New suspension suture eases pain of a facelift

Dr. Sorin Eremia, M.D.
San Diego — A new application for a commonly available suture material makes it possible to perform a higher-quality facelift without the expense or difficulty of standard facelifts.

The technique employs an anchor suspension suture to maneuver the facial mass into position without the cutting and trimming involved in most facelifts, says Sorin Eremia, M.D., assistant clinical professor and director of cosmetic surgery, division of dermatology, University of California, Los Angeles.

The procedure involves a new use of suture material as well as a new device for inserting the anchors beneath the SMAS, Dr. Eremia says, who has applied for a patent on the procedure, and is completing a study of the technique in a group of 20 patients.

The procedure can be used as a stand-alone technique or in conjunction with a standard facelift. The study involved about 13 suspension procedures and six or seven traditional lifts.

The results so far have been promising and less complicated than most facelifts, according to Dr. Eremia at the American Academy of Cosmetic Surgery annual meeting, here.

"With the traditional facelift, you're cutting a bunch of skin up and tightening the excess tissues and trimming them off. There is a procedure similar to mine called the FeatherLift, in which they use a barbed suture, but they put it much more superficially," Dr. Eremia says. "The only type of problem we encountered very early on was that occasionally, if the suture was placed too superficially, you could feel the knotted anchor under the skin. But so far there have been no hematomas, infections, nerve injuries or any other complications."

"As with everything, there is a little learning curve," he says.

No tissue troubles The anchor suture technique makes it easier to deal with facial tissues.

"With the traditional facelift, one of the greatest challenges has been dealing with an area we call the malar fat pad," Dr. Eremia says. "The farther down you go under the superficial musculo-aponeurotic system, the more tissue you lift up, the greater the incidence of hematoma, because the facial nerve branches become more superficial."

The procedure involves taking a common monofilament suture material, polydioxanone (Ethicon), and placing a square knot in it.

"We space five to seven of these knots about a centimeter apart. We take another suture about a centimeter long, tie the knot over the middle of the small suture, and end up with a cross stitch tied into the long suture. Its like a single climbing rope with a piece of wood in it. There's one free end, and at the other end it has a needle attached to it," he says.

"The suspension lift is vaguely similar to the FeatherLift, which uses barbed sutures or Aptos threads. The anchor-type suture I use is far more sturdy, it is absorbable, it is placed much deeper, right on the SMAS and sutured to fascia, and the instrument I designed eliminates the need for an exit point. Conceivably one could use both systems together in the same patient. We have also started to study the combined use a variety of ablative and nonablative methods from CO₂ and erbium to Thermage^® and Sciton scanned 1319 nm laser to enhance long-term results of pure suspension lifts," Dr. Eremia says.