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
Sun-damaged skin may be encountered more frequently in this population. In these patients, the increased capillary fragility and comparatively thinner dermis may lead to more bruising; however, the patient may be counseled on the relative risk. For the patient shown in Figure 4, absorbable suspension sutures were able to address both facial asymmetry and inferior displacement. For patients who are not a candidate for surgery, the effacement of the nasolabial fold, tissue repositioning throughout the cheek and midface, and the improved definition of the jaw line achievable with absorbable suspension sutures is often a procedure with high patient satisfaction.
Additional Patient Populations
Initial recommendations in the first consensus paper underestimated the potential of absorbable suspension sutures in thicker-skinned patients, as the authors have subsequently found that positive outcomes are achievable if a sufficient number of sutures is utilized and the skin is of sufficient mobility and pliability. Absorbable suspension sutures are a valuable tool for the treatment of patients with round faces who require volume correction or reshaping, but for whom fillers are not ideal, or for the management of facial asymmetry.Patients with very early signs of inferior displacement of facial features are also excellent candidates for absorbable suspension sutures. Candidates for prejuvenation may be genetically predisposed to early development of a more pronounced nasolabial fold or jowling. In these patients, placement of comparatively fewer sutures on each side is a procedure associated with high patient satisfaction. Ideal candidates for prejuvination wish to prevent or minimize the progression of tissue inferior displacement, are comfortable with injections and aesthetic medicine, and have sufficiently mobile skin.
Placement of absorbable suspension sutures takes approximately 30 minutes in the hands of a skilled practitioner. The most time-intensive phase of suture placement is pre-treatment planning; the procedure itself is technically straightforward and highly adaptable. The number of sutures may be easily increased to suit the needs of the individual patient, as using the marked entry and exit points of other sutures as a guide eliminates the need to re-measure the patient should the need for additional sutures emerge after the procedure has begun. The number of sutures should be adjusted to suit individual patient treatment goals and may be different on each side of the face to account for asymmetry. While treatment must be adapted to suit the needs of individual patients, there are several considerations that have emerged as critically important over the past year that the authors wish to emphasize. First, physicians interested in adding absorbable suspension sutures to their practice should seek out training by contacting a Silhouette InstaLift™ representative or by submitting a request through www.instalift.com. In addition, there are CME resources available that include videos of the procedure performed by authors of this publication available through X-Medica, LLC. The procedure is technically straightforward, and the learning curve is easily managed; however, proper technique is critically