Resuspension of the SMAS with permanent fixation sutures through minimal incisions offers patients the "pick-me-up" of a facelift without the scars, anesthesia and recovery that are typically associated with a traditional surgical facelift procedure, says Steven B. Hopping, M.D., director of the Center for Cosmetic Surgery, Washington, and a clinical professor of surgery at George Washington University.
According to Dr. Hopping, this permanent suture fixation technique is particularly appealing to men and younger patients because they are most sensitive about wanting to avoid a "surgical" look and visible scars.
"They're a little nervous about looking as if they've had a facelift, but they still want to get improved tightness in their jaw line and improved tightness in the neck," he says. "The younger patients, the male patients and patients who have already had some surgeries and now want to tighten up their neck because that area has aged a little faster, are all good candidates for these permanent fixation sutures."NEW TWIST "The newest twist to facial rejuvenation in our practice that seems to be very popular and effective is the use of permanent resuspension sutures to tighten the SMAS. The advantage of these sutures is that they can be placed through extremely small incisions," Dr. Hopping says. "Obviously, the SMAS is the system that we have traditionally tightened whenever we're doing facelift surgery, but today's patients tend to be looking for facelift results without the risks, recovery and operated 'look' of a facelift, and that's what they like about the lower and mid-face SMAS suspension technique."
The attraction to this technique falls in line with the current paradigm shift in aesthetic surgery, Dr. Hopping says. "Now, it's all about earlier intervention with less invasive procedures. So rather than letting people age and then trying to reverse the aging, which usually requires a substantial surgical procedure, the paradigm shift is that we are trying to extend patients' youthfulness with less invasive interventions so that they don't ever need to resort to the big cut that inevitably looks 'done,'" he says.
Dr. Hopping has taken the popularity of these minimally invasive permanent suture SMAS tightening procedures a step further by introducing the use of micro incisions to minimize scaring. "We've been using permanent sutures in facelifts for a long time, and we've been tightening the SMAS for a long time. My contribution to this is the addition of tightening the SMAS through minimal incision access so we accomplish substantial tightening with minor incisions," he explains.
LOWER AND MIDFACE The "suture necklift" is best for patients with platysma banding and skin laxity who do not want a formal facelift, Dr. Hopping says. These would include men, younger patients and previous facelift patients who have developed neck laxity.
"In the neck, we're actually doing a suspension that goes from ear to ear with a permanent fixation suture. It's helpful for patients who have hanging platysma bands, and (it) appeals particularly to men because it is minimally invasive," he says.
The "suture midface lift" can provide subtle improvement to the midface and jowl region without the need for an anterior facelift scar, Dr. Hopping says. Often, the "suture midface lift" is combined with the "suture necklift" and midface volume enhancement with autologous fat to achieve the best results for patients wanting to avoid visible scars and protracted recovery.