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In men, because the amount of subcutaneous fat between the skin and fascia is less than in women, so the skin-fascia bond is often firmer.

Due to this lower amount of subcutaneous fat, it is not uncommon to find men with unexpectedly thin skin, and a thin fascia is also common. 

However, starting from the lower face - where the platysma muscle begins to become apparent - muscle development is more pronounced, resulting in a stronger, more robust fascia. Therefore, in men, the effects of surgery in the lower face and neck area tend to be pronounced and long-lasting.

Since the patient had undergone numerous prior lifting procedures, we anticipated that the elasticity of the fascia would be reduced, and that a substantial number of residual lifting threads would likely be found; the surgery was planned with this in mind.

Lifting threads themselves do not add significant volume, and in many cases they are gradually converted into collagen fibers, or they induce collagen fiber formation and then disappear. For this reason, in cases where the fascia is thin, they are sometimes deliberately left in place to help maintain the strength of the fascia. Because this was a revision surgery and the patient was male, for the reasons above, complete removal of the residual lifting threads was not specifically explained to the patient beforehand as a planned part of the surgery.

▲ (Image showing the threads removed during surgery - removed as intact as possible, with a large number of various types of threads removed)

However, things do not always go as expected in the real world. Contrary to what had been explained before surgery, it turned out that a large number of threads had to be removed during the actual procedure.
 

There were several reasons for this:

1) Non-absorbable threads: Due to the nature of non-absorbable threads, numerous adhesions resembling retaining ligaments had formed in addition to the patient's natural retaining ligaments; these threads were removed in order to release such adhesions.

2) Thin tissue: As this was a revision case, the overall tissue, including the skin, had become thinner, raising concerns that any remaining lifting threads could become prominent (protrude) or shift out of position.

3) Excessive number of threads: The greater the number of threads, the more the elasticity of the fascia tends to decrease, and in some cases the tissue does not pull/tighten well even after dissection. In addition, a larger number of threads is often associated with a higher likelihood that some were inserted in inappropriate positions, which frequently does little to help prevent sagging.

Unlike true foreign bodies, lifting threads do not necessarily have to be removed.
 

It is important to weigh the advantages and disadvantages of leaving lifting threads in place and make that judgment during the surgery itself, since not everything can be determined in advance. Furthermore, as patients are only human, it is natural that they may not remember all of their past surgical and procedural history. For this reason, no matter how much experience one accumulates, revision surgeries always offer something new to learn, and this case served as a reminder of the importance of maintaining a humble attitude.