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Wahdan W, El Saloussy Y. The Use of Multifilament Suture for SMAS Plication in Rytidectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5199. [PMID: 37593702 PMCID: PMC10431410 DOI: 10.1097/gox.0000000000005199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/29/2023] [Indexed: 08/19/2023]
Abstract
Background In the public's mind, rhytidectomy, better known as a facelift procedure, is the technique most closely associated with plastic surgery. When done correctly, it yields highly satisfactory results. The aim of our study was to retrospectively review results of our patients whose procedures were performed using the superficial musculoaponeurotic system (SMAS) plication technique. Plication was performed with multifilament braided sutures, which provided a sustainable lift and satisfactory results. Methods This study involves a retrospective review of 137 patients who underwent primary or secondary facelift procedures over a period of 46 months. The average patient age was 59 years, with ages ranging from 30 to 77. Patients were reviewed at 6 and 12 months postoperatively. Subjective evaluation based on photographic analysis was performed pre- and postoperatively. Results All cases included in this study indicated satisfaction with postoperative results on 1 year postoperative review for both the patients and performing surgeons. Four patients presented with a postoperative hematoma that required surgical intervention. One patient developed skin infection that was followed by skin necrosis. Another patient presented with wound infection that resulted in partial wound dehiscence. Both cases were managed conservatively. Conclusions With the abundance of techniques directed toward the SMAS layer, it has become a pivot point for facelift procedures. This expansion in approaches places emphasis on the SMAS layer and its manipulations. The type of suture material utilized in SMAS plication is, therefore, undoubtedly essential. Our use of braided multifilament sutures for SMAS plication provided satisfactory results at 1-year postoperative review.
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Affiliation(s)
- Wessam Wahdan
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
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Wong CH, Mendelson B. Commentary on: Sub-SMAS Reconstruction of Retaining Ligaments. Aesthet Surg J 2022; 42:1218-1221. [PMID: 35731703 DOI: 10.1093/asj/sjac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Wong CH, Hsieh MKH, Mendelson B. Asian Face Lift with the Composite Face Lift Technique. Plast Reconstr Surg 2022; 149:59-69. [PMID: 34758001 PMCID: PMC8700314 DOI: 10.1097/prs.0000000000008686] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The composite face lift is becoming increasingly popular following recent advances in understanding of facial anatomy that enable safe sub-superficial musculoaponeurotic system (SMAS) dissection. This article presents the authors' technique for composite face lift in Asian patients and reviews their experience and outcome with this procedure. METHODS Composite face lifts were performed on 128 Asian patients between January of 2010 and June of 2020. Ninety-four were primary face lifts, and 34 were secondary or tertiary face lifts. The authors' surgical technique and adaptations for the specific requirements of Asian patients are described in detail. The mean follow-up was 26 months (range, 6 to 108 months). Fat grafting was an integral part of our procedure, with 95 percent having concomitant facial fat grafting with their face lift. RESULTS Patients were followed up in accordance with a standardized schedule. The majority of patients reported high satisfaction with the aesthetic outcome of the technique, with natural, long-lasting results. The face lift plane of dissection is through the facial soft-tissue spaces, which provide atraumatic sub-SMAS access with precise release of the intervening retaining ligaments for effective flap mobilization. By emphasizing tension on the composite flap with no tension on the skin closure, the scars were discrete in the great majority of patients. Complications were few, with no hematomas or skin flap necrosis. The temporary nerve injury rate was 1.5 percent, with no patient having a permanent nerve injury. CONCLUSION The composite face lift is an ideal technique for Asian patients, as it delivers natural, long-lasting results; a quick recovery; and high patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Chin-Ho Wong
- From W Aesthetic Plastic Surgery; the Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital; and the Centre for Facial Plastic Surgery
| | - Michael Ku Hung Hsieh
- From W Aesthetic Plastic Surgery; the Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital; and the Centre for Facial Plastic Surgery
| | - Bryan Mendelson
- From W Aesthetic Plastic Surgery; the Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital; and the Centre for Facial Plastic Surgery
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Yu N, Yu P, Liu Z, Cho J, Zhang W, Liu Y, Zhu L, Zeng A, Si L, Long F, Xiao Y, Wang X. Elastic thread modified minimal access cranial suspension lift for lower and middle third facial rejuvenation. Medicine (Baltimore) 2020; 99:e19381. [PMID: 32221066 PMCID: PMC7220681 DOI: 10.1097/md.0000000000019381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.
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Affiliation(s)
- Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Panxi Yu
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhifei Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Jeongmok Cho
- Banobagi Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Yutong Liu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Loubin Si
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Fei Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
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Meyer DC, Hasler A, Wyss S, Nuss K, Benn MC, Gerber C, Wieser K. Mechanisms of Suture Integration in Living Tissue: Biomechanical and Histological In Vivo Analysis in Sheep. Orthopedics 2019; 42:168-175. [PMID: 31099883 DOI: 10.3928/01477447-20190424-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
The potential of nonabsorbable suture material to augment tissue strength in the long-term is by far not exploited by most of the currently used sutures. The authors hypothesized that different sutures yield specific histological tissue reactions associated with specific mechanical shear resistance of the suture against the tissue. Four different suture types (Orthocord, Ethibond, FiberTape, and FiberWire) were implanted in 36 sheep shoulders (supraspinatus/greater tuberosity). One thread at each time point (6, 16, and 22 weeks) was used for histology, and 11 threads at each time point (0, 6, 16, and 22 weeks) were used for biomechanical longitudinal pullout testing. Histology included tissue maturity, activity of tissue reaction, and invasion of cells and tissue into the suture material. Fiber-Tape had the highest mean pullout strength at 6, 16, and 22 weeks of 4.4 N/cm (SD, 2.1 N/cm), 10.1 N/cm (SD, 5.1 N/cm), and 12.8 N/cm (SD, 6.0 N/cm), respectively. However, general pullout strength at 22 weeks was surprisingly low, particularly for Ethibond, Orthocord and FiberWire. The overall maturity of the surrounding tissue correlated (r=0.84, P=.001) with mechanical performance. Interestingly, in all 4 suture types, an intimate in- and on-growth of fibrous tissue to the filaments and into the space between suture fibers could be shown. However, for Ethibond, Orthocord, and FiberWire, the authors found an unexpected circumferential space around the sutures, often forming an inner and outer capsule, separating the sutures from the surrounding tissue with a shifting layer. [Orthopedics. 2019; 42(3):168-175.].
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Clinical Evaluations of a Novel Thread Lifting Regimen Using Barbed Polyglyconate Suture for Facial Rejuvenation: Analysis Using a 3-Dimensional Imaging System. Dermatol Surg 2019; 45:431-437. [DOI: 10.1097/dss.0000000000001642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kazmer DO, Eaves FF. Force Modulating Tissue Bridges for Reduction of Tension and Scar: Finite Element and Image Analysis of Preclinical Incisional and Nonincisional Models. Aesthet Surg J 2018; 38:1250-1263. [PMID: 29635348 PMCID: PMC6195176 DOI: 10.1093/asj/sjy079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Force modulating tissue bridges (FMTB) represent a new class of combined wound closure and scar reduction device designed to optimize the tension milieu of the healing wound. Objectives Engineering analysis and testing in both intact skin and incisional models was undertaken to assess changes in tissue tension associated with device placement and compare to standard suture closure. Methods Nonlinear, large deformation finite element analyses (FEA) were performed to compare the strains applied to tissues with sutures and FMTB. In the incisional model, a freshly euthanized Yorkshire pig received full thickness cutaneous incisions followed by alternating closure with sutures and FMTBs. FMTBs were also applied to intact adult human skin after pattern application. In each of the experiments, photographs were taken preapplication and postapplication and the resultant dot grid pattern changes were analyzed by image recognition algorithms to calculate applied strains. Results FEA indicate compressive stresses at the tissue:suture interface on the order of 4000 mmHg and 20 mmHg at the tissue:FMTB interface. Strain analysis of the sutures and FMTBs applied in the incisional lab testing indicated imposed strains on the tissues of around 40%, with FMTBs providing 10% more compression than sutures and 25% more compression between the applied devices (P = 0.000057). In the longitudinal study, tension reduction of the order of 30% was maintained over the treatment period of 10 days to verify device efficacy. Conclusions FMTBs provide wounds while simultaneously modulating skin tension and thus have the potential to improve scar appearance.
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Affiliation(s)
- David O Kazmer
- Department of Plastics Engineering, UMass Lowell, Lowell, MA
| | - Felmont F Eaves
- Division of Plastic Surgery, Emory University
- Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, GA
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Oh CH, Jang SB, Kang CM, Shim JS. Buttock Lifting Using Elastic Thread (Elasticum ®) with a New Classification of Gluteal Ptosis. Aesthetic Plast Surg 2018; 42:1050-1058. [PMID: 29610954 DOI: 10.1007/s00266-018-1124-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Conventional buttock lifting is invasive, so it is difficult to recommend it to patients especially to those who do not have severe gluteal ptosis. In addition, the gluteal area is a large area change among the joints. Therefore, this surgery can cause pain during hip flexion after lifting using a conventional thread. The authors report on buttock lifting using an elastic thread with high satisfaction from patients. METHODS From July 2016 to June 2017, 60 patients were enrolled in this study. The degree of gluteal ptosis was graded from Grade 0 to Grade 6. All patients underwent lifting of both buttocks using Elasticum®. We drew a circle along the outer edge of the buttock and another small circle inside the first circle. A stab incision was done at 5 points (A, B, C, C', and D), and then according to the circle, lifting was done. Postoperative grade changes and complications were evaluated. RESULT Grades 2-5 were lifted to at least Grade 2 after surgery, but Grade 6 was at most Grade 3 (14.2%), with 85.8% of these to either Grade 5 or Grade 6. Seven patients (11.67%) complained of postoperative pain, and 6 patients (10.00%) showed skin dimpling or creases 10 days after surgery, all of which disappeared at 1 month after surgery. CONCLUSION Buttock lifting with elastic thread is effective in pre-ptosis to moderate gluteal ptosis. Because of the elasticity of the thread, postoperative pain is low on hip flexion, so the lifting is done naturally. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Kang MS, Shin JS, Nam SM, Park ES. Evaluation of Elastic Lift for Facial Rejuvenation. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2016. [DOI: 10.14730/aaps.2016.22.1.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jin Su Shin
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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Kang MS, Kim SH, Nam SM, Park ES. Evaluation of Elastic Lift for Neck Rejuvenation. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2016. [DOI: 10.14730/aaps.2016.22.2.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sang Hun Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon, Korea
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Cartmill BT, Parham DM, Strike PW, Griffiths L, Parkin B. How do absorbable sutures absorb? A prospective double-blind randomized clinical study of tissue reaction to polyglactin 910 sutures in human skin. Orbit 2014; 33:437-443. [PMID: 25244631 DOI: 10.3109/01676830.2014.950285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the tissue reaction produced by 2 gauges of implanted polyglactin 910(Vicryl) suture material in human skin. METHODS A prospective, double masked, parallel randomized IRB approved clinical trial. Consecutive patients with involutional entropion and horizontal eyelid laxity were randomly allocated to 5/0 or 7/0 gauge test suture groups. Symptoms were alleviated during the wait for definitive surgery by placement of eyelid everting sutures. After 28 days, surgical entropion correction including eyelid wedge excision was achieved. Histological analysis was carried out, masked to the suture gauge used, on the excised eyelid containing one of the temporary everting sutures. Both patient and analyst were masked to the suture group. The four primary outcome measurements were granuloma outer diameter, central cellular diameter, giant cell number and area of fibrous coat and a statistical comparison made between suture gauge groups. RESULTS 21 patients were allocated to each group, and histological analysis was possible in 36 patients. Significant suture-related granulomatous inflammatory reactions were found in all specimens. Medians of the measurements for 5/0 and 7/0 gauge sutures, respectively, were 0.855 mm versus 0.387 mm granuloma outer diameter (p = 0.0001); 0.464 mm versus 0.250 mm central cellular element diameter (p = 0.0003); 0.194 mm(2) versus 0.053 mm(2) fibrous coat area (p = 0.0009) and 0.8 versus 1.2 giant cell number (p = 0.7511). CONCLUSIONS Polyglycolic acid sutures elicit a significant foreign body inflammatory response proportional to suture gauge. This reaction may be minimized by early suture removal. The study validates a novel and ethical approach to the examination of human skin response to implanted suture material.
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Affiliation(s)
- Barry T Cartmill
- Royal Bournemouth Hospital , Bournemouth, Dorset , United Kingdom and
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Sardesai MG, Zakhary K, Ellis DAF. Thread-lifts: The Good, the Bad, and the Ugly. ACTA ACUST UNITED AC 2008; 10:284-5. [DOI: 10.1001/archfaci.10.4.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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