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In this case, we're doing threads to lift the face, lift the eyebrow and the jowls, and I'm going to use the ultrasound first. This is the 15 Clavius device to detect the subcutaneous tissue, because this is where exactly the threads should be inserted. So primarily we're going to detect the thickness of the subcutaneous part that we're going to insert the threads at.

And then we will do the thread injection or the threads insertion. And while doing the threads I'm going to show you where exactly the cannula of the threads is inserted to make sure it's in the right plane. And after finishing the procedure, we're going to make sure that the threads are on the same plane and same placement that we need it to be.

Let's start by unfreeze.

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And then here we are on the cheeks we can see the cheekbone area. There is a little bit of fillers which has a part over the cheekbones. There's this mass on top, which is the little bit whitish layer, and there is the subcutaneous part and the skin. And we can see here that the subcutaneous part on top of the bone is very minimal.

And it's almost 0.1mm. Uh, and if you go a little bit further to the cheek.

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You can see that there is a little bit of subcutaneous tissue. And then this mass and the deep fat layer which has a little bit of fillers and periosteum or the bone.

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So I'm going to be using the threads first in that area. And then we'll do a little bit of lifting to the eyebrow part using threads. And this part is very critical because the amount of subcutaneous fat is almost non-existent. There is a small part of subcutaneous. Then in the temple there is the temporal parietal fascia of the superficial temporal fascia.

So we need to be on top of that to elevate the skin. So now we're preparing the procedure with using a local anesthesia. It's lidocaine with epinephrine.

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Just to make sure the patient is comfortable. And also to decrease the bleeding by using the epinephrine.

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Of course everything is sterile. And this is just our entry points. And later from the needle and move to a cannula.

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I don't blame.

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Now we start with the threads. The first thread will be inserted in this fashion, uh, on the cheek. And, um, I'm going to use the ultrasound to detect where exactly the cannula is inserted. Then I'm going to confirm after we're done doing the threads. The thread is a little bit long. It's 19cm so it can do multiple loops inside.

I'm going to show you under the ultrasound where exactly the thread will be located or the cannula it is and the thread as well.

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So this is inserting the thread with the cannula. So the cannula is inserted. You can see the cannula here. It's confirmed in the subcutaneous part. And the thread should be.

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Going with the cannula. Now I confirm my canyon location. And it's in the subcutaneous area just above this mass under the skin.

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Inserting the thread now in the same plane.

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Reaching the corner of the mouse, elevating the tissues up, removing the thread and doing another loop.

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Just a little bit higher subcutaneously. Going to the nasal labial fold. This time going back and the last part of the thread, I'll insert it in between the two limbs of the of my insertion. Now we're done. So this is the first thread inserted.

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And let's confirm our location.

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And here.

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And this is the thread.

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It's subcutaneous. You can see the hypergolic part subcutaneously, which is at 0.1 or 0.2 centimeters from the skin.

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This is the thread. And if I go a little bit lower

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you can see pieces of the thread here.

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Now you confirm its location.

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We can proceed with the second thread. This is the second thread going in And after finishing the second thread, I'll do another two threads from the tragus part to the gel area to the lower face, and at the end I'll do one thread in the temple area, elevating the eyebrow and the corner of the eye.

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So same insertion subcutaneously as the first one,

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reaching the nasal labial fold,

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elevating the skin and

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doing another loop.

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And finishing the thread.

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Then we'll go here and we can confirm that using the ultrasound.

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This is the cannula inserted.

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You can see where the camera is located.

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It's subcutaneous in the subcutaneous part, and part of the thread

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should be at the top of the cannula. Can you see that? See the tip of the cannula. And now you can see the thread coming out of the tip. So there is part of the thread that is located at the longitudinal axis of the cannula going parallel to the cannula itself. That's the thread on top of the cannula coming out.

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All right. Going subcutaneous on top of the.

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Of the masseter muscle.

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Going to the area.

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All right. Last. Last one.

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It will be in. That will be in the temple area.

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So now see where the thread is located in the temple part.

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We're going here a little bit in the fascia. So you know we need to go a little bit higher. On top of that this is my cannula. You can readjust where we want to have it.

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Then going a little bit super efficient.

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Because this is where exactly yes, we need our cannula to be with the thread subcutaneous. All right.

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Now we confirm it where exactly the thread is located. With the cannula we can proceed with the lifting.

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All right.

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Okay. Now we're done with this side.

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Let's confirm.

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threads location on that side and move to the other side.

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So the first line here subcutaneously above the fascia is the thread. It's hyper echoing.

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Hyper echo. Continuous line. And underneath is the fascia.

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Try to find the other one. There's another piece here. It's in the fascia

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and subcutaneous. This is a very small area to work with.

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Considering the thickness of the skin here.

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And this is the cheek area.

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Checking where our threads are located.

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And then we can see

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how subcutaneously our thread is located here.

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Let's go for

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the lower part of the face.

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So this is the thread.

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You can see pieces of threads and you have to connect them together on the screen.

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And when I freeze the image here, you can see part of the thread in the subcutaneous area on the left side of the screen under curious sign. This is the part of the thread here, and This part has a continuation from the entry point.

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This part.

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And now we can see pieces of threads here

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making sure it's in the same plane. And if you can see there is part of the period a thread and there is part of the anesthetic around it. So there is a rim of fluid which is hypoxic area around the hyper egoic piece of the thread here.

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That's the thread. That's where with suture you can see part of it. And if we move here

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to the gelled area.

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That's again that's the thread. You can see it here.

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Very obvious

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hyper egoic line.

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This is exactly where we needed to be located. Now we will do the other side of the face. Everything will be the same and we start doing threads and the cheeks and the lower part of the face, and then the temples. Um, after we finish with everything, we confirm again with ultrasound location and placement of our threads, just to make sure everything is in the right placement and right plane.

All right, now we're confirming the other side threads insertion placement. And we can see here

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under the corner of the mouth the subcutaneous area where the thread is located. It's hyper egoic part when I move. You can see the lamination and the loop of a thread. You can see the loop two on top of each other here. And the reverberation artifact from the thread.

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So this is a confirmatory sign. This is a thread with the two illumination that we can see.

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This is where the thread is.

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This is where it is. And let me mark it up for you.

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That's the thread. We can see that here. Very clear and obvious. And there is another loop under the thread.

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That's another loop also.

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So there is two loops of the thread in here.

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All right.

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And we're done.