Morphological foundations of facelift using APTOS filaments（2）
Results and discussion
On day 3 after subcutaneous implantation, the filament was found to be isolated from the surrounding tissue mass by an immature connective tissue capsule (fig. 1a) the lateral sides of which gave rise to connective tissue bands. The capsule wall was much thicker close to the Barbs than near the Smooth thread portions. Also, the capsule wall facing epidermis was significantly thicker than its remaining part, probably due to mechanical pressure exerted by the integumentary tissues on the filament and the capsule developing around it. Such variability of the capsule wall thickness is considered to be beneficial for the final face lifting effect and improve its stability.
The histological study revealed marked hyperemia of the Microvascular bed. It was especially pronounced where Barbs rose from the shaft of the thread. The barbs looked braided with tissue cells. The inner capsule layer at the Base of the Barbs was composed of Fibroblasts dominated by Y oung cells. Connective tissue bands growing from the capsule wall were readily apparent as well as inflammatory reaction that resulted in Fibroblast accumulation around the Barbs and thickening of the capsule wall where it faced Epidermis. There were practically no signs of inflammation in the form of infiltration around the implanted filaments.
The structure of the capsule surrounding a smooth polypropylene filament on day 3 after implantation was not substantially different from that formed around a barbed APTOS filament. Only the wall thickness was smaller, being 19.25 mem on the side facing Epidermis and 23.5 mem on the side facing the Subcutaneous fat layer. A Thinner capsule around Smooth filaments was due to the Absence of barbs and the respective less injurious effect of the implanted material.
The shape of the capsule developing after the implantation of both APTOS and smooth filaments was that of a rhombus. However, the capsule around smooth filaments gave out no connective tissue bands arising from their lateral walls.
On day 7, the Capsules around APTOS filaments became thicker due to a rise in the number of collagen fibres. Each capsule exhibited Two distinct layers characterized by different Cell to Collagen fibre ratio (fig. 1b)：
（1）Inner layer enclosing the filament and dominated by young（Fibroblast）Cells and
（2）Outer layer in which Collagen fibres predominated.
The capsules assumed the rhomboid shape while their lateral apices gave rise to connective tissue bands that became thinner as the distance from the capsule increased(fig. 1c). The total length of a band（the capsule wall inclusive）was 886 mem, the width ranged from 108 to 187 mem. The capsules remained well-vascularized despite a progressive rise in the number of collagen fibres within 7 days after filament implantation. The capsule walls were penetrated by a large number of capillary vessels, microvascular hyperemia persisted both in the immediate proximity to the filaments and at a certain distance from them. No signs of pyogenic inflammation could be seen.
The outer capsule layer, although rather thin, always contained a large number of capillary-type vessels.
Isolated lymphoid and plasma cells as well as swollen fibroblasts were readily apparent close to microvessels. The amount of blood congestion in the microvascular bed decreased with the distance from the filament.
The thickness of the capsule formed around a smooth polypropylene filament by day 7 after implantation was 17.75 mem on the side facing epidermis and 17.25 mem on the side facing the subcutaneous fatty layer. Lateral walls were as thick as 54.5 and 25 mem(fig. 1c/).
On the whole, the major morphological characteristics of the tissues surrounding smooth filaments on day 7 after implantation underwent significantly smaller modification compared with the tissues responding to APTOS filaments.
Fig. 1. Microphotographs of the capsule surrounding APTOS filament (a-c) and smooth polypropylene thread (d). Van-Gieson pyrofuchsin staining
a - 3 days after implantation. Cellular elements predominate over fibrous ones, the number of microvessels increases (x100);
b - 7 days after implantation. The capsule has a bilayer structure, persistent hyperemia develops due to marked vasodilation (x100);
с-7 days after implantation. Connective tissue bands can be seen arising from the upper poles of the capsule (x40);
d - 7 days after implantation (x40)
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