monofilament threads was originally pioneered by Marlen A. Salamanidze, M.D. of the
Clinic of Plastic and Aesthetic Surgery in Moscow, Russia in 1999.   It also worthy of notation that the original, Russian-made threads are different than the K.M.I. threads, as is another company's threads in Brazil.

The APTOS threads have cogs or barbs which lie in one direction and open up, so to speak, when implanted into the subcutaneous fat and tugged into place.  The tissue is caught slightly in these cogs and the tissue is then suspended and lifted.  The threads are placed in carefully predetermined areas if the face to support the tissue and lift it.  Even better, the results are improved over time as your collagen encapsulates and "bunches" around the threads causing an even further lifting effect.  

This procedure is considered much less invasive than traditional mid-face, face and brow lifts, requiring less operating room time and less downtime.  The Feather Lift is also becoming popular with younger persons wishing for subtle changes or to possibly delay the signs of aging such as facial drooping.

There are only 12 clinical sites for the FDA investigation on the efficacy and safety of the Feather Lift.  The Feather Lift name is trademarked and no one is allowed to use it unless they are trained by KMI.  They must also buy the treads from KMI.  Anyone not participating in the FDA studies are probably not using KMI threads and must therefore call it APTOS lift and not the Feather Lift.  The Feather Lift threads are expected to be approved by the FDA possibly this year.

What Areas Can Be Treated?The areas which may be treated thus far with APTOS threads is the outer brow for zygomatic arch ptosis (1), the cheeks for buccal and infraorbital ptosis (2); the jaw line for mental ptosis such as jowls (3) and the neck for submental ptosis (4).  Diagram five (5) is an alternate suture suspension technique for the cheeks.

Most younger patients will not need all these areas corrected.  Common areas for younger patients are the cheeks and brows since they are the first in line to begin their descent.  As you age the lower half of the face begins to sag as well.

Are You A Candidate For Feather Lift (APTOS Thread Lift)? If you are in good physical and emotional/mental health, have realistic expectations, no serious health defects, have reasonably normal skin thickness and have the desire to rid yourself of loose sagging tissue of the face and neck, you may be a good candidate for a Feather Lift.  

Those with considerable laxity may opt for a face, brow and neck lift instead.  Please discuss this with your surgeon at your consultation.  Only a qualified medical professional will be able to determine your needs as an individual.  It is also smart to have several opinions to help you decide which options may be best for you.  However, please know that the Feather Lift is a newer procedure and many doctors will not agree with or be familiar with this procedure.

Also, if you are considering losing weight you may want to wait until after your desired weight is met.  You may need additional lifting or skin removal surgery to alleviate excess skin after you have lost the desired weight which would mean that the money spent on the procedure may be wasted.

What To Expect At Your ConsultationAfter deciding on a few doctors, you will make appointments for pre-operative consultations.  These appointments are basically interviews to help you decide which doctor you wish to have your procedure with.  At your consultations you should discuss your expectations, desires and complaints that you may have.  Make sure you give your doctor full medical disclosure.  This is very important, if you do not alert your doctor to your specific medical history you may have problems which arise at very critical times.  Or may experience complications due to decisions made on the information (or lack thereof) your doctor was given.

*Please disclose all medications you are presently taking and have taken within the last 6 to 9 months,  This can be very important.  Do not be embarrassed as your health can depend upon these factors.  This includes vitamins, supplements and over the counter medications.

The doctor should discuss in detail the procedure and its risks and complications and what to expect during the procedure. You will also discuss the available anesthesia that will be used for your procedure.  Most feather Lift procedures are performed under regional or local anesthesia with the addition of an oral sedative.  However, increasingly, doctors are using twilight sedation with local anesthesia.  

You will discuss what areas will be treated such as the brow lift, the cheek or jowl lift or even the neck lift.  Not everyone will need all of these.  A full set consists of 18 APTOS threads.  A full face lift requires all 18 although not everyone may need a full lifting procedure.  The threads required per area would be 2 for each brow, 3 for each cheek, 2 for each jaw line and 2 for each side of the neck -- equaling 18 threads.

You will discuss treatment protocol and discuss what to expect immediately post-op and over the following few days after treatment.  You should also discuss the procedure fees and pre-op/post-op medications, and topical creams, if necessary.  Your doctor may take before photos of the area to be treated, but usually this is reserved for the day of the procedure. 

Your Pre-operative Appointment You may or may not have a pre-operative appointment for the Feather Lift.  Often you will book the same day as your consultation, should you decide on that particular doctor and then be given a date after partial or full payment.  You may either receive your info packet, medications and/or instructions at your pr-operative appointment or at your consultation once you pay.  All offices are different so please discuss this at your consultation should you decide to book.

You will be told how to care for yourself and what to expect after your procedure.  Your doctor should tell you to avoid certain medications which may increase your chances of bleeding, bruising, or even a negative reaction with certain anesthetics and medications.  If you are not told well in advance of any of the above before your procedure, please ask your doctor for specifics. 

Preparing For Your ProcedureBe sure to follow your doctor's guidelines regarding medication alerts and avoidances.  Caffeine and Nicotine may be on this no-no list as they are vasoconstrictors.  Vasoconstriction is when the bore of your blood vessels are narrowed, decreasing the amount of blood to the treatment area.  Obviously hemoglobin and oxygen are vital for proper healing -- so not smoking is especially helpful.  Vitamin E, alcohol, and aspirin increases the chances of bleeding and bruising.  Inquire about the cessation of these two as well.

Vitamin C is considered helpful in collagen synthesis and health by some doctors so please ask your doctor if you may take this vitamin and what dosage.  Some doctors suggest that their patients take Arnica Montana or Bromelain to help with bruising and swelling.  However, it is very important to ask of your own doctor's approval before consuming any of the above.

Make arrangements for someone to drive you to and from your procedure.  The medications and experience will make you drowsy and dizzy, thereby being very dangerous for you to drive.  You more than likely may not be able to drive yourself home after your procedure.  

As far as directly before your treatment, you may be given an oral sedative an hour in advance or be asked to take it before you arrive.  

How Feather Lift (APTOS Thread Lift) Is Performed  The face is swabbed and scrubbed usually a Betadine solution to decrease the amount of surface bacteria to help avoid infection.   After you are dried your face is carefully felt and measured and will be marked for the placement of the threads.  If the marker used is single use there is usually no need for a re-washing of your face.  If not or just to be doubly careful, the face may be wiped again, leaving a faint but definitive lines are on your face as a guide for your doctor.

Your doctor then begins to infiltrate the area using a hypodermic needle with a local anesthetic mixture comprised usually of Lidocaine, epinephrine, normal saline and a sodium carbonate buffer.  This ensures that you will not feel any pain and also the epinephrine decreases the amount of blood loss and anesthetic absorbed during the procedure.  The epinephrine does this by temporarily narrowing the bore (vasoconstriction) of the blood vessel.

After you are adequately anesthetized, your surgeon inserts a hollow trocar (a stainless tube with a needle-sharp end) at the specified entry points and through the subcutaneous fat along a specified plane.  The tissue is dissected along this plane as needed based upon the individual patient.  The exit point is then made and the APTOS thread is then inserted into the trocar.  The thread is pulled through the other side of the trocar and the trocar removed, with the thread staying in place.  The thread is positioned, tugging and testing its placement and finally anchored when the needed placement is achieved, the threads are cut just at the skin and inserted under the surface of the skin.

Each area is treated and the treatment areas normally taped to prevent movement in the first few days.  Excessive movement can dislodge the intended placement of the threads, altering the desired result.

Remember that all doctors have different surgical protocols so please discuss with your surgeon his or her surgical technique as but may very well be different than the above.

The Road To Recovery Although not as invasive as other lifting procedures, this procedure will cause swelling and possibly bruising. The area will be sore, and puffy and possibly discolored from the minor intraoperative bleeding (aka a bruise).  You are told not to make exaggerated facial expressions, massage the face, rub the face in anyway, not the sleep on the face or disturb the face if at all possible.  Any of the above can, again, disrupt the placement of the threads.

You can resume normal activities (light walking, sitting up, watching television, computer, etc.) within the hour and are told to take it easy during the first few days.  This means no exercise, no sexual activities, no excessive talking or exaggerated facial movements, again no facial massage, no shaving of your face, scrubbing, rubbing, chemical peels, harsh cleansers, or facial sleeping for 5 days.

In The Months Ahead There is often immediate results however, the results continue to improve over a 3 to 6 months period.  This improvement is due to the collagen synthesis and lifting/bunching effect.  

There are individuals where the lift may not have taken effect at all.  Please discuss your options beforehand with your doctor in the event this may occur (or not occur for that matter).

Risks & Complications Of Feather Lift (APTOS Thread Lift) Risks include an allergic reaction to the anesthetic, hematoma, seroma, infection, palpability pf the APTOS threads resulting in a telltale line.  Sometimes a thread end my poke through the skin, if this should happen contact your doctor immediately for an in-office visit.  Do not attempt to re-insert the thread yourself, at any time.  This may possibly result in an infection.

Dislodging of the thread may occur resulting in a lopsided or crooked result (asymmetry). Please contact your surgeon as soon as possible for an in office visit. Please discuss your options beforehand with your doctor in the event this may occur (or not occur for that matter).

The Average Prices Of Feather Lift (APTOS Thread Lift) 

The average prices in the United states for this procedure is about $300 to $350 per thread, although I have heard others charging as much as $600. per thread.  Some surgeons may also charge a separate fee for O.R. time and anesthesia.