Cosmetic procedures can be minimally invasive, long lasting

A surgeon recommends two methods of upper-face lift and rejuvenation that require the use of only simple tools.

Easy surgical techniques with simple, inexpensive instruments can effectively improve the aesthetics of the forehead and periorbital area by addressing glabellar frown lines, brow ptosis and aging skin around the eyes, according to one surgeon.

“I have developed and experienced these methods for many years. Patients like them because they are minimally invasive, effective, long lasting and have no side effects,” said Des Fernandes, MD, of Cape Town University.

His method of brow lifting requires only a scalpel, a 15/11 blade, a 21-gauge spinal needle and nonabsorbable thread. It leaves a natural appearance to the forehead and no visible scarring. The same method can be used for smoothing glabellar frown lines without Botox (botulinum toxin type A, Allergan), he said.

Twelve to 16 tiny stab incisions are made in the hairline, in between hair strands.

“I use just a simple hair gel of the kind you can buy in any supermarket. This allows me to work in between the hair without having to shave the area,” Dr. Fernandes said.

A series of tunnels are created beneath the forehead skin to break the collagen attachments between the frontalis muscle and the skin. This will encourage shrinkage after the operation and reduce frown lines, he said.

One stage of the operation of brow lifting using 5-0 nylon thread. Images: Fernandes D

“At this point, I insert the spinal needle 0.5 cm below the eyebrow and drive it upwards, towards the forehead incision. I withdraw it down from the forehead to the eyebrow, and once it has caught the brow, then without removing it from the skin I push it up from the eyebrow and I drive it back to the forehead again and bring it out. I use a Mayo needle to pass the thread through the galea to the other incision and tie it tightly. I set the tension of the threads according to the amount of brow lifting I want to obtain, slightly exaggerating,” Dr. Fernandes said.

Lift and shape

With this simple method, the brow can be lifted and shaped according to individual aesthetic requirements. The direction of the sutures can also be changed to be more horizontal to address frown lines.

“The effects are just as good as with Botox, but you keep your natural movements and normal eyebrow elevation. The only movement you can’t do is depress the brow,” Dr. Fernandes said.

Before and after brow lifting with suture suspension.

Dr. Fernandes had his glabellar frown lines reduced using a combination of suture lifting and needling.

The procedure lasts 30 to 40 minutes. After surgery, patients will experience some pain for about 48 hours, which is “the main drawback of the technique,” according to Dr. Fernandes.

He said that the scars are almost invisible and that the knots will not be palpable if 5-0 sutures are used instead of 3-0 or 4-0 sutures.

“You might feel some firmness in the area around the knots but not the presence of a foreign body,” he said.

Results are long lasting. Dr. Fernandes said he has been performing the technique since 1994 and that none of his patients have had a dehiscence of the brow line after this operation. In rare cases, knots might slip, but this can be avoided if at least six threads are put into each knot and pulled tightly, he said.

Needling

A second technique that is simpler, quicker, less expensive and minimally invasive corrects upper-face wrinkles and lines as well as brow elevation laxity by fine, deep, repetitive needling. This needling stimulates the formation of new collagen, Dr. Fernandes said.

This collagen induction therapy (CIT) requires only a simple tool called the Medical Roll-CIT (Environ), a small cylinder covered with fine needles.

The Medical Roll-CIT device is rolled upon the areas that need resurfacing. By pricking the skin, the device activates the natural inflammatory response that will eventually lead to new collagen and elastin formation.

Some areas, such as the lower eyelid area, are treated by hand, using a dental needle or a very fine stainless steel needle. The derma is scratched to create as much mini-trauma as possible.

“The device is rolled upon the areas that need resurfacing. By pricking the skin it activates the natural inflammatory response, which will eventually lead to new collagen and elastin formation,” Dr. Fernandes said.

Before the treatment, the skin is prepared with vitamin A for a minimum of 3 weeks but preferably for about 3 months to maximize DNA activity and ensure accelerated dermal matrix fibroplasias and cellular generation. The treatment is then performed under topical anesthesia. Some areas, such as the lower eyelid area, are treated by hand, using a dental needle or a very fine stainless steel needle. The derma is scratched to create as much mini-trauma as possible, he said.

Clinical results 4 months after needling of the forehead.

After needling, the skin is cleaned with balanced salt solution, and essential oils containing high concentrations of vitamins A, C and E are applied.

“If the skin has been properly anesthetized, it will not be painful because the pain stops about 1 hour after the operation and before effects of the anesthesia wears off. Thereafter, it just feels like a moderate sunburn. Don’t administer any anti-inflammatory drugs because they would minimize the response and lead to less collagen production,” he said.

Because the needles work by breaking blood vessels, there will be some bruising in the treated area, which can keep people out of work for about 1 week. For the area around the eyes, where the skin is thinner and more delicate, a longer recovery time of about 10 days might be necessary.

Noninvasive, long lasting

“This very simple treatment produces quite astonishing results. The skin looks rejuvenated with fewer and shallower wrinkles. The tightening and smoothening of the skin on the forehead produces a natural eyebrow elevation,” he said.

“For my own glabellar frown lines, I had a combination of this therapy and suture lifting, and people no longer tell me that I look worried, crossed or under stress all the time,” he said.

Results of needling treatment on the lower eyelid.

According to Dr. Fernandes, the technique leaves no scars and has no side effects such as inflammation or sun sensitivity and pigmentation problems. The treatment can be repeated two to three times for best results, at about 1-month intervals. Dr. Fernandes said that results are stable in his patients after 7 years.

“It is a very low cost, safe, effective treatment with a very fast recovery. I found that it meets the requirements of many patients who don’t like to have an operation but want long-lasting effects,” Dr. Fernandes said.

For Your Information:

Des Fernandes, MD, can be reached at 12th Floor, 2 Long St., Cape Town, South Africa; 27-21-425-2310; fax: 27-21-418-1113. Dr. Fernandes is the medical adviser for Environ Skin Care Co. Ltd., and he is a shareholder of Vivida C.C., the manufacturer of the Environ Roll-CIT.Environ Skin Care can be reached at P.O.Box 36057, Glosderry, 7702, South Africa; 27-21-671-1467; fax: 27-21-683-1016; e-mail: factory@environ.co.za; Web site: www.environ.co.za.Michela Cimberle is an OSN Correspondent based in Treviso, Italy.