PRIME Journal Vol. 12 Issue 1

CORRECTINGTHE GLUTEAL REGION USINGTHREADS AND POLYLACTIC ACID FILLERS NataliaMarkovaMD, SvetlanaPervykhMD, EliskaKubiková MD, Chuan-yuanLin,MD, and HsuNai-Jen,MD discuss their novel non-surgical technique for addressing thisproblemarea ABSTRACT Loss of elasticity, volume, and ptosis of soft tissue in the gluteal region due to involutional changes lead patients to search for minimally invasive aesthetic solutions with short rehabilitation periods, such as correction with threads and soft tissue fillers. However, the use of minimally invasive methods also requires confirmation of the anatomical safety and clinical effectiveness of the proposed correction methods. Improving the quality of the skin and non- surgically increasing the volume in the gluteal area has recently gained popularity among patients. The most common complaints are reduced turgor in the gluteal zone, skin flabbiness, ptosis, and insufficient volume of soft tissues in the upper inner and outer quadrants of the gluteal area due to lipodystrophy. For the correction of the gluteal zone, classical surgical techniques are currently used: liposuction and lipofilling 1 , buttock endoprosthesis 2 , and surgical lifting. Additionally,minimally invasivetechniquesare also becoming popular in this area due to their ease of use, lack of intervention in the long-term post-procedural period and reduced surgical risks, the ability to perform them under local anaesthesia, and quick rehabilitation. In addition to filling with hyaluronic acid, thread lifting and reinforcing thread methods, soft tissue fillers based on collagen-stimulating substances from polycaprolactone and polylactic acid deserve close attention. Such drugs, depending on the volume of the active substance, are sometimes called tissue substitutes. Buttocks are considered aesthetically ideal when the gluteal sulcus is short and does not reach themidline of the posterior surface of the thigh; the transition of the back/buttocks in the lateral projection is S-shaped, the maximum projection point of the buttocks is in its central zone. OBJECTIVE The purpose of this article is to describe a minimally invasive method of aesthetic correction of the gluteal zone using lifting, reinforcing threads, and soft tissue polylactic acid fillers, to demonstrate their anatomical safety and clinical efficacy. In our article, we would like to discuss the correction of the gluteal zone using the combination of thread lifting and reinforcing methods and soft tissue polylactic acid fillers. In our clinical cases, we used threads made of polymer consisting of polycaprolactone (75%), polylactic acid (25%), and soft tissue polylactic acid filler (1000 mg). The purpose of using thread lifting methods is to move soft tissue and fix them to a new position3. The purpose of using thread reinforcing methods is to strengthen the subcutaneous fat layer due to the collagen-stimulating composition of the reinforcing threads and slight lifting of soft tissues in the direction opposite to the ageing vectors due to the fixing device (barbs) on the threads. Thepurposeoftheuseofcollagen-stimulating and tissue-replacing methods is to achieve, by administration of the drug based on polylactic acid, an increase in volume and skin elasticity, followed by the secondary replacement of the administered volume with the patient’s own tissue without the use of permanent or non- absorbable implants or fillers. T O UNDERSTAND AND PREDICT THE results of procedures and the safety of their performance, it is necessary to understand the functional and layer-by- layer anatomy of the gluteal region 4 . It is bounded from above by the iliac crest, from below by the gluteal fold, from the inside by the sacrum and the coccyx (medial line—intergluteal cleft, themedian ridge of the sacrumand coccyx), laterally—a line drawn from the anterior-superior iliac spine, anterior superior to the greater trochanter (trochanter NA). In the case of two gluteal folds, the lower fold is considered the border of the gluteal region. The anatomical base and the main anatomical landmarks are always bones. In the gluteal region, there are two deep cellular spaces (deep gluteal and supratrochanteric). It is in the deep cellular space between the gluteus medius and minimus muscles that the branches of the lower gluteal vessels and nerves pass, and the fascial sheath of the sciatic nerve is located. Due to the presence of these important anatomical structures, it is undesirable to work in deep cellular gluteal spaces without using direct visualization of the above structures, which limits the work with minimally invasive technologies in this zone. However, we are more interested in the superficial KEYWORDS Absorbable Threads, Aptos, thread lifting, polylactic acid filler NATALIA MARKOVA MD , Dermatovenerologist, MedicalEsthetic, Prague, Czech Republic; SVETLANA PERVYKH MD , Ophthalmologist, Gwangju city, Republic of Korea; ELISKA KUBIKOVÁ MD , Surgeon, Anatomický ústav Univerzita Komenského v Bratislavě; CHUAN-YUAN LIN, MD , Head of ToBeauty Aesthetic clinic, Chief of Plastic and reconstructive division, Taipei Veteran General Hospital, Taiwan; HSU NAI-JEN, MD , Director, Hsu Nai-Jen Dermatologic clinic, Tainan city, Taiwan email: nm@imageline.cz AESTHETIC FEATURES | THREADS AND FILLER | 20 January/February 2022 | prime-journal.com

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