SutureSuspensionTechniqueforMidfaceandNeckRejuvenationGloriaMabelGamboaMDFACSandLuisOVasconezMDFACS ID: 413662
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OCIETYOFLASTICAND SutureSuspensionTechniqueforMidfaceandNeckRejuvenationGloriaMabelGamboa,MD,FACS,*andLuisO.Vasconez,MD,FACS Seventeenpatientsaveraging51yearsofageunderwent23surgicalprocedures,includingsuturesuspensionforbothmidfaceandneckrejuvenations.A3/0polypropylenethreadwithbioabsorbableconeswith ReceivedAugust29,2008,andacceptedforpublication,afterrevision,August30,2008.Fromthe*SectionofPlasticandReconstructiveSurgery,MedicalCollegeofGeorgia,Augusta,GA;and DivisionofPlasticSurgery,Universityof FIGURE1.Frontalbranchofthefacialnerve,A,B,inrelationwiththetemporalvesselsandtheorbitalrim;C,beneaththesuture;D,abovethesuture.AnnalsofPlasticSurgeryVolume62,Number5,May2009|www.annalsplasticsurgery.com surgicalknotwaslocatedontopofthesurgicalmeshtopreventasymmetriescausedbydisplacementofthesuture(Fig.3B).ThedeploymentofsutureswasdeeptotheDTFandplacedatthesubcutaneouslevelatthehairline,withdigitalassistance;theneedlewasthreadedinauniformfashion(Fig.3C).Thevectorsofthe2medialsutureswereslightlyhorizontalandthelateralsutureswerevertical.Thewoundwasclosedinlayers,andapapertapewasappliedtotheliftedareaandmaintainedinthispositionfor3to4days(Fig.3C).Thenecksuspensiontechniquewasperformedeitherwithorwithoutsuction-assistedlipectomy.Asmall,1-cmretroauricularskinincisionwasmade.Subsequently,sutureswerethreadedinauniformfashionatthesubcutaneouslevelandexitedatthemidlineoftheneck(Fig.4).Theprocedureswerecarriedoutinanoutpatientsettingandtheaveragedurationwas45minutes.AhistologicillustrationshowingÞbrosisaroundthepolypropyleneknotandconewasdemonstratedinabiopsy6monthspostapplicationofthesuture(Fig.5).Twenty-threesurgicalproceduresin17patientswithameanfollow-uptimeof9monthswerestudied.Ofthe23procedures,12involvedtheprocedureformidfacerejuvenation,3forfacialpalsyasymmetry,5forneckaestheticprocedures,2forbrowptosis,and1forbrowasymmetry.Themidfacesutureliftprovidedanteriorprojectionofthecheek,elevatedthecornerofthemouth,andimprovedthejowls(Fig.6).Thebrowptosiscorrectionsimprovedthelateralthirdoftheeyebrowwithelevationeitheraboveorintheorbitalrim(Fig.7).Theneckprocedureshowedthesatisfactorydelineationoftheneck-man-dibleangle(Fig.8). FIGURE2.Polypropylenewithbio-absorbableconeswithmultiplepointfixation(SilhouetteLift,KolsterMethodsInc). FIGURE3.A,Preoperativemarking;B,2surgicalmeshsutureatDTF;C,deploymentofsu-ture;andD,surgicaldressing. FIGURE4.A,Solidlineshowstheextensionofthesuction-assistedlipectomy.Interruptedlineshow-ingthesutureposition;B,retroau-ricularincision;andC,delineationoftheneckwithsuturesuspension.AnnalsofPlasticSurgeryVolume62,Number5,May2009SutureSuspensionTechnique ©2009LippincottWilliams&Wilkins Complicationswereminimaltemporaryedemainallpatients;2patientsdevelopedbruisingand2hadanonlymoderateaestheticimprovement.Ofthese2moderatelyimprovedpatients,1patientunderwentresuspensionofthesuturesafter4monthsofsutureplacement.Typically,patientscanreturntoworkin3to4daysafterTheSilhouettelift,amodiÞedpolypropylenesuturewithabsorbablecones,providesadvantagestosurgeonsandpatientswithminimalmorbidityforfaceandneckrejuvenation.Thesurgicaltechniqueissimple;patientsneedonlylocalanesthesiaandthemeanoperationdurationis45minutes.Additionally,thesuturescanbeusedincombinationwithotheraestheticandreconstructive- FIGURE5.Biopsyofapatientafter6monthsofsutureplacement.A,Fibrosisaroundandinthecone;B,fibrosisaroundtheknot(CourtesyofDr.FrancoPeregoandDr.RobertoPizzamiglio). FIGURE6.Top,a43-year-oldfe-malepatientpreoperativeview.Lower,9monthspostoperativemidfacesuturesuspension. FIGURE7.A38-year-oldfemalepatient.Top,preoperativeview.Lower,browsutureliftingandblepharoptosiscorrection.GamboaandVasconezAnnalsofPlasticSurgeryVolume62,Number5,May2009 |www.annalsplasticsurgery.com©2009LippincottWilliams&Wilkins facialprocedures.Furthermore,theoverallpatientsatisfactionat9monthsis90%verysatisÞedand10%moderatelysatisÞed.Thelongevityandthelong-termeffectsofthesuturesthemselvesremaintobedetermined.TheauthorsthankDrs.FrancoPeregoandRobertoPizzamigliofordemonstratingthesurgicaltechniqueandMr.ChristopherBobadillaforeditingthemanuscript.1.SaylanZ.Pursestring-formedplicationoftheSMASwithÞxationtothezygomaticbone.PlastReconstrSurg.2002;110:667Ð671.2.TonnardP,VerpaeleA,MonstreyS,etal.Minimalaccesscranialsuspensionlift:amodiÞedS-lift.PlastReconstrSurg.2002;109:2074Ð2086.3.SasakiGH,CohenAT.Meloplicationofthemalarfatpadsbypercutaneouscable-suturetechniqueformidfacerejuvenation:outcomestudy(392cases,6yearsÕexperience).PlastReconstrSurg.2002;110:635Ð654.4.ErolOO,SozerSO,VelidedeogluHV.Browsuspension,aminimallyinvasivetechniqueinfacialrejuvenation.PlastReconstSurg.2002;109:5.SalascheSJ,JarchowR,FeldmanBD,etal.Thesuspensionsuture.JDermatolSurgOncol.1987;13:973Ð978.6.RobinsonJK.Suspensionsuturesinfacialreconstruction.DermatolSurg2003;29:386Ð393.7.DiMarzoL,HunterWJ,SchultzRD,etal.Invivostudyofexpandedpolytetraßuoroethylenevascularsuture.VascSurg.1989;23:77Ð82.8.YousifNJ,MatloubH,SummersAN.Themidfacesling:anewtechniquetorejuvenatethemidface.PlastReconstrSurg.2002;110:1541Ð1553.9.SulamanidzeMA,FournierPF,PaikidzeTG,etal.Removaloffacialsofttissueptosiswithspecialthreads.DermatolSurg.2002;28:367Ð371.10.SulamanidzeMA,PaikidzeTG,SulamanidzeGM,etal.FacialliftingwithÒAptosÓthreads:featherlift.OtolaryngolClinNorthAm.2005;38:1109Ð1117.11.LyckaB,BazanC,PolettiE,etal.Theemergingtechniqueoftheantiptosissubdermalsuspensionthread.DermatolSurg.2004;30:41Ð44.12.WuWTL.Barbedsuturesinfacialrejuvenation.AestheticSurgJ.2004;24:13.LeeS,IsseN.Barbedpolypropylenesuturesformidfaceelevation.FacialPlastSurg.2005;7:55Ð61.14.UsherFC,AllenJE,CrosthwaitRW,etal.Polypropylene-monoÞlament:anew,biologicallyinertsutureforclosingcontaminatedwounds.1962;179:780Ð782.15.VanWinkleWJr,HastingsJC,BarkerE,etal.Effectofsuturematerialsonhealingskinwounds.SurgGynecolObstet.16.JeongS,MaYR,ParkerYG.HistopathologicalstudyoffrontalissuspensionJpnJOphthalmol.2000;44:171Ð174.17.AlexJC,NguyenDB.Multivectoredsuturesuspension:aminimallyinvasivetechniqueforreanimationoftheparalyzedface.ArchFacialPlastSurg18.LittleJW.Three-dimensionalrejuvenationofthemid-face:volumetricres-culpturebymalarimbrication.PlastReconstrSurg.2000;105:267Ð285.19.VazquezGD.Facialpercutaneoussuspension.PlastReconstrSurg.2005;116:656Ð660. FIGURE8.Top,preoperativeviewofa38-year-oldwomanwithse-verenecklipodystrophy.Lower,7monthspostsuction-assistedlipo-suctionandnecksuturesuspen-AnnalsofPlasticSurgeryVolume62,Number5,May2009SutureSuspensionTechnique ©2009LippincottWilliams&Wilkins