Suture Facelift Techniques
Non-surgical facelift procedures improve hyperdynamic and static wrinkles, volume loss, and skin surface imperfections but do not address ptosis of deeper tissues including the malar fat pad and the superficial musculoaponeurotic system (SMAS). Although a
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Peter M. Prendergast
25.1
Introduction
In recent years, minimally invasive facial rejuvenation procedures have become more popular. From 1997 to 2008, surgical cosmetic procedures in the USA increased by 180% whereas non-surgical cosmetic procedures in the same period increased by more than 750% [1]. Patients seek minimally invasive treatments that do not require prolonged recovery periods, are low risk, inexpensive, and provide results that look natural. These include chemodenervation with botulinum toxins, soft tissue augmentation using injectable implants, laser skin resurfacing, and skin “tightening” using a variety of light and radiofrequency-based technologies [2]. Non-surgical procedures improve hyperdynamic and static wrinkles, volume loss, and skin surface imperfections but do not address ptosis of deeper tissues including the malar fat pad and the superficial musculoaponeurotic system (SMAS). Although an open facelift remains the gold standard for sagging skin, fat, and the SMAS in older patients, less invasive measures using various suture systems and designs provide a novel alternative for younger patients with early signs of aging. Suture facelift techniques are used as adjunctive measures during traditional open procedures [3], as a complement to less invasive open techniques [4], or as closed procedures without dissection through minimal incisions or punctures [5]. This chapter will focus on closed suture lifting techniques, commonly referred to as “thread lifts”, for the face and
P.M. Prendergast Venus Medical, Dundrum, Dublin 14, Ireland e-mail: [email protected]
neck using various suture materials and designs. These include barbed and non-barbed sutures, coned sutures, and slings using materials such as polypropylene, polytetrafluoroethylene, and polycaproamide sutures. Although still in its infancy, the practice of suture lifting to improve facial contours, restore appropriate tissue projection, and redefine bony landmarks has been widely adopted. Despite this, published data on safety, efficacy, and long-term results remains scant [6]. Unfortunately, the furor and media-driven hype over suture lifts, touted as “lunchtime facelifts” or “1-hour mini-lifts”, often generate unrealistic expectations amongst potentially suitable patients, or sway patients who would best be treated with a conventional rhytidectomy into believing they can achieve similar results with a suture facelift [7]. Nevertheless, these innovative techniques should be embraced rather than discarded so that they can be further studied, improved and refined, and eventually find their rightful place in aesthetic surgery and medicine. In the author’s view, suture facelift techniques currently provide a “better alternative” to non-surgical tissue tightening devices such as radiofrequency and infrared light for patients who would benefit from lifting mild to moderate ptosis, but they do not replace open facelift procedures for those with more severe ptosis or excessive skin laxity (Table 25.1).
25.2
Concept
The goal of any
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