Patient Preparation

1. Remove all jewelry and piercings
2. Use a bouffant cap to keep the face clear of hair
3. Remove make-up
4. Take a picture of the patient before treatment
5. Determine the areas to be treated and the vectors
6. Draw vectors using the Silhouette Soft Ruler and a marking pen (image to the right)
7. Choose the variant or length of suspension suture according to the needs of the patient

Minimum length between the entry and each exit points for all patterns
8 cones device / 6cm
12 cones device / 9cm
16 cones device / 11cm

The anaesthesia of the mid face treatment is realised at the entry and exit points where the pre-op marking was previously drawn.

It is not advised to inject along pre-marking path to avoid depth placement issues.

The anaesthesia of the eyebrow/neck treatment is realised at the entry and exit points where the pre-op marking was previously drawn.

To help cones going through the tissue and limit the pain, local anaesthesia could be also administered along the pre-marking path.

For the procedure it is advised to prepare the following material:

• Treatment Gown for the patient
• White coat for the physician
• Non sterile gloves for the anaesthesia
• Lidocaine 1% with adrenaline 1:200.000
• Syringe : 3 to 5cc
• Needles : 31G x 2 and 18G x 1
• Silhouette Soft suspension sutures
• Needle : 18G x 2 (pre-hole)
• Sterile scissors
• Sterile gauzes
• Sterile gloves for the suture insertion
• Antiseptic solution
• Make-up remover

1

Cover the patient’s head with a sterile field

• Once the material is prepared, and the anaesthesia performed, it is recommended to cover the patient head with a sterile field.
• Put your sterile gloves on
• Cut a circle of the size of the patient’s head
• Use a 90x 75 cm sterile drape
• Fold it in 4 and cut it with your sterile scissors
• Place the field over the patient’s head

2

Disinfect the area for a third time

3

Prepare the suspension suture

Remove Silhouette Soft device from the tray, and with slight traction pull on each end of the suspension suture, to tighten the knots and check the device conditions.

4

Entry hole creation

Create an entry hole with a 18G needle. Before inserting the SS needle, create the entry hole with an 18G needle and enter perpendicular to the skin. While entering the tissues maintain the skin flat until you’ve reached the hypodermis. When reaching the subcutaneous fat pinch the skin, to avoid lesions of underlying tissues.

5

Enter perpendicularly to the skin to a depth of 5mm

Insert the first suture needle perpendicularly to the skin through the entry point to a depth of 5mm into the subcutaneous tissue until the black line disappears.

6

Insert the suture parallel to the skin

Guide the needle paralleled to the skin through the subcutaneous tissues until the exit point.

Extract the needle and gently pull it out

Once the needle has reached the exit point, gently exit the needle and pull it to allow the first series of cones to enter in the adipose tissue.

Exiting the needle

Before exiting check the regularity of the insertion depth by slightly lifting the needle. Extract the needle through the exit point helped with the cap of the 18G needle.

Cut the needle

The needle may be cut off leaving the free ends long.

10

Insertion of the other half of the suture

Then start with the insertion of the second half of the suture. Introduce the needle perpendicularly to the skin in the same entry hole, respecting the depth of 5mm into the adipose tissue. And proceed the same way then for the first needle.

11

Repeat these actions with each suture

The entire suture has now been implanted and is positioned in the superficial layers of the hypodermis. Repeat these actions with each suture, then on the other side.

12

Tissues positioning over the cones

With all the fingers of one hand, pinch the tissue, while applying gentle pressure. At the same time, pull the exposed ends of the sutures with the other hand, so that the cones connect with the tissue to maintain the compression.

Check symmetry once the patient sits up

Results adjustment

Once adipose tissue compression has been completed, trim the free ends of the sutures at the exit points.

Trim the suture

Use the tips of the scissors to gently pull back the skin in order to trim the suture at a deeper level. It is desirable to bury the end of the sutures under the skin to avoid possible erosion of the device through it. This last step is crucial to prevent extrusion of the device that could cause irritations of the skin for the patient.

Clean the treated area and apply antiseptic ointment.

Provide patients with the Post Treatment recommendations leaflet. After the treatment, a slight oedema or bruising may occur. Sometimes, a slight depression or skin irregularity may appear at the entry points. These inconveniences disappear a few days after treatment.