Expert Consensus on Achieving Optimal Outcomes With Absorbable Suspension Suture Technology for Tissue Repositioning and Facial Recontouring
June 2018 | Volume 17 | Issue 6 | Original Article | 647 | Copyright © 2018
Z. Paul Lorenc MD FACS,a Glynis Ablon MD,b Julius Few MD,c Michael H. Gold MD,d David J. Goldberg MD JD,e Stephen Mandy MD PhD,f Mark S. Nestor MD PhD,g and Susan H. Weinkle MDh
aLorenc Aesthetic Plastic Surgery Center, New York, NY; Lenox Hill Hospital, New York, NY bUniversity of California, Los Angeles, CA; Ablon Skin Institute Research Center, Manhattan Beach, CA cFew Institute for Aesthetic Plastic Surgery, Chicago, IL; University of Chicago Pritzker School of Medicine, Chicago, IL; Northwestern University, Evanston, IL dGold Skin Care Center, Nashville; Tennessee Clinical Research Center, Nashville, TN; Vanderbilt University School of Nursing, Nashville, TN; Meharry Medical College, School of Medicine, Nashville, TN eSkin Laser & Surgery Specialists of NY/NJ; Icahn School of Medicine at Mount Sinai, New York, NY; Fordham Law School, New York, NYfSouth Beach Dermatology, Miami Beach, FL; University of Miami Miller School of Medicine, Miami Beach, FL gCenter for Clinical and Cosmetic Research, Center for Clinical Enhancement, Aventura, FL; University of Miami Miller School of Medicine, Miami, FL hBay Area Medical Complex, West, Bradenton, FL
A complete approach to facial rejuvenation includes restoration of the skin’s surface, relaxation of muscles that contribute to hyperkinetic movement, revolumization, and repositioning/recontouring of descended tissues and fat pads. After receiving 510(k) clearance from the US Food and Drug Administration (FDA) in 2015, the Silhouette InstaLift™ absorbable suspension suture became the only available non-surgical technique for repositioning of facial tissue. In January 2017, a consensus paper presented a review of the literature on the efficacy and safety of absorbable suspension sutures and provided information on treatment procedures. Since that time, the clinical experience of the authors has further shaped their treatment practices, highlighting the need for additional guidelines to support an optimal treatment approach. This update will expand upon the 2017 consensus paper on the safety and efficacy of absorbable suspension sutures and provide guidance for obtaining consistently high patient satisfaction with the procedure. Recommendations are based on the extensive clinical experience of expert physicians with absorbable suspension sutures over the past 2.5 years. Here, the authors provide guidance on full face assessment and treatment to support maximum benefit and provide patient selection and procedural recommendations. In addition, the authors stress the benefits of the dual mechanisms of action within the absorbable suspension suture: the immediate lift and volumizing over time that together lead to the outcome of recontouring. J Drugs Dermatol. 2018;17(6):647-655.
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The hallmarks of facial aging include diminished skin tone, increasingly uneven texture, appearance of wrinkles, volume loss, and the descent of facial features.1 Age-associated decreases in ligament stability and involution of bony attachments, coupled with the descent of the fat compartments and changes in musculature, cause the inferior displacement of tissue characteristic of facial aging.2-4 Compounding this loss of underlying support is an increase in skin laxity caused by a reduction in the supportive capacity of collagen and dwindling levels of elastin.4 Together, these physiological changes result in increased prominence of the nasolabial fold, redistribution of tissue along the jowl, and descent of facial features (inferior displacement). A complete approach to facial rejuvenation and restoration generally requires that multiple aspects of facial aging be addressed. Treatment plans may include resurfacing with lasers, skin tightening with energy-based treatments, relaxation with neuromodulators, revolumization with fillers, and repositioning of descended tissue.5 In a global composite approach,