Journal of Aesthetic & Reconstructive Surgery

Elastic Liftings of Marionette Wrinkles

Background: Vertical face-lifts correct gravitational ptosis and act on drooping neck skin. When the skin at the sideburns can be pinched between two fingers, we carry out elastic MACS lifting without dissection of the cheeks. Non-absorbable elastic threads mounted on an atraumatic two-tipped needle are used to create three Isosceles triangles: two to lift the cheek and one to lift the malar region; the threads are anchored to the temporal fascia. All the tissues inside the triangles are lifted. The excess temporal skin is dissected up to the zygomatic arch and removed. If the skin at the sideburns cannot be pinched between two fingers, the elastic thread can be implanted through holes made with a 16 G needle.

Once the vertical drooping has been corrected and the face has been made more triangular, the patient may still require lifting by means of oblique traction, to correct marionette wrinkles and better delineate the jaw. One or two Isosceles triangles with the base fixed to the fascia of Lore are used to perform elastic lifting of marionette wrinkles [1].

Methods: The preoperative design is first drawn out. Through an 8 mm skin incision behind the lobe of each ear, a few cm2 of skin above the fascia of Lore is dissected. The two-tipped Jano needle is used to anchor the elastic thread to the fascia, and a triangle is created, which suspends the subcutaneous tissues. If the skin is very slack, two triangles can be created by implanting threads through the same incision behind the earlobe, and the excess preauricular skin is removed. The Elasticum EP3.5 (Korpo) elastic thread is impalpable, does not cut into the tissues and, when colonized by connective cells, becomes an "integrated ligament".

Results: The result is immediately visible and permanent.

Conclusion: Elastic lifting of marionette wrinkles completes vertical elastic lifting of the face. The procedure is efficacious and simple; no skin dissection is needed, and the results are long-lasting.

Author(s): Sergio Capurro*

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