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Serdev Sutures® in Lower Face and NeckNikolay Serdev[1] New Bulgarian University, Sofia, Bulgaria1. One option that you have is getting bigger breasts without surgery by using natural breast enhancement. Many women that are reading this article will think about using one of these methods, but then will decide to go back and be uncomfortable and unhappy with their bodies. I am going to read through the full Triactol review and order the product immediately after reading the user testimonials.
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Triactol can help you with increasing your breasts, making them firmer and making them healthier. Reaction RF is brand new technology unlike any previous systems used for non-invasive non-surgical skin tightening systems.
Since the Reaction procedure heats tissue under the skin’s surface, patients of any skin type or age can be treated. The price starts as low as $150 but is highly dependent on the size of the area to be treated – the more time needed to treat, the higher the price. Pioneered through a combination of surgical advances, the Pinnacle Face Lift is the next plateau of facial aesthetics for stunning results. The sculpting of the nose is an extremely important and delicate procedure as it is the centerpoint of each face. With your natural beauty plus todaya€™s latest scientific advances for gentle, minimally invasive enhancements, the Beverly Hills Biomed Spa is your new best friend. Visible change in the lower face appearance after lower SMAS lift by sutures with skin punctures only. Before and after temporal SMAS, brow, and lower SMAS lift using sutures with skin punctures alone, combined with rhinoplasty.
Immediately after simultaneous temporal, medial and lower SMAS face lift by sutures using skin punctures only, brow lift by sutures, rhinoplasty, and lip augmentation.
IntroductionThe concept of lower face SMAS lift via sutures, through skin punctures alone (or by hidden incisions in the retro-lobular fold), explains how to re-structure and re-position the lower face, associated facial elements and neck, without visible pre- and retro-auricular scars. Cheek SMAS and platysma are captured with a mosquito instrument, pulled out into the wound opening and sutured to colli fascia and mastoid.
Most of the women that you see on television have nice, perky breasts that allow them to support the hottest trends. I know that I need a beauty boost in the bust area that I will get from using this natural breast augmentation product. It can be highly embarrassing to have to stuff your bra when wearing tops and of course everyone is going to know. Botox in Thailand was introduced in early 2003 and has since been one of the top 3 nonsurgical cosmetic surgeries in Thailand each year.Botox can also be used to get rid of the dreaded frown lines, crow’s feet and even furrows on the forehead area. Reaction goes deep in the deepest layers of the skin to cause collagen remodeling taking years off your appearance without downtime or pain. Generally, results are best seen in patients between the age of 30 to 45 with mild to moderate skin laxity. Garth Fisher has earned the trust of the family to perform delicate procedures for a group that is always under the spotlight.
This minimally invasive procedure uses incisions designed to align with the bone structure and anatomy of each patient to reduce scarring and create youthful results that avoid a tight or pinched look. Fisher's body contouring is optimal for moms who desire the best mommy makeover results to return their bodies to their pre-baby figures or for those who have achieved major weight loss goals. Facial enhancements range from facials and microdermabrasion to facial fillers and Ultherapy ultrasound technology for lifting and firming the skin.
Garth Fisher or the cosmetic procedures offered at his office in Beverly Hills, please contact us today. Lidocaine infiltration of the mastoid periosteum, colli fascia and SMAS at perforation points A, C, and along the line A-C, B. The needle is introduced through the skin perforation point A, then tangentially through the mastoid, superficial subdermal through colli fascia, above the sternocleidomastoid muscle, through platysma and perforation point B in the direction of the cervico-mandibular angle, B. After Lidocaine infiltration, retrolobular incision and about 3 cm blunt dissection of the preauricular and subauricular zones, the platysma is fixed with the needle in point B and the needle is threaded, B. Immediate total change in the lower face after temporal, brow lift and a lower SMAS lift, using sutures with skin punctures alone. Different variations of fixation of the fibrotic soft tissue, with or without fixation to menton3.3. Before: aging face, disproportions and lack of aesthetics in all proportions, volumes and angles. The author uses the specially designed, curved elastic Serdev® needles with lengths of 60 mm, 100 mm and 140 mm and prefers the Bulgarian semi-elastic, polycaproamide (Polycon) surgical suture USP 2, with long delayed absorption durability.2. In this manner the lower face and neck SMAS lift is developed from the preauricular SMAS (at the level of the earlobule) and platysma (at the mandibular angle), and attached posteriorly to the mastoid process. If you do not have perky, firm and bigger breasts, you can attempt to wear the clothes, but you will not look as good as they do. Men are interested in breasts, and when you have lovely, large breasts you can wear lingerie more confidently and have a better sex life. Botox can also treat a number of other medical conditions, including problems with involuntary eye coordination,minor ocular muscle spasms, migraine headaches and even severe armpit perspiration. The combination of sensitivity and attentive listening plus an artistry translated from eye to hand makes Dr. The Pinnacle Face Lift properly maintains and considers the hairline and other facial contours, especially around the ears, providing among the best facelift results possible. Body contouring combines procedures such as a breast lift, tummy tuck, arm lift and thigh lift to tighten sagging skin and achieve a youthful, toned look.
Fishera€™s eye for symmetry and harmony allows him to consult patients on choices that will enhance the facial bone structure and flatter other facial features. CoolSculpting is also available for tightening and eliminating stubborn pockets of fat—all without surgery. The suture is introduced from the skin perforation point B into the opening of the retrolobular incision. Nice young lady, but with longer nose, small chin; disrupted golden section rule, lower face proportion and the line of straight profile.
Lower face and neck lift by sutures, with skin perforations only or by using a hidden 2.5 cm retro-lobular incisionThe first methos is a closed approach suture method of lower SMAS face and neck lift.
Medium elastic tension is applied, providing a lower face SMAS backward & upward lift and platysma upward lift (Fig. Putting your head up high and holding your shoulders back can do a lot for the way that you look. Most people notice their skin to be firmer and more plump to the touch, with an improved brighter appearance.
Fishera€™s skill also extends to breast lifts, breast reduction and breast implant revision surgeries. Body contouring may include liposuction for any pockets of stubborn fat that have remained. Options include reducing the nasal hump, addressing the overall size of the nose, reducing and lifting the tip and addressing any structural issues to ensure that profiles and direct views of the nose are straight. Biomed Spa technicians are at the top of their field and provide the ultimate in analysis and care. Second pass of the needle following the same plan, 2-3 mm away from the first one, D.The second end of the suture is introduced through the second needle pass, suture loop dives into the skin perforation point B and the suture circle is fulfilled. A tangential bite of the mastoid from point A and suture end is introduced from the incision to point A. After lower face SMAS lift with retro-lobular incisions in a 40 years old man, plus T-excision and columella sliding rhinoplasty. The additional upper lip augmentation is a part of the face proportion adjustment and beautification. Simultaneous rhinoplasty – T-excision and columella sliding for nasal tip rotation and projection. A slender neckline, due to skin lift forward (when moving the submental skin perforation point A in front of the menton) is obtained and is recognized as an attractive feature of youth with this method. After scarless closed approach suture Brow, Temporal, Mid-face, Lower face and neck lift, Chin enhancement and Rhinoplasty.
The author uses skin punctures alone to introduce the needle and suture, in order to capture, lift and fix loose lower face and neck SMAS to stable structures like periosteum, without tissue undermining.
Fresh No operated-on appearance and open eye look, sparkling radiation, proper proportions are present, straight profile, angles lifted laterally, volumes, beauty triangle, defined jaw line and cervico-mandibular angle are present. Colli fascia, mastoid or occipital periosteum are used as anchor points to fix and elevate the lower SMAS, enabling lower face and neck lifting.
They have so much confidence because they know that their clothes fit right and that they look stunning.


Results of are visible in less than one week post treatment and can remain for a minimum of two to three months each time.Botox should only be used and injected using sterile instruments with authentic Botox made in the USA.
Fisher is a breast expert and is extremely sensitive to womena€™s concerns and wishes concerning the appearance of their breasts.
Skin dimpling at skin perforation point B is removed by releasing the skin from attachments, using a mosquito clamp, F. The needle is introduced again from skin perforation point A subdermally to perforation point B and the needle is threaded. After lower SMAS-platysma lift with retro-lobular incisions in a 37 years old female patient. In the second method, the author uses limited undermining of 3-4 cm in front of the tragus, via retro-lobular incision. Thai Medical Vacation offers dozens of great non-invasive solutions from the Top Skin doctor’s in Thailand for an affordable price. Second pass of the needle following the same plan 2-3 mm away from the first pass, the needle eye is threaded, no dimpling is visible above the needle, F. Skin dimpling at skin perforation point A is removed by releasing the skin from attachments using a mosquito clamp, G.
Introduction of the suture in line B-A follows, the suture loop will dive in perforation point B and the suture circle will be finalized. It is difficult to find any change in the operated chin position during the 5 year follow up. The fold behind the earlobule is the only place to hide the incision and at the same time obtain the optimal approach to cheek SMAS and platysma in front of the tragus. Botox injections are available in Bangkok and Phuket are usually performed under local anesthesia or some numbing cream on an outpatient basis. Clients having treatment may have minor discomfort from the injections, but the needles used by TMV accredited doctors are so thin and fine grade that the procedure is basically painless.
After the retrolobular incision and undermining is done, a 60 mm Serdev® needle is introduced in the undermined subdermal space and biting SMAS, arrives in perforation point C in lower face (or B in neck). The concept Ptosis and laxity of the “subdermal facial mask” - the SMAS - in lower face and neck reflects the signs and appearance of lower face aging.
Skin dimpling has been removed by releasing the skin from attachments using a mosquito instrument., H.
The concept of using the closed approach semi-elastic sutures with delayed absorption, is to tighten and elevate the lower face and neck, without unnecessary incisions. Then, from skin perforation point A, tangentially through the mastoid, the needle arrives in the retrolobular incision and takes the suture end, introducing it at skin perforation point A.
The suture is located in the line A-C in the lower face (or A-B in the neck area) fixing mobile SMAS (platysma) and immobile mastoid periosteum. The TMV approved doctor will most likely select a few different injection points depending on the areas being treated. Accordingly, lifting and fixing the SMAS into a more favourable position enables repositioning of soft tissue facial structures as well. Second pass is subdermal again taking the second suture end at point C (or B) and introducing it into skin perforation point A.
These specific points are important because these points are where the facial muscle contract.The Authentic dermal fillers are then carefully injected into previously marked points under the skin. Thus, the circle of the suture is fulfilled and the suture loop dives in point C (or B in neck). In young patients without genuine ptosis, heavy facial features, poorly expressed cheekbones and jaw lines, flawed proportions and angles, as well as sad appearance should be corrected. In many patients heavy subdermal fat and fat pad should be removed simultaneously.Classic face lifts can not avoid some visible scars or an "operated-on" appearance, secondary to skin and SMAS rotation and pull. Skin dimpling at points C and B is removed by traction of the skin perforation points C or B and the suture in opposite directions. The concept of the suture lift of lower face and neck SMAS is to achieve immediate results and to avoid trauma, visible pre- and retro-auricular incisions, excisions and scars.
One or two stiches are placed, in order to close the wound.Both Serdev Suture® techniques of lower face and neck SMAS lift are quicker and safer than classic invasive face lift techniques.
As subdermal and submental fat in the lower face is superficial to SMAS, it cannot be lifted with the SMAS lift. Mobile SMAS is lifted behind the ear lobule and sewn down to stable bone and periosteal structures.
This technique gives an aesthetic and normal “non-operated on” appearance to the face, without scars and totally covers patient’s expectation.It is also possible to combine lower SMAS lift with other procedures such as fat pad removal, ultrasonic assisted liposculpturing of lower face and neck, medial platysma suturing, skin resurfacing, rhinoplasty, etc. The author uses ultrasound assisted liposculpturing in the lower face and neck since 1994 (SMEI Sculpture and later - VASER) as a best option for atraumatic fat removal and tightening of skin. Definition The two methods, described by the author, represent lower face and neck SMAS suspension, tightening or duplication, using elastic sutures durable through extended absorption delay, via needle perforations alone or via hidden retro-lobular incision, where SMAS-platysma is lifted and fixed to the mastoid, and in some selected cases - to occipital periosteum. It is used for sculpturing the jaw line, softening the nasolabial fold and beautification, mostly in minor and medium jowling, submental laxity. In cosmetic surgery it is very important to respond to patient’s requirements for immediate beautification, to avoid visible scars, as well as to give patients the chance to promptly resume work and social activities, without long recovery period. Anatomy Face droops with age, due to gravity, atrophy and loosening of the facial ligaments.
Complications Minimal and very rare problems have occurred with the suture technique in some patients. As described above, one case of taking a facial nerve branch in the suture during performing method II led to ptosis of the upper lid and was solved immediately by removing of the suture. It is a rare complication, because the facial nerve runs a little higher, just below the tragus and immediately after that penetrates deep into the parotid gland. The SMAS is a fibro-muscular layer that connects platysma and galea and acts as a suspension for the overlying facial skin.
The continuity between the facial SMAS and the platysma is an anatomical fact, useful in performing facelift surgery. In method I, the needle penetrates the tissue much lower and we have had no cases of facial nerve insertion in the suture.
The trauma of involving the great auricular nerve in the suture, provoked by a lateral traction, adapts in some weeks.
In method I, in very loose skin cases, it is possible to obtain some swelling (bulging) effect at the sternocleidomastoid site that adapts and disappears in 2-3 weeks and could be easily covered by hair in female patients. The concept that lifting this layer leads to better long-term suspension of overlying skin has become universally accepted. In method II, skin undermining prevents from bulging or folding.In method I, the skin punctures disappear in 2-3 days. SMAS continues inferiorly towards the platysma and represents aponeurotic connections between mimetic musculature and the overlying skin.
In method II, the skin scar in the retrolobular fold is invisible and, additionally, there is no skin tension.
Discussion Beautification and immediate social activity are the first and most important aspect of patients’ requirements.
SMAS overlies the parotid gland in mandibular angle and tends to be substantial and easy to handle, because the parotid gland, zygomaticus major and minor muscles protect underlying facial nerve branches. The author's experience indicates that his specific methods of lower SMAS lift can be performed safely with minimum complications and maximum patient satisfaction.
With regard to protecting the facial nerve structures, we can accept that lower SMAS-platysma face-lift “by sutures only” or “with a retro-lobular incision” is done in a fairly secure area. Excision SMAS lifts, extended SMAS lift, deep plane, and sub-periostial face-lifts are associated with a number of complications, including haematoma, pixie ear, nerve injury, and skin sloughing. Surgical technique The scarless lower face and neck SMAS-platysma lift by sutures takes about 10 minutes per side and is done under local anaesthesia and i.v. Rejuvenation of the face.In one case, when method II, option one was used, upper lid ptosis occurred during fixation of the pre-auricular SMAS. Deep-plane and composite techniques achieve a deeper suspension, but the risk of facial nerve injury is higher. Immediate release of the suture solved this “complication” on the spot and another suture was performed without further complication. Post-operative care is longer and pre- and retro-auricular incisions are not the patient’s best contemporary option. In one 63 year old patient, in line with her aesthetic requirements, an additional pre-auricular skin excision (S-lift) was performed 3 years after the suture lift. The author’s suture methods are performed to obtain and preserve a youthful lower face and neck through fixing lower face and neck SMAS to mastoid (or very rarely to occipital periosteum). Due to the previous SMAS lift using method II, it was not possible to excise more than 2 to 3 mm skin in front of the ear. These techniques of “scarless lower SMAS face and neck lift” provide a safe alternative to other face lifts using preauricular skin incisions and elevation, platysmal and subplatysmal flaps, SMAS dissections, submental surgery, deep plane or composite face lifts.
Lower face SMAS lift by suture (A-C)First Pass A-Ca) Perforate points A, B, and C with a No.
Injury to the facial nerve in rhytidectomy has been described in less than one percent of the cases, and a spontaneous return of function results within 6 months in more than 80 percent of these injuries. With the introduction of the author’s technique, performed without aggressive platysmal and subplatysmal flaps and SMAS dissections, the risk of injury to facial nerve branches has decreased significantly.


Nevertheless, the operating surgeon must follow up the patient’s reactions carefully for signs of facial palsy during operation.The scarless lower face and neck SMAS lift by sutures, using skin needle perforations only or hidden retro-lobular incision, provides a safe and effective ambulatory method for beautification and rejuvenation of early and medium sagging face.
Stay away from deep mastoid penetration (at point A), stay away from parotid gland (located deeper at point C), and submandibular gland (located more medially, could be near point B). A nice and youthful shaped jaw, acute cervicomandibular angle and straightened cervical skin are the most desirable effects.
Do not push needle perpendicularly into mastoid - it is very soft and can be easily perforated (be aware of mastoid and inner ear anatomy). The lower SMAS lift is a bidirectional lower face and neck lift that gives a harmonious, strong lifting effect on the sub-zygomatic area and jaw and creates an acute cervicomandibular angle. In author’s patients, the lower SMAS-platysma lift is very often combined with temporal, mid-face SMAS lift and brow lift by sutures, in order to obtain a “total SMAS lift”.
Avoid this by twisting the needle backwards and then forwards again, a little deeper (but still in a superficial plane). Chin enhancement and form correctionThe primary goal of facial aesthetic (cosmetic) surgery is beautification, achieving balance and harmony.
The concept of augmenting, correcting and adjusting the chin position has evolved so significantly that it is now an important procedure in face beautification. Never introduce the needle into or below the sternocleidomastoid muscle (vascular nerve bundle, a.
The advent of synthetic materials has given rise to various types of alloplastic implants with their advantages, disadvantages and complications. The author's technique of chin soft tissue suspension, using a simple durable suture with extended absorption delay, is indicated to correct microgenia, to obtain the necessary projection and to adjust chin symmetry. Introduction The importance of the chin in face beautification is determined by the fact that the chin is a part of the lower third of the face. Aesthetically it has to fit to the straight line of the noble profile, to the "beauty triangle" of the lower face, and the facial golden section rule of 3 proportionally equal parts.
Chin prominence gives the essence of visage character.Profile deficiencies are due to congenital, traumatic and aging factors with different degrees of deformity. Loss of volume or a genetically small mandible affect the aesthetics and expression of the face, mouth, chin, and neck.
Disharmony between the skeletal support and the soft tissue envelope is a common cause of aesthetic concerns. Place skin perpendicular to needle tip, twist the needle softly and progress gently and easily.
Although standards of beauty evolve over time, classical facial features such as symmetry, straight profile, good chin projection and proportions remain as rules.
A comprehensive beautification (including rejuvenation of the chin) depends on accurate analysis of the lower face with attention to the contours and underlying structures. Perforation or resistance indicates engagement of dermis, resulting in a dimple that is difficult to remove. Free the needle tip and repeat the movement until the tip appears without the feeling of resistance. A large variety of materials are used by surgeons for augmentation purposes, although the search for the perfect implant continues. The author's surgical suspensory procedure, using a simple suture, has the aim to return the chin's soft tissue to a more aesthetic and youthful position and to meet patients' demands for immediate result, fast recovery and beatification without implanting foreign materials. Second Pass A-CThe second parallel needle pass goes through the same skin perforations and tissue plane, 2-3 mm away from the first one. Anatomy Although the process of facial aging is predictable, the rate of changes varies from person to person.
Appearing in perforation point C, the needle is threaded with the second end of the suture that is withdrawn through the second needle pass C-A. With aging, laxity develops in the skin and subcutaneous tissues, the result of which is an aesthetically incorrect projection and contour of the anterior mandible.
Aging (Witch) chin is an unpleasant aesthetic defect, characterized by ptosis of the premental tissue and a deep submental fold. Possible skin dimples should be managed by pulling the skin away from the suture, using a mosquito instrument.
Thus, the first suture of lower face SMAS fixation to mastoid (or to occipital periosteum – rare and mostly in men to hide the swelling bulging) is fulfilled (Fig. Loss of bone volume leads to loss of support for the soft tissues of the face.Aesthetic cosmetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues. This depends on the bone structure, amount and distribution of subcutaneous fat, as well as the interconnectedness of the superficial muscles to the overlying skin.
The objective The objective of the author's specific technique is to suspend the loose and hanging soft tissue of the chin, to give natural height of the chin projection and to advance the submental skin in order to obtain a youthful jaw line. Definition Suturing and suspending the loose chin soft tissue in front of the immobile menton in order to obtain volume, projection and a straight profile. Author's surgical techniqueOne or more Serdev Sutures® of the chin soft tissue could be used to obtain roundness and projection of the chin, where desired. The author uses only two skin perforation points (A and B) in the sub- and supra- mental folds to insert the needle and perform a suture, which, bulging the sutured fibrotic soft tissue, creates volume in front of the immobile menton. Using different angles of needle positioning, the author has introduced the Serdev Suture® method for total or partial enhancement, augmentation and positioning of the chin up or down (to adapt facial aesthetic proportions), or left or right (to obtain symmetry). When positioning the needle in the skin perforation point, the submental perforation has to be moved forward anteriorly to the menton.
If a “Witch” chin has to be lifted, the submental skin perforation point should be positioned much more anteriorly, so the projection will be higher. If the chin has to be projected downwards, the second perforation point B can be lower than the supramental fold and first point A should be maximally dorsal at the submental fold. Vertical chin sutureA 50 mm or 60 mm Serdev® needle enters through the submental skin puncture, then in front of the menton, slips along the anterior surface of the bone and exits through the other skin puncture at the supramental fold.
After threading the needle with surgical suture USP 0, the suture is positioned in the deep first needle pass.
Performing the second pass, the needle re-enters through point A, then medium deep through the soft tissue, and exits through point B to take the second suture end and introduce it in the second pass. If skin dimpling appears above the needle, the pass is too superficial and should be repositioned deeper. Thus, the suture circle is finalized and when pulling the suture, the suture loop dives in perforation point B. Then, any dimpling and skin attachment to the suture should be removed using a mosquito clamp. If the needle pass does not engage dermis, removal of dimpling at the skin perforation points is easy. If dermis is caught, dimple removal is impossible and the suture procedure should be repeated. In cases of persistent deep chin dimple, 2 sutures are possible both sides.If the projection is not sufficient, an additional horizontal suture can be added. The horizontal suture has 2 perforation points laterally and 2 passes should be done – the first one deep near the menton and the second - middle deep. The number of sutures could be more than two, in order to obtain the necessary projection.This ambulatory procedure takes only a few minutes. The skin puncture in the supra-mental fold could be visible for 2-3 days and patients may use make up. Results1095 patients underwent the above-described procedures for ambulatory suture chin augmentation in the author’s clinic and abroad, between 1993 and 2012. Patients were followed up between 2 and 11 years and have reported excellent clinical success.
On the contrary, this particular technique has been used to solve problems with asymmetry of the face.
The author frequently leaves a bit of dimpling at the lower submental perforation area that defines the lower chin line better and enhances the Caucasian appearance that is very much appreciated by patients. In order to reach a straight profile line, a second suture enhancement has been done in 21 cases and in one case of pronounced retrogenia and small amount of soft tissue, the enhancement was done in 3 steps.
The obtained chin projection enhances the "beauty triangle" of the "chin and checkbone complex". The author has had a satisfactory longevity of results in his patients and secondary chin enhancement after years was necessary only in 5 cases. Using serial photography during the follow up period he has not noticed remarkable changes in the result.
The chin soft tissue suture technique for anterior adjustment and form correction provides a soft, natural facial appearance and it continues to be the method of choice for form correction, augmentation and beautification of the chin.
Chin dimpleDimple formation is easy and consists of dermis fixation to periosteum by Serdev Suture® scarless closed approach. In such case, 2 points at the 2 ends of the dimple are used to capture the dermis between them.



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