Changes in the neck tissue layers during pinch manipulation: Implications for lipolytic deoxycholate injections for double chin.

BACKGROUND: The skin of the neck is often pinched during minimally invasive esthetic procedures for the double chin using a lipolytic agent in order to facilitate injecting into the subcutaneous fat layer rather than under the platysma muscle. However, how the neck tissue layers move during the pinch manipulation is not well understood. AIMS: To determine which layer of the neck is lifted during pinching and to evaluate the usefulness of the pinch manipulation during injection therapy. METHODS: The pinched submentum of a living person was scanned using MRI, and ultrasonography was also performed in the same area in both resting and pressed states. At four sites on a fresh cadaver, the skin of the neck was pinched and the elevated neck skin was excised. The exposed areas were grossly examined. RESULTS: MRI scanning revealed that the pinch manipulation extended the subcutaneous fat layer and moved the platysma muscle to a deeper location. Ultrasonography revealed that the thickness of each layer of the neck was reduced when pressing the neck. In the cadaver examination, pinching resulted in part of the subcutaneous fat lifting, and this was removed when the lifted skin was cut, leaving the platysma muscle intact. CONCLUSIONS: When performing an esthetic procedure that involves injecting a lipolytic agent into the submental area, the pinch manipulation is a very useful technique for ensuring a safe procedure that avoids injecting into the deep layer under the platysma muscle.

Changes in the Layers of the Temple During Pinch Manipulation: Implications for Thread Lifting.

BACKGROUND: During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation. OBJECTIVE: To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching. MATERIALS AND METHODS: At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined. RESULTS: With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin. CONCLUSION: When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.

Tissue changes over time after polydioxanone thread insertion: An animal study with pigs.

BACKGROUND: Polydioxanone (PDO) sutures have been widely used to tighten and lift the face. However, why the complexion brightens and skin elasticity is maintained with a smaller facial outline after a PDO monofilament thread treatment remains unclear. AIMS: We aimed to determine what significant changes occur in the tissue over time when a PDO suture is inserted. METHODS: We selected four White Yucatan variety pygmy pigs with skin that most closely resembles the structure of human skin. 4-0 PDO thread was inserted into the subcutaneous fat. Tissue samples were obtained at 4, 12, 24, and 48 weeks. For the histologic analysis, H&E staining, Masson trichrome staining, and anti-smooth muscle actin immunohistochemical staining techniques were used. RESULTS: Nine histological findings appeared over time, and these findings are summarized as five tissue changes. CONCLUSIONS: PDO sutures cause specific changes to the surrounding tissues that result in neo-collagenesis, a fibrous merging effect, fat reduction, tissue contracture, and an improved vascular environment. The results of this study explain the positive changes described in previous clinical research.