The operation with Aptos thread is easy and quickly performed. Indications for use of the thread include any problem causing ptosis of the tissue of the face and neck with flabbly flat face and poor aesthetic contouring. Most often ptotic buccozygomatic areas where treated (62% patients) since patients seemed to be mainly concerned about the area.

Surgical Technique

Local infiltration is used with a thin gauged neddle: 1% lidocaine solution in the area of entry and exit of the guide and along the passage in the fat. Average use is 0.5-0.7 cc for one thread.

The guide needle is placed through the skin, along the preliminary marked contour at the required depth, and brought out at the exit point. The thread is threaded through the needle with the converging cogs and the needle removed. This fixes the thread in the desired position in the tissues.

The ends of the thread may then be pulled up so that each cog engages the soft tissue. This allows shifting and grouping of the soft tissues within the zone of the thread’s action. The ends of the thread are cut below the skin surface.

Separate portions of the ptotic tissues required special marking for lifting (Fig.5).Lifting the buccozygomatic are requires three threads to be passed under the skin from both sides; one long (8.5cm) and two short (5.0cm). the long one must be passed sufficiently deep within the fat tissue, like at bow-string,that, when stretched, provides the effect of lifting the flabby buccal tissues and gives a round contour to the skin. The inferior short thread passed parallel to the long one is needed to maintain the effect created by the long thread and to provide a more convex contour to the skin. The superior short thread is passed subcutaneously along a steep arch from the zygomatic area towards the check. This lifts the over-hanging skin above the nasolabial fold upward and laterally , removing the lachrymal groove.

Mental overhang is treated with two long threads on each side at a depth of 1-2 mm.Two long threads implanted in the submental area improve the contour of the soft tissues of the subzygomatic region.

Post Operative

The immediate postoperative period was uneventful; in four cases (2.5% of patients)the thread became disrupted due to unilateral weakness of the edges and threads emerging through the skin surface.These required removal and secondary reimplantation.

The use of Aptos threads is single conservative procedure that leaves no visible scars. This can be used as an alternative to the classic techniques of facial cosmetic surgery for ptotic type and contouring.