Mid-facial Rejuvenation With Thread Lift Assisted By Platelet Concentrate

Objectives:The mid-cheek groove is one of the common manifestations of facial aging,but existing repair efficacy is often poor.The present study aims to investigate the efficacy of different planar thread lifting techniques for improving the mid-cheek groove and explore whether different types of platelet concentrates affect the efficacy and safety of the thread lifting technique,thus to explore better solutions to the mid-cheek groove.Methods:Patients were randomized to receive one of the following mid-cheek groove repair options:(a)sub-SMAS plane thread lift,(b)supra-SMAS plane thread lift and(c)hyaluronic filler injections.Photos were taken before and after 6 months Clinical efficacy was assessed using the GAIS score,while side responses between the three treatments were also compared.Auto-PRP,Artificial PRP(Art-PRP),liquid phase CGF(LPCGF),and gel phase CGF(GPCGF)were prepared,and a full-thickness skin defect model was established.Skin defects were treated with normal saline,Auto-PRP,Art-PRP,LPCGF,and GPCGF,respectively.Wound size was measured and calculated on day 3,5,7,and 10 post-surgery though histological analysis.Three minipigs were divided into control,PRP,and CGF groups.After lifting 20 PDO cog threads into subcutaneous fat,each group was injected with 2ml of saline,Art-PRP,or LPCGF.Tissue samples were taken at 2,4 and 8 weeks post-operative to observe the thread absorption and histological changes.LPCGF was randomly injected on one side of the face of thread lifting patients.Immediately,1 week,1 month and 3 months post-surgery,skin condition,differences in efficacy and postoperative patient satisfaction were compared to explore whether LPCGF has an superior effect on thread lifting patients.Results:Procedures were performed in 117 patients.The patients of sub-SMAS group exhibited greater degree of improvement compare with that of supra-SMAS and HA groups.The differences in GAIS score among three groups significantly increased over time.Sub-SMAS group showed a lower GAIS score 6 months post-procedure.SubSMAS was shown to have a longer lasting visible effect than supra-SMAS and HA.All four platelet concentrates promoted wound healing in mice.The LPCGF TNFand IL-1 were significantly lower in the LPCGF and Art-PRP groups than in the control group,while VEGF and CD34 were significantly higher than in the control and AutoPRP groups.At two week post-surgery,the numbers of neutrophils and macrophages were significantly lower in the PRP and CGF groups than in the control groups(p<0.001).At weeks 4 and 8,the numbers of neutrophils were lower in the PRP and CGF groups(p<0.001),and the collagen fiber content was higher.At week 8,wire absorption was more pronounced in the control group compared to the PRP and CGF groups.Between the first and second week of surgery,the improvement of the skin and the treatment group was more significant compared with the control group,with a lower adverse reaction rate,which all reach to a statistical difference.Conclusions:This deep plane thread lifting via the sub-SMAS spaces incorporating with knitcircuit technique is a safe procedure for correcting mid-cheek groove with favorable longevity of effect.All four platelet concentrates have their effects in promoting wound healing.Compared with Auto-PRP,the LPCGF,GPCGF,and Art-PRP appear to have stronger effects in promoting angiogenesis,epithelialization,and reducing inflammation,which all contribute to promoting wound healing.PDO cog threads combined with Art-PRP or LPCGF subcutaneous implantation alleviates inflammatory responses around wires in early period post-surgery and promotes collagen formation.This helps to accelerate the early recovery from PDO line implantation,reduce the absorption of the wire,and promote the proliferation of its surrounding,collagen.With the assistance of platelet concentration solution,operators are able to reduce the incidence of adverse reactions post-surgery and improve the efficacy in the treatment of mid-cheek groove through knit-circuit technique via the sub-SMAS space.