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Combined Protocol for Restoration and Repositioning of Natural Volumes of the Face in a Patient with Peripheral Hemiparesis of Right Facial Side
Barbara Claysset*, Maurizio Cavallini
Department of Aesthetic medicine, Curative and preventive foreign medicine, Italy
Received Date: 26/01/2022; Published Date: 09/02/2022
*Corresponding author: Barbara Claysset, Department of Aesthetic medicine, Curative and preventive foreign medicine, via murri, Bologna, Italy
Abstract
Neoplastic pathologies, in particular those involving patient’s face, may cause dysmorphic lesions and function limitation which can lead to depression, frustration, discouragement and/or anger. Self-perception could lead to more discomfort in addition to pathology-linked pain and suffering.
Aesthetic Medicine may improve the function of the involved parts and also restore an emotional sense of wellbeing, giving back self-confidence and reinforced relationships.
I present here the case of a 60-years-old man, affected by ductal carcinoma of parotid gland, who underwent total right parotidectomy, consensual lymphadenectomy, VII cranial nerve resection, that was unavoidable, and emptying LCII-V; this demolitive kind of surgery led to hemiparesis of the right side of his face, that required a four-sessions treatment. In the first one I volumized the zygomatic—malar area by injecting hyaluronic acid filler (Revofil Ultra – Caregens) through a 22G cannula positioned above the periosteal level using the retrograde linear submuscular technique. During the second session I placed two polydioxanone threads V-LIFT PRO Tensio through the vectorial line from the ear lobe to the labial commissure, using the innovative one-point technique. In third session two more threads V-Lift Pro Tensio were placed from zygomatic bone to pre-jaw and from maxillary bone to jaw, in order to lift up the angle of the mouth, using two independent vectorial lines. In the last session I performed a new refilling treatment with Revofill Ultra, restoring volumes of the right part of the face.
Results, which consisted in lifting-up and volumizing the right part of the face, are confirmed at 6 months follow-up and the patient has confirmed his satisfaction, having recovered his self-comfort and a new emotional status.
Introduction
Neoplastic pathologies, in particular those involving patient’s face, may cause dysmorphic lesions and function limitation which can lead to depression, frustration, discouragement and/or anger. Self-perception could lead to more discomfort in addition to pathology-linked pain and suffering.
Aesthetic Medicine may improve the function of the involved parts and also restore an emotional sense of wellbeing, giving back self-confidence and reinforced relationships [1].
I present here the case of a 60 years old man, affected by ductal carcinoma of parotid gland, who underwent total right parotidectomy, consensual lymphadenectomy, VII cranial nerve resection, that was unavoidable, and emptying LCII-V; this demolitive kind of surgery led to hemiparesis of the right side of his face, that required a four-sessions treatment alternating hyaluronic acid, that can volumize the empty zone, and traction threads, that can lift-up the loose area.
Case Report
The first treatment consisted in hyaluronic acid filler (Revofil Ultra – Caregens) injection; this filler has a high G prime, an acid solution of 23 mg/ml and includes biomimetic peptides able to link to cell wall receptors and to stimulate the production of hyaluronic acid, collagen and elastin. I placed a 22G cannula with a 18G needle above the periosteal level of the zygomatic-malar area, where a bolus was injected, and pulled it back using the retrograde linear submuscular technique.
During the second session I placed two polydioxanone threads V-LIFT PRO Tensio through the vectorial line from the ear lobe to the labial commissure, using the innovative one-point technique. A small bolus of lidocaine 2% (0,2 ml) was injected in order to reduce the patient’s discomfort, then I put the cannula containing the threads trough a 18G needle and drew it back pulling the threads up to the desired amount of traction, I tied them up, removed the excess and pushed the knot down to be sure it was left inside the derma, so that could stimulate a fibrosis process.
In third session I placed one more thread V-Lift Pro Tensio from the zygomatic bone to pre-jaw and another one from maxillary bone to jaw, using two independent vectorial lines, in order to lift up the labial angle.
During the last session I used a high G prime hyaluronic acid injected through a 22G cannula into the zone between maxillary bone and jaw, so that the entire right cheek was re-volumized and the third median zone was lifted-up.
Discussion
Hyaluronic acid filler [2,3] (Revofil Ultra – Caregens) contains 2 kinds of biomimetic peptides: CG Bostrin, which inhibits hyaluronic acid degradation, and CG Glamerin, that stimulates endogenous hyaluronic acid, collagen and elastin; these peptides are linked to hyaluronic acid through stabilizing ionic bonds that ensure sizeable and long-lasting results and safety of the treatment, both in healthy and neoplastic patients [4].
V-lift Pro Tensio threads are commonly used for lifting-up loose big parts of the body [5]. I chose these kinds of threads because they can generate a huge traction force, thanks to their dimensions (18G x 100mm length) and their fishbone shape, that works like anchors in the tissue [6]. Moreover, polydioxanone stimulate production of type 1 and 3 collagens, so that a re-firming effect is added to the lifting-up one [7].
Customized treatments based on the patient’s needs are essential in Aesthetic Medicine, as well as the knowledge of new and advanced techniques and materials, that allow the physician to choose the most effective solution; in this case I needed an unusual traction force on the face, then I opted for threads that are commonly used for parts of the body, instead of regular visage threads, that enabled me to re-equilibrate the anatomic asymmetric and to improve the hemiparesis. These two effects not only made the function and the appearance better, but also gave back to the patient his self-confidence and a new quality of life.
References
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- Suh DH, Jang HW, Lee SJ, Lee WS, Ryu HJ. Outcomes of polydioxanone knotless thread lifting for facial rejuvenation. Dermatol Surg, 2015; 41(6): 720-725. doi: 10.1097/DSS.0000000000000368. PMID: 25993611.
