so here we're going to use a barb three
along the jaw line to get lift through
here this is really common people
complain about the neck and loose kinam
platysma banding from the age of 30 on
and I'm using a 20 gauge needle and what
we're doing and opening your little poke
and if you want to you can use a little
lidocaine with epinephrine to create an
area here but really it doesn't even
bleed or bruise down there but sometimes
it does add a bit of comfort for the
patient now this is really nice we used
to use barbed ones a lot of people are
disappointed to see them go the barbed
threes are an improvement here's the
opening bevel up okay to put it in and
then bevel down and now I'm stretching
the skin again traction here this is my
endpoint we used to come in here and go
all the way across but now I like
treating along the edge here okay so
we're pushing through we're pushing
along it's pretty easy to push through
here and this is why I'm pointing it
right near that platysma band and you
can see it go through this is a cannula
it's not a needle so they almost never
bruise at the end now I need to engage
it because it's a barb this is key I
feel the end of the metal a lot of
people will follow the metal up as they
pull it out but really it's engaging the
end of the thread a twist right and left
use at least two fingers not on the
metal but where the thread is and then
we're gonna lift through and that will
engage beautifully
these barb threes are great now here's
my threat I can pull it and you can see
it tighten there and now I'm gonna do
one pull here to engage those Barb's and
really create a concavity at that neck
which is what people want to see they
want no loose skin and you can tighten
that to the level you want I'm pretty
happy there so I'm gonna take the
scissors and this is very very important
what I'm doing I'm pushing down but I'm
not first of all you don't want that
much of the scissors open okay what just
a tiny bit so I don't get the skin
you'll never bruise them if you don't
cut them and I'll pushing down on the
skin cutting and that buries the thread
and then I'm massaging up to further
engage it and you can see we've created
a nice jawline so we're cleansing we're
trying to go to that platysma band to
create the opening again with this 21
gauge so our a 20 gauge Neal we have to
put in very far it's the dermis we're
trying to get and you almost never see
blood in that area so we get our barb 3
2.5 inch and sometimes you can squeeze
it to get a little drop of blood so you
can find the opening off and that can be
a problem just finding where you went
bevel down and now we're you can see it
track through the tissues you want to be
not too deep and not too superficial
it's a cannula so it's really hard to
get too superficial it's pretty pretty
easy to be in the right plane as long as
you're not deep and now I'm just pushing
the skin I'm holding it where the thread
is some feeling where the metal is I
hold it and then I twist it to engage it
and then I can feel it engage and I'm
pulling out and here's my thread I grab
it pull to the level I want engage it a
little bit further because I want more
lift I can feel the barbs and pull it to
where I want the tightness
that's right about where I want it now
I'm gonna clip that avoiding clipping
the skin pushing down on the thread
clipping and giving a last engagement of
those Barb's up they'll never bruise
they'll never see the opening they have
to keep it clean