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Midface elevation technique


Dr. Isse
New Orleans — Barbed polypropylene sutures for midface elevation provide another technique that can be used by facial plastic surgeons in selected patients to address, in particular, ptosis of the midface, according to Nicanor Isse, M.D., a pioneer in scarless and minimal incision endoscopic cosmetic surgery. He is in private practice in Newport Beach, Calif.

A recent study, published in the January-February issue of Archives of Facial Plastic Surgery, coauthored by Dr. Isse and Dr. Lee, showed that all patients demonstrated improvement in the midfacial area and jowls, with minimal complications, using the barbed polypropylene sutures technique.

In the past decade, the popularity of minimally invasive procedures for midface rejuvenation has greatly increased and offers alternatives to the standard facelift.

Dr. Isse's technique using percutaneous barbed polypropylene sutures is designed to specifically address midface aging.

"It can be used to reposition on the brow, with reservation, because of the high incidence of rupture, extrusion and palpation," he says.

"It can be performed in a closed or open approach, depending on the degree of tissue repositioning required," Dr. Isse explains.

The procedure In 1992 Dr. Isse introduced the endoscopic procedure, which uses an endoscope and requires fewer incisions than a standard facelift procedure.

Recently, he developed "the extended mono-directional" barbed suture material, which is introduced under the skin and pulled back to tighten the face.

"The barbs grab and pull the tissue up; the proximal end is secured to the deep temporal fascia," he explains.

"With this procedure, we further reduce the incision and dissection on the face," he says. "With the endoscopic approach, although the incisions were small on the temporal area, the dissection on the midface was wide."

The study Dr. Isse set out to determine the efficacy of the extended mono-directional barbed polypropylene suture in the elevation of the aging midface and the rate of associated early complications. The results obtained in 44 percutaneous barbed polypropylene suture treatment patients from his private practice plastic surgery facility were examined.

Of these patients, 34 underwent an open approach and 10 a closed approach procedure.

"We focused our attention on improvement of the aging midface, including the infraorbital hollow, lower lid position, nasolabial and melolabial creases and nasojugal groove. We also focused on improvement of the jowls," Dr. Isse explains, noting that all patients demonstrated improvement in the midfacial area and jowls, with minimal complications.

"With these barbed sutures the amount of dissection is much less, and the surgical time is less," Dr. Isse says. "At this time, with the follow-up of a year-and-a-half, the longevity of this technique using this type of suturing appears to be as good as the standard procedure."

Structural sutures One drawback of the barbed sutures is that because the suture is cut to make the barb, it is weakened.

"In the study there was some breakage of the barbed sutures," he says. "Some broke and some were not held properly."

This led Dr. Isse to develop a second-generation suture currently referred to as the "structural suture." The structural suture, which recently received U.S. Food and Drug Administration approval, is designed to be stronger and without cuts.

"Instead, we added another structure to the suture to create a grasping effect," he says.

Dr. Isse says that the structural sutures are designed to create a greater and stronger collagen tissue formation around the sutures.

"It will be so strong that not only will we be able to pull during surgery, but at a later date, we can come back to pull further," he says.


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