Jowl lift with MINT threads - Weinstein Plastic Surgery Center

Jowl lift with MINT threads

Diagram MINT LIFT® is a facial lifting, designed with a cogged 360 degree PDO (polydioxanone) dissolvable suture thread. Best application is to rejuvenate the jawline of the face, by pulling up the sagging skin tissues. Normal activities are possible on the day of the non-surgical, at times painless procedure. The procedure only requires a local anesthesia. Virtually a scarless procedure. In the right hands of a competent plastic surgeon, it is a safe, straight forward, versatile and reproducible procedure. The indications for MINT lifts are for the sagging tissue of the face. I have used it to lift Jowls and restore a youthful jawline. It can be used to improve nasolabial folds, necks and/ or brows. I think the single best use of these sutures is to restore the heart shaped appearance of the jaw line. The masculinized bulldog like jawline cannot be fixed with fillers and/or Botox.

In my hands as a board certified plastic surgeon, a face lift, rhytidectomy with SMAS remains my best method for immediate or longtime enhancement of the jawline , to eliminate jowls. However these MINT threads provide a quick fix nonsurgical alternative to the more extensive procedure of a facelift. My indications to use the Mint threads has tipped in the favor of a patient on anticoagulation medication. A patient with asymmetry in her jowls after a facelift by someone else had her jowls improved with MINT threads with local Xylocaine anesthesia.

Contraindications

Active infections of the face, such as acne or herpes are best not treated until completely resolved. Patients with allergies to PDO or PDS suture materials should not use MINT PDO threads. Fatty faces or necks are not going to be helped by a little MINT PDO thread. Fatty necks are better served by liposuction or surgical removal of fat with a face lift. Skinny patient with thin skin is not a good candidate for MINT lift, as the threads must be placed in the fatty layer and/or SMAS layer. Very old thin skin is best not treated, the threads may tear the skin. Of course a patient with body dysmorphic syndrome will never be happy and is best avoided.

Methodology

A full set of facial photos are taken with and without animation. I have my patients wash with Hibiclens or Phisohex soap the night before and/or the morning of the procedure. The patient has Doxycycline 100mg PO and Tylenol 650mg PO before and PRN after. I check the vectors that would be best treated with the patient seated and the neck at a 90 degree angle. I discuss the angles of lift with the patient, the entry and exit points of the threads. I have the patient hold two icepacks on the face for ten minutes. I use alcohol swabs on the skin before I inject 6 to 10 cc of local lidocaine with epinephrine with a 25 gauge long needle. I reapply the ice packs for several minutes. I paint the face with Betadine, including the ears , temples, cheeks and hair bearing areas where needles will penetrate. I use Bacitracin liberally applied to the hair, to keep it away from my entry tunnels. I use sterile towels and sterile gloves. I apply a moist saline sterile 4 X 4 sponge over the eyes to protect them from instrumentation and suture material. I use a sterile field and was most shocked when watching physicians perform this procedure with clean contaminated techniques at a recent MINT symposium. This should be a sterile procedure as we are placing sterile threads that can be seeded with bacteria and become sources of infection.

I prefer the MINT 1043 threads that are self anchored. I place the tunneling device through a 16 gauge needle puncture hole in the hair bearing temple. The blunt tipped trochar is passed to the jawline below the jowl , nasolabial fold or posterior border of jowl. The trochar blunt core can be removed, leaving a sharp end that can be passed through the distal skin. The thread is then passed through the core outside the distal end, the trochar is then slipped out distally. The trochar is then passed through the previous 16 gauge puncture site again in a different direction to form a inverted V through the fatty tissue or SMAS. After removing the trochar the distal threads are pulled out the distal hole as the opposite hand pushes the skin over the threads in an upward direction to engage the cogs. If the suture is placed to shallow , it is best to remove it and place a deeper suture, pinching the tissue while passing the thread may allow deeper placement Any visible puckering is massaged out as the distal thread outside the skin is cut off. I use saline gauze to clean the face of any visible Betadine. I apply Bacitracin to the puncture sites. I reapply new ice packs.

Post Procedure

Advise patients not to plan lunch with the girls the day of the procedure. Tell patients to use ice to tolerance to the face for the day of the procedure and that evening. All my patients have done well with Tylenol PRN for discomfort after the procedure. I instruct patients to avoid exercise, exertion, laughing, yelling, drinking or sun for the first 48 hours after the procedure. Some dimpling or contour irregularities are to be expected. The patient return to check for dimpling or contour irregularities that are massaged PRN by myself and the patient. A gloved hand of the physician can insert an index finger in the mouth to massage out a dimple with bidigital massage PRN. Patients may shower the evening after surgery and / or wash face with Dove soap and water. They are instructed to wash with soap twice a day and apply Bacitracin or Neosporin to all puncture wounds. Elevation of head while sleeping is preferred in the 3 days after surgery. I tell patients to put a wedge or sofa pillow under their mattress to elevate the head area. They are told to expect swelling, especially at 48 hours after the procedure. Tenderness may or may not be appreciated, it resolves and can present many months after the procedure when the threads are dissolving.

Complications

Bruising is a risk factor, if noted at the time of the procedure 5 to 10 minutes of pressure applied to the area usually keeps it to the minimum. Slight asymmetry is to be expected and is relative to the individuals pre-procedure skin, subcutaneous tissue, muscle and bone. Gross asymmetry may require additional threads or filler to enhance the result. Infection has been reported and can be treated with massage, antibiotics and possible removal of the thread. Thread protrusion through the skin or mouth mucosa is treated by clamping the thread pulling it and snipping it at the skin edge. Internal thread points that cause points on the skin, usually resolve without need of puncture and removal. Allergic reaction can be treated with topical hydrocortisone cream or Benadryl cream, may last 10 days. Granulomas can form and resolve over time. Loss of sensation or loss of motion have not been seen by this author. Tethering of the neck has been reported on animation of the neck when platysma bands are treated. I have not used them for this indication. Less effect then desired I have seen, however the patients have been pleased with the subtle improvement. The procedure initially will take longer then expected as there is a learning curve with the familiarity of the suture material.

Discussion

Thread lifts or suture lifts in various forms have been described by various plastic surgeons over the last 30 years. Cogged sutures were FDA approved 13 years ago. They were thin polypropylene sutures that had a high incidence of extrusion especially in inexperienced hands. The silhouette lift involved thin permanent polypropylene sutures with little cones that helped support loose tissue of the face. Only dissolvable PDO sutures with cones are available at this time. These cones are problematic, as they can form granulomas when dissolving. To many extrusions of the permanent sutures over time. Wu in Singapore reported 85% of patients with polypropylene barbed sutures requested further threads at 2 years.

The MINT threads have helical spaced barbs 360 degrees around the suture, which may be an advantage from other quadrilateral cogs or barbs of other dissolvable sutures. Apparently the purple PDO MINT threads become clear over 3 to 6 weeks in vivo.. The cogs are added to the MINT threads as opposed to angle cuts into the threads that could weaken the suture as made by other manufacturers. The PDO threads induce epithelial morphogenesis or neocollagenesis at 3 months. In other words as they dissolve they leave residual fibrous tissue. I have used the MINT 1043 1-0 PDO thread which has more substantial pull then other less thick and less durable threads.

Example of 61 year old woman with improved jowls after MINT lift.

Face

Exactly how long the results last remain to be determined. Patients of mine at 6 months remain satisfied with their outcome. To early for me to determine long term satisfaction.
One of my 66 year old female patients who plans on retiring in one year wanted a quick fix meanwhile and was satisfied and understood the temporary nature of the threads.(attached pre and post MINT thread lifts)

Face

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