Restoring facial symmetry after nerve palsy

Dr Usman Qureshi (aka Dr Q) describes his innovative technique to correct facial droop

Most treatments in aesthetic medicine are carried out for the psychological well-being of patients, without an underlying disease process. However, sometimes we see patients who have been affected by physical diseases resulting in psychological manifestations. In some cases, the psychological distress caused by the treatment of the disease is just as upsetting as the disease itself.

A 55-year-old lady attended my clinic for correction of a left-sided facial droop that resulted from surgery for salivary gland cancer some two years previously. The left facial nerve was diseased and was therefore removed, causing severe left facial droop. The marked facial asymmetry was very distressing to the patient. She was of a strong mind and was determined to live her life to the max. She did not want any further surgery and was also advised previously that the outcome of such procedures may not be favourable, so we decided upon a face, neck and brow lift using permanent silicone threads.

PERMANENT SILICONE THREADS

I have been using permanent threads for several years now and have been getting great results. I use Spring Threads, which have patented elasticity to allow for facial movements. Each thread contains 24 tiny cogs per cm that point in four directions. It is 300mm in length with long blunt needles at each end.

PROCEDURE AND CHALLENGES

The procedure was done using tumescent anaesthesia, comprising of normal saline, lidocaine 2%, adrenaline and sodium bicarbonate. Three areas were targeted: brows, face, and neck. Both sides were treated but additional threads and traction were used on the affected left side.

Brow: One thread was placed in the forehead in a U-shaped arrangement with the base of the U within the eyebrow.

Face: Three threads were placed on each side targeting the nasolabial fold, the marionette fold, and the jowl. Two additional threads were placed in the left jowl.

Neck: Three threads were placed on each side.

THE RESULT

The patient was seen one week after the procedure and again at five weeks. There was a marked improvement in the left-sided facial ptosis. The brows were higher, reducing the hooded appearance seen previously. The heaviness of the left jowl was almost gone, and the jawline was visible. There was an overall lifting of the face and neck. There was slight pinching of the skin over the left brow, which will settle in due course.

PATIENT’S EXPERIENCE

The patient was thrilled with the result. She did not believe that such a lift was possible. She had tried polydioxanone (PDO) threads previously but that only provided a nominal improvement. Further surgery was not advisable for her, nor did she want to go through anything invasive again after her cancer treatment. The permanent thread lift gave her the confidence boost she needed.

I believe that permanent threads are underutilised. They have a very strong lifting potential and provide longevity of results for three to five years. A minimally invasive procedure, they take a little more time and preparation than non-surgical treatments. People often compare them to PDO threads but, in my opinion, permanent threads have a completely different and unique profile. They can be thought of as an alternative to surgical face and neck lifts, rather than an upgrade on PDO threads.

Before

After

DR USMAN QURESHI

Dr Usman Qureshi (aka Dr Q) is a cosmetic doctor and founder of Luxe Skin by Doctor Q in Glasgow. He focuses on non-surgical and minimally invasive cosmetic procedures for the face and body.