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
approval of a new technology comes a need to optimize patient selection, clarify the details of an ideal treatment approach, determine how to best use the new technology in combination with other modalities, and offer guidance on how to best prevent and manage any adverse events. Within this update, the authors provide a consensus on each of the above elements of patient care, with special consideration for maximizing the high patient satisfaction achievable with absorbable suspension sutures.
Absorbable suspension sutures provide a minimally invasive option for highly specific, segmental treatment of facial laxity. Candidates for absorbable suspension sutures often desire facial recontouring but require repositioning of facial tissue beyond what fillers can provide through volumization alone. These patients may not yet be a candidate for a surgical facelift; may wish to delay the procedure for personal or financial reasons; are unwilling to undergo surgery or require minimal down time; or have already had a facelift and wish to extend the results. In each scenario, the patient should be appropriately counseled about the expected results. The lift provided by absorbable suspension sutures is not a substitute for a surgical facelift. Rather, the sutures provide a combination of repositioning and volumization that give rise to a recontouring that is unique to this device. Further, absorbable suspension sutures can be used with a wide range of complementary treatments to achieve optimal results. Absorbable suspension sutures are a highly adaptable treatment that may benefit a wide array of patients. Below, the characteristics of the “ideal” patient are presented; however, there are many patients outside of this ideal for whom suspension sutures are an appropriate and beneficial treatment. In each of these categories, clear communication between patient and physician is key for shaping patient expectations.
The “Ideal Patient”
The “ideal” patient has strong bony projections, skin of sufficient thickness to prevent palpability of the suture, as well as pliability and mobility to allow for repositioning. The patient may have a visible nasolabial fold, visible marionette lines, loss of definition along the mandibular boarder, and/or jowling, as well as some redundancy of the skin. Patients often have an additional need for volume restoration due to excess ptosis of skin that cannot be managed by filler placement only. Patients with thin skin, excessive fibrosis, sun damage, or excessive local rhytids are generally not the best candidates for absorbable suspension sutures alone.
Mature patients also benefit from tissue repositioning and recontouring. While loss of elastic tissue fibers and a diminished ability to produce collagen may reduce the degree of volumization achieved by the suture’s PLLA/PGLA, tissue may still be effectively repositioned in mature patients and some benefit from the biostimulatory activities of PLLA/PGLA likely obtained. Absorbable suspension sutures are an important treatment modality for patients who are not candidates for a surgical facelift or who wish to maintain the results of a previous procedure without further surgical intervention. Of note, the difficulty in concealing scars from a surgical facelift in men makes absorbable suspension sutures a particularly useful treatment option for male patients.