Palm Desert, Calif. — Suture suspension is a technique that "falls in between" more invasive procedures like the standard facelift and less invasive techniques like filler injections as a method of facial rejuvenation and midface elevation, according to a panel of plastic surgeons here.
Speaking at the annual meeting of the American Society of Plastic Surgeons, Nicanor Isse, M.D., an assistant clinical professor at the University of California at Los Angeles School of Medicine, says the technique, which involves percutaneous application of a needle through the skin, currently provides a duration of effect of anywhere from four to six months. But he predicts that the duration of effect will be prolonged with the application of more and better sutures.
The Silhouette (structural suture), soon to be released.
"Applying sutures will be an intermediate step in the armamentarium of facial rejuvenation," says Dr. Isse, who has a private practice in Newport Beach, Calif. "On the one hand, you have fillers, which are very noninvasive as a procedure, but their effect is limited to four to six months. On the other hand, you have major surgery, which can last five to six years, but is very invasive. This procedure will lie somewhere in between."
Making a good technique better
In data published in the January-February 2005 edition of Archives of Facial Plastic Surgery, Dr. Isse reported results with using barbed polypropylene sutures to elevate the aging midface. Of the 44 patients studied, 34 underwent an open approach, or Malar dissection, while 10 underwent a closed approach. The surgeries focused on improving the infraorbital hollow, lower lid position, the nasolabial and melolabial creases, the nasojugal groove and the jowls. The study found all patients experienced improvement in the midfacial area and jowls, with minimal complications.
The conventional barbed suture, currently in use. Photos: Nicanor Isse, M.D.
While the technique has demonstrated some success in addressing ptosis of the midface, relapses are seen in patients, which is why investigators are reinforcing the tissue with graft and developing new types of sutures, Dr. Isse says.
Dr. Isse has been developing a suture that has received approval from the Food and Drug Administration. Called "structural sutures," these new sutures are stronger than barbed sutures and stand less of a chance of breaking or cutting. They are also designed to interact with normal tissues through surrounding collagen tissue formation.
Comparison of the conventional barbed suture and the Silhouette.
"I think this technique can eventually create an effect that lasts about three years," Dr. Isse tells Cosmetic Surgery Times. "One key to achieving that is to create more of an interface between sutures and the normal tissues. Using barbed polypropylene sutures does not create much of an interface. The longevity of the effect will depend on how the sutures are manufactured and how many sutures are being applied. We want to minimize the need for repeat procedures."
Complications and cautions
In terms of complications, no infections have been reported with suture suspension employed for midface rejuvenation in Dr. Isse's series. Patients typically feel some pain and tenderness following the procedure. Occasionally, the sutures might break and migrate, requiring a minimal incision for extraction.
Experience to date has shown that suture suspension is more effective a technique for midface elevation than for the forehead or the neck, Dr. Isse says. Clinicians have to be cautious when placing sutures, he adds.