Morphological foundations of facelift using APTOS filaments（3）
On day 40, further thickening of the capsule wall around both the shaft and the barbs of APTOS filaments took place; however, the capsule development was not completed. The capsule wall facing Epidermis was significantly Thicker than that facing the Subcutaneous fat layer（58 and 18.75 mem, respectively）. Connective tissue bands arising from the capsule walls, shafts and barbs of APTOS filaments became thicker and longer than before. Simultaneously, the number of Microvessels increased. Most of them underwent Hyperemia, but no signs of exudation were documented. A peculiar morphological finding on day 40 was Parallel bands composed of Connective tissue fibres and extending towards the Subcutaneous fat layer. According to micro-metric measurements, the bands were from 5,000 to 8,000 mem long and from 900 to 300 mem wide. They occupied a total area of 4,200 mem.
Characteristic changes in loose connective tissue close to the implanted filaments included：
• an increased number of vessels in the Micro-circulatory system（arterioles, venules, pre-and postcapillaries, and capillaries）compared with tissues located farther from the implants;
• Micro-vessels looked overfilled with blood, i.e. had an open lumen, any time after the implantation of APTOS filaments; in other words, Implantation induced persistent hyperemia and therefore stimulated blood supply to the tissues surrounding APTOS filaments;
• Fibroblasts of Loose connective tissue had enlarged nuclei and plasma volume and finely dispersed chromatin which suggested a functionally active state.（Loose connective tissue is a category of connective tissue which includes Areolar tissue, Reticular tissue, and Adipose tissue.）
Staining with toluidine blue revealed an increased number of mast cells in the loose connective tissue layer surrounding APTOS filaments. These cells were concentrated in perivascular space of the microcirculatory system (fig. 2).
The tissue response to smooth polypropylene filaments on day 40 after their implantation was not significantly different from that to APTOS filament. However, the capsule developing around smooth polypropylene threads had Thinner walls and Matured quicker than around APTOS filaments, evidently due to less severe irritating effect on the tissues. The capsule wall thickness varied from 52,5 mem on the side facing epidermis to 42.75 mem on the side facing the subcutaneous fat layer. The lateral walls of the capsule were approximately 400 mem thick. The width of the middle part of the lateral walls was around 136.75 mem. Tissues surrounding smooth filaments contained an increased number of microvessels, but hyperemia and vasculariza-tion were less pronounced than around APTOS filament.
On day 90 after the implantation of APTOS filaments, the Inner capsule layer was composed of functionally active Cells, each containing a large amount of cytoplasm, The Outer layer consisted of Collagen fibres and a small number of fibrocytes (fig. За). Fibrous capsule structures and similar structures of the surrounding tissue merged into one another giving rise to a continuous network. In the course of time, the Fibrous capsule became more and more tightly integrated with the Surrounding tissue which promoted Solid fixation of the implanted filaments. Both the Shaft and the Barbs of the filaments were braided with Fibrous tissue structures. The capsule wall near the Barbs was Thicker but Less mature than around the shaft of the filaments; it contained more Cellular elements than fibrous ones. Simultaneously, the number of mast cells increased. Giant cells close to the filaments were very Rare and localized near the Barbs.
Fig. 2. Microphotograph showing accumulation of mast cells around APTOS filament. Staining with toluidine blue (x 40)
Fig. 3. Microphotographs of the capsule surrounding APTOS filament and its barb. Van-Gieson pyrofuchsin staining (a-b)
a - 90 days after implantation. The capsule wall around the barb is much thicker than around the shaft. Cellular elements predominate (x 40);
b - 210 days after implantation. The capsule wall around the shaft is thin and contains few cells. The capsule around a barb contains many cellular elements (x 40)
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