prior to starting the face type
procedure a wheel of 1% lidocaine with
epinephrine is raised under each ear and
cement alee the mandibular border is
marked as well as the marionette lines
additionally a betadine solution is used
to prep the neck for sterility a 16
gauge needle is used to create the pilot
report holes for which this tumescent
anesthesia solution is instilled first
in the lateral neck I'm using an 18
gauge cannula here to instill some of
this tumescent solution and then in the
submental and central neck areas if you
choose a small liposuction cannula can
be used to reduce some of the submental
and lateral neck fat this is a look at
the face tight handpiece consisting of a
subdermal 10 centimeter probe and
surface bipolar electrode dry passes are
made through the porthole laterally to
allow the probe to slide underneath the
surface of the skin in a pre platysmal
fashion this ensures that the probe does
not get hung up on the fiber septal
Network underneath the skin as it is
passed when heat is applied next you see
ultrasound gel is applied to the neck
the probe is advanced and slowly
withdrawn the energy is going from the
deep probe to the more superficial probe
that rides on top of the surface of the
skin the probe is passed radially from
this lateral port pre platysma lee and
the skin is pinched in-between the deep
subcutaneous electrode and the more
superficial skin receiver electrode
while the skin is pinched between these
two probes you can see here that the
surface probe is just riding a long top
of the skin while the underlying probe
is advanced in this radial motion to
treat the lateral neck and jawline one
of the unique and important things to
know about this device is that the
energy is passed you need
rationally simply from the deep
electrode to the more superficial
electrode it is not being sprayed in all
directions and only in that single
direction you can see here now we are
treating the other side of the neck
through the right lateral port or pilot
hole treatment of the lateral next take
about seven to ten minutes per side and
about three kilojoules of energy is
instilled into either side of the neck
you can see we are continuing to
radially treat the neck in this pre
platysmal plane while pinching the
subcutaneous tissue between the two
probes once the appropriate amount of
energy and time has been spent on the
lateral neck attention then moves to the
sub mental or central neck area this is
treated in much the same way as the
lateral neck is treated you can see here
how the probe is radially fan from that
sub mental crease port or pilot hole
when you're treating the central area
most of the lateral treated area that
you are also fanning across has also
previously been treated that is why less
energy is able to be placed there
finally treatment of the jowl and
jawline area is performed it is of
utmost importance that you stay
immediately subcutaneous in this area
and don't dive deep into the jowl area I
will treat from laterally all the way up
to the marionette line as shown you do
not want to dive deeply into the jowls
for risk of the deeper marginal
mandibular branch of the facial nerve in
this area finally at the completion of
the procedure the central and lateral
port or pilot holes are closed with a
single 6 o fast absorbing gut suture
only if liposuction is added this is a
picture of a 48 year old woman before an
after the face type procedure at
approximately four months after the
procedure