2TOPICS FOR DEVELOPMENT: Historical backgroundMechanism of actionIndicationsPreoperative phaseTechniquePostoperative phaseComplicationsAdvantagesConclusions
3HISTORICAL BACKGROUND Ancient Egypt: threads of pure gold1960s: Caux , subdermal gold threads in facial surface1970s: J.Conley and D.Baker, implantation of the thread under (and adapting to) the wrinkle1992 : D.Orenes (gold + catgut), vertical and horizontal implantation1992 : application kit (Lorca Marin, S.A.), combining gold thread with simple catgut
4MECHANISM OF ACTION GOLD THREAD: Produces a granulomatous reaction characterized by the appearance of abundant elastic fibres around the implant, together with neovascularization of the implant zone. This affords skin youthening in the implant zone.POLYGLYCOLIC ACID:Produces minimum acute tissue inflammation, followed by gradual encapsulation by the connective tissue. Posteriorly, gradual tension strength is lost, with hydrolysis-mediated absorption that is completed within days after implantation.
5MECHANISM OF ACTION Gold + PGA PVDF 180 days - Collagen fibers are observed in the adipose cellular structure, i.e., collagen formation has extended beyond the capsule limits.- The structure is completely surrounded by newly formed blood vessels.- A significant presence of mast cells is observed.The thread is surrounded by a capsule composed of collagen bundles.- The presence of mast cells is nonsignificant.
6INDICATIONS: Elimination of flabbiness Filling of grooves and wrinkles Incipient agingElimination of flabbinessFilling of grooves and wrinkles
7The correction of facial wrinkles is one of the main challenges in esthetic surgery and exerts a negative psychological and emotional effect upon patients.The existing surgical methods are traumatic and imply the need for anesthesia and postoperative period.Our aim is therefore to increase efficacy in combating and preventing involutional changes through “skin firming with special surgical threads”.
8SKINGOLD – Gold ThreadSKINGOLD is a filler implant developed by LORCA MARÍN for the prevention of face and neck ptosis, and flabbiness of the inner arm and thigh skin surfaces.SKINGOLD can also be used to correct neck and face wrinkles.SKINGOLD is applied by means of a simple “ambulatory surgery” technique.SKINGOLD has no adverse effects.SKINGOLD affords evident results within one month.SKINGOLD maintains the visible effects for more than 5 years.SKINGOLD is CE certified.SKINGOLD is a registered trademark of LORCA MARÍN.
9PREOPERATIVE PHASE : Case history Treatment: analgesic - antiinflammatory, antibioticInformed consentPreoperative photographs
12TECHNIQUE : Preparation of the surgical field, with strict asepsis. Anesthesia:either topical (EMLA° type cream)or local subdermal infiltration at entry and exit points10-15 ml lidocaine 2%0,1 ml adrenalin 1%°25G 5/8 or 30G ½ needleSubdermal implantation of the gold thread (accordion effect)CompressionImmobilization? (micropore° dressing)
13POSTOPERATIVE PHASE Local application of ice Antibiotics (oral and topical)Immobilization (avoid facial gestures, micropore*)Control after one week
15ADVANTAGES Rapid return to social and labor activity Important youtheningWITHOUT scarsNO pain
16TESTS CARRIED OUTExperimental clinical group – A. V. Vishnevski Surgical Institute( Moscow).These investigators conduced comparative and experimental studies with implants of gold thread + PGA and Trofilene ( PVDF ) in 300 patients.Study of the mechanism of action of gold thread (morphological changes).
17TESTS CARRIED OUTClinical observations: correction of involutional changes in face and neck.Immediate and long-term effects.Assessment of blood flow in the tissues surrounding the implant (SRSV).Evaluation of surrounding tissues.Tissue microcirculation.
18CONCLUSIONS1.- Before treating the patient with this technique, evaluation is required of tissue condition – objectively establishing the involutional grade and defining the choice of technique for firming, in order to be able to predict the outcome.2.- The morphological changes around the implant are characterized by: functional activity of the fibroblasts, collagen production and increased capillaries.
193.- The procedure increases the microcirculation indexes between 44-53%, thus favoring nutrition in the area.4.- firming can be applied as prophylaxis (grade I cases) and as corrective measure (grades II, III and IV).
20.5.- In grade I and II cases, the technique is effective as an independent method (75% good results).6.- In firming of the infraorbital zone, implants should also be placed in the malar region and temples – with implants in the rest of the face on a unified basis.7.- In grade III cases it is advisable to implant supplementary threads in the oval facial zone.
218.- In grade IV cases it is advisable to combine the procedure with surgical corrective measures (liposuction and ritidectomy / face lift).9.- No leakage is observed after implantation of over 0,5 cm in young patients.10.- In patients over 56 years of age, leakage of tumor-like appearance is observed, with local inflammation.
22GOLD THREAD KIT / SKINGOLD Ready to use (gold + PGA), 25 cm length, boxes with 12 UTriangular straight, atraumatic needle (60 mm length)Gold thread (24 kt 99,99% purity) 0,1 mm diameterColorless polyglycolic acid thread (caliber 3/0 USP)Sterile (EO)Histocompatible.