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English to Thai: “G String” new way to lift your face General field: Medical Detailed field: Medical (general)
Source text - English If a person’s neck does not appear youthful, the face – no matter how limited the aging changes are – will often not be perceived as youthful either, unless the aging neck is concealed.
Even in the absence of other signs of facial aging, a poorly-defined or sagging neck can add years to a patients overall facial appearance. When performed expertly and with great attention to detail, a necklift surgery can dramatically restore a natural and youthful neck profile, with no outward evidence that surgery has been performed.
Over the past 17 years many cosmetic neck lift operations have been designed to restore the loss of the youthful neck and jaw line. None have been so successful and long lasting as the Suture Suspension Technique in both men and women.
Recent modifications of this operation have further increased its utility and effectiveness to a wider range of patients. With the availability of the new Contour Thread™ suture, the possibility for a total neck rejuvenation in the office setting, without intravenous or general anesthesia has now become a reality.
Necklift surgery can consist of a variety of surgical techniques that are carefully selected to meet each individual patient’s particular needs. It is therefore important to select a qualified physician with a great deal of experience in numerous necklift procedures.
Who is the candidate?
While it is impossible to tell you definitively whether a neck lift is the right solution for your concerns, here are some general questions that suggest you may be a suitable candidate for a neck lift:
• Is your facial skin and tissue healthy?
• Are you realistic about your expectations for the outcome of the neck lift procedure?
• Are you in reasonably good physical and psychological health?
In younger patients with good skin tone, submandibular liposuction alone may produce a dramatic improvement. For some patients with good skin tone but poor definition at the angle of the neck, I add a suture-suspension necklift to sharpen the angle between the jawline and neck. This procedure is minimally invasive and has a very quick recovery. It will not, however, improve the situation if a true excess of skin is present.
Patients with more advanced aging changes in the neck generally require tightening of their neck skin as well. The neck is the one area in facial rejuvenation where a tighter and more toned surgical result looks natural and aesthetically ideal (as opposed to the face where ‘tight’ and ‘tighter’ just looks like surgery). Neck skin removal is accomplished through incisions around the ears which can be extended a short distance into the scalp if necessary.
If the incisions are created and closed correctly and without undue tension, a very natural looking result can be obtained with no obvious signs that a necklift has been performed. A great deal of experience and expertise is required to avoid distortion of the ear and surrounding skin.
The ideal patient for the "G" String neck lift technique is the Class 1 or 2 neck deformity previously described. In summary, these neck classes include those patients with just loose platysma muscle with small amounts of submental and submandibular fat. Both patient types have naturally deep submental angles and strong mandibular bony outlines.
How is the procedure performed?
Both the original formal Suture Suspension Technique and the Contour Thread "G" String Technique utilize permanent sutures that create a new "supporting ligament", that holds the platysma muscle in an internal and superior "vector" which restores both the cervicomental angle and mandibular borders. This creates a youthful neck and jaw line.
The "G" String neck lift Technique now allows the "appropriate patient" to obtain optimal neck and jaw line improvement in the office setting under local anesthesia, involves the careful evaluation of six key anatomic points:
1. Cervicomental angle depth
2. Mandibular border definition
3. Mandibular angle definition
4. Labiomandibular fold prominence (jowling)
5. Chin Prominence
6. Neck width
By carefully assessing each one of these points during the consultation, the aesthetic surgeon can choose the neck lift procedure that will give the patient the best aesthetic result desired.
If both you and the physician decide a G String Neck Lift is the best choice for you, expect to receive instructions about how to prepare for surgery, as well as information about local anesthesia, sedation, pain control options, and post-surgical care.
Post Operation
The skin is dressed with strips of brown surgical tape or Steri-strips over the cervicomental angle and suction sites at the submandibular borders. A mild compressive rubber dressing or Ace wrap are used for 24 - 48 hours post-operatively along with oral Tylenol or Tylenol with Codeine as needed for pain.
The dressing is removed in the office along with the skin tape by the surgical staff after 24-48 hours. New small pieces of Steri-strips are placed on the submental incision site. The patient is instructed to limit their activity for an additional 48 hours when they can remove the residual Steri-strips described above. Sutures in the submental area are removed in one week and in the postauricular area in two weeks if they have not dissolved at that time. Full activity including heavy exercise is limited to four weeks. Activities of daily living can be resumed as early as when the dressing is removed in 12-24 hours.
Most patients report minor post-surgical swelling and/or mild bruising that lasts about a week. Your stitches are removed 7 to 10 days after surgery.
The long-term at the 12 month post-op period the results have continued to improve with no relapse in neck or jaw line contours present. The incisions are virtually unnoticeable and recovery is limited to 3-5 days on average. It is the author's opinion that the "G" String technique will fill the niche created by the new patient demands for rapid outpatient office based procedures that deliver both immediate short-term and long-term results.
The Result
The "G" String technique for neck rejuvenation using Contour Threads has resulted in excellent youthful contours of the neck and jaw line when used for the correct category of surgical candidates. The patients have been limited to Class 1 and 2 neck categories and have all had their procedures done under local anesthesia with or without oral sedation in the office setting as an outpatient.
The “G” String Neck Lift procedure involves a small incision underneath the chin, through which excess fat in the triangle below the chin and jaw line is suctioned with a very thin cannula. Then, through small incisions inconspicuously placed in the creases behind each ear, a permanent nylon suture is drawn underneath the chin and neck muscle situated on either side of the neck and an artificial ligament is created.
Once the suture is anchored in place, the muscle is tightened and held in a more youthful position. Additionally, because the technique is performed below the jaw line, the chance of damaging facial nerves, which is always a risk with a facelift, is minimal.
This approach for neck rejuvenation should result in an excellent long-term result, since it is based on identical procedural concepts as the original suture suspension technique of the neck, which has stood the test of time over the past 13 years.
English to Thai: What Types of Facial Fillers that Fit You General field: Medical Detailed field: Medical: Health Care
Source text - English Fillers, also known as injectable implants, dermal fillers, or wrinkle fillers are medical device implants approved by the Food and Drug Administration (FDA) for use in helping to create a smoother and/or fuller appearance in the face, including nasolabial folds, cheeks and lips and for increasing the volume of the back of the hand.
Before delving into a discussion about dermal fillers, it is important to make one point. Dermal fillers, such as those listed above, are often confused with wrinkle relaxers, such as Botox and Dysport. While dermal fillers and wrinkle relaxers are both considered “injectables,” they are in two entirely different categories. Botox and Dysport are used to paralyze muscles and stop the motion of muscles that cause wrinkles. They are not used to fill, plump, or enhance an area. They can however be used in conjunction with fillers.
Dermal fillers can be used to plump thinning lips, give the eyebrows a bit of a lift, enhance cheek bones, decrease hollowing under the eye to help reduce dark circles, decrease the appearance of smile lines and overall just give you a well-rested and rejuvenated appearance. They can be done in less than an hour and have little to no downtime.
In some people, dermal fillers may cause some mild bruising, temporary swelling, or temporary redness at the injection site. Rarely, a person might experience an allergic reaction. The major disadvantage of dermal fillers is the effects are indeed temporary. There is one exception to that, though, which will be addressed. For the most part, however, the effects can last from a few months up to a year and a half.
Most dermal fillers have a temporary effect, because they contain materials that are absorbed by the body over time. The FDA has approved only one product made from a material that remains in the body and is not absorbed. Some soft tissue fillers also contain lidocaine, which is intended to decrease pain or discomfort related to the injection.
Below are material and brief directory about name, how it use and how it works.
Absorbable (temporary) materials
1. Collagen: Collagen is a type of protein that is a major part of skin and other tissues in the body. Sources of purified collagen used in soft tissue fillers can be from cow (bovine), pig (porcine) or human cells. The effects of collagen fillers generally last for 3-4 months. They are the shortest lasting of injectable filler materials.
• EVOLENCE
- Uses : Evolence® Collagen Filler is a sterile, injectable, biodegradable, yellowish, opaque gel that is injected into the inner layers of facial skin (mid to deep dermis) in order to correct moderate to deep facial wrinkles and folds such as those around the nose and mouth (nasolabial folds).
- How It Works : Collagen Filler functions as a filler material which is injected into the appropriate area of the face in order to reduce the appearance of the wrinkle or fold.
- Duration : 12 months
- Price : $500 / 1 syringe
2. Hyaluronic acid: Hyaluronic acid is a type of sugar (polysaccharide) that is present in body tissues, such as in skin and cartilage. It is able to combine with water and swell when in gel form, causing a smoothing/filling effect. Sources of hyaluronic acid used in dermal fillers can be from bacteria or rooster combs (avian). In some cases, hyaluronic acid used in dermal fillers is chemically modified (crosslinked) to make it last longer in the body. The effects of this material last approximately 6 – 12 months.
• Juvéderm
- Uses: Good for fine lines medium or deeper lines and wrinkles of the faces, such as the nasolabial folds. It is also useful for plumping up lips, earlobes, and cheekbones, filling acne scars.
- How It Works : It absorbs water and as a result plumps up the area in which it was injected.
- Duration : 6 – 9 months
- Price: $450-$600 / 1 syringe
- Antidote/Reversal Agent : hyaluronidase.
• Restylane / Restylane-L
- Uses: Restylane is used to improve moderate to severe facial folds and wrinkles. It can also be used to enhance the lips.
- How It Works: The area of injection is enhanced due to absorption of water by the hyaluronic acid.
- Duration: Restylane’s manufacturer claims results can last to up to 18 months. That is however, with repeat injections at 4.5 months or 9 months. Without repeat injections, Restylane may last up to 6 months.
- Price: Restylane is priced similarly to the Juvederm products.
- Antidote/Reversal Agent: Hyaluronidase is the antidote to Restylane.
- Special Notes: Restylane and Perlane are made by the same manufacturer. Perlane is the thicker/more viscous of the two products and is used for more heavy duty rejuvenation.
• Perlane
- Uses: Perlane is used to add volume to flattened areas, to plump up lips, and to help reduce the appearance of fine lines and deep folds. It is manufactured by the same company that makes Restylane. Perlane is thicker than Restylane, thus it is better for deeper or more prominent folds.
- How It Works: Water is absorbed by the injected hyaluronic acid. This has the effect of building up the area of injection.
- Duration: Some people find Perlane to be longer lasting than Restylane. However, the FDA commentary is that it lasts up to six months.
- Price: One syringe of Perlane runs about $400-$600.
- Antidote/Reversal Agent: Hyaluronidase is the antidote to Perlane.
3. Calcium hydroxylapatite: Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones. For wrinkle filling in the face or for the hand, calcium hydroxylapatite particles are suspended in a gel-like solution and then injected into the wrinkle in the face or under the skin in the back of the hand. The effects of this material last approximately 18 months. While in the body, calcium hydroxylapatite will be visible in x-rays and may obscure underlying features.
• Radiesse
- Main Ingredient: Radiesse is made up of calcium hydroxylapatite in the form of microspheres.
- Uses: Radiesse is used for the treatment of maoderate to severe facial wrinkles and folds, such as the nasolabial folds. It can also be used to plump up cheek bones. It is not used in the lips.
- How It Works: Radiesse stimulates the body to form new collagen. This is supposed to make the produce last longer, thus reducing the need for a touch up. Additionally the gel and calcium-based microspheres add volume to the injected area.
- Duration: Results are clinically proven to last a year or more.
- Price: Radiesse normally costs approximately $1,000 per syringe.
- Antidote/Reversal Agent: There is no antidote for Radiesse.
4. Poly-L-lactic acid (PLLA) : PLLA is a biodegradable, biocompatible man-made polymer. This material has wide uses in absorbable stitches and bone screws. PLLA is a long lasting filler material that is given in a series of injections over a period of several months. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years.
• Sculptra
- Uses: Sculptra was initially limited to use in patients with HIV who had loss of facial fat caused by antiviral medications. Now it is approved for cosmetic use in non-HIV infected individuals for building up the cheeks, filling in hollows or sunken areas of the face, and increasing skin thickness which decreases the appearance of folds and lines. It is not used to enhance the lips.
- How It Works: Unlike the hyaluronic acid based fillers, Sculptra’s mechanism of action encourages the formation of new collagen in the injected area and the effects are not immediate. Multiple treatments are required, approximately 4 weeks apart. The number of treatments needed depends on the severity of the facial aging. The skin thickness increases gradually.
- Duration: In a clinical study, the effects of Sculptra lasted up to 2 years after the first treatment session. A full treatment consists of an average of three injections approximately 4-6 weeks aparts.
- Price: Sculptra comes in a vial as opposed to a syringe. One vial will cost anywhere from $750-$1000.
- Antidote/Reversal Agent: There is no reversal agent for Sculptra.
- Special Notes: The results from Sculptra are not immediate and are more subtle. It can take months to notice improvement, but it is long lasting.
5. Fat Fillers (Fat grafting) : There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing, when performed by a plastic surgeon with expertise using the ideal instrumentation. See link below to my gallery of before and after fat grafting patients.
However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed. A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure.
As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration. This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.
If enough fat resorption occurs following a fat grafting procedure such that the desired result is not achieved, a second 'touch-up' procedure can easily be performed to augment the result obtained from the first injection.
Non-absorbable (permanent) materials
6. Polymethylmethacrylate beads (PMMA microspheres): PMMA is a non-biodegradable, biocompatible, man-made polymer. This material is used in other medical devices, such as bone cement and intraocular lenses. PMMA beads are tiny, round, smooth particles that are not absorbed by the body. When used as a soft tissue filler, PMMA beads are suspended in a gel-like solution that contains cow (bovine) collagen and injected into the face.
• Bellafill (ArteFill)
- Uses: Bellafill is used to smooth moderate to severe facial folds and wrinkles from the nose to the corners of the mouth (nasolabial folds). Bellafill is meant to be a permanent wrinkle solution. It has been found to be a safe dermal filler that restores volume and fullness to the skin. It is also used to correct acne scars on the cheeks in those over 21 years of age.
- How It Works: The collagen in Bellafill® provides immediate volume and lift. Over time, the collagen is reabsorbed while the PMMA microspheres remain in place and create a base that provides structural support for smoother-looking skin.
- Duration: Satisfaction and effectiveness for the correction of nasolabial folds have been established through 5 years. Effectiveness for the correction of acne scars has been proven through 12 months.
- Price:
- Antidote/Reversal Agent: Bellafill is a non-resorbable dermal filler, unlike many other dermal fillers that are absorbed and require reinjection. Results are permanent and surgical removal of the collagen is required for reversal of effects.
Finding the right dermal filler for you will depend on your budget, your doctor’s experience and preference, and your individual skin nuances (e.g. amount of sun damage, skin elasticity) and facial features. What works for your friend may not be the best option for you. It is best to select dermal filler type on a case-by-case basis.
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