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 © June 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,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

correction of inferior displacement through repositioning ensures an optimal outcome for each of the other modalities used. Prior to the 2015 FDA 510(k) approval of the Silhouette InstaLift™ absorbable suspension suture (Sinclair Pharma, London, UK) for use in the midface,6 the primary tool to address inferior descent was surgical facelift or placement of a permanent suture that required open dissection of the temporal fascia with suture fixation to the fascia. While fillers represent a noninvasive method that can reverse the descent of facial features to some degree through their capacity to restore volume and support overlying tissues, they are not designed to reposition tissue, and their theoretical capacity for lifting is limited by the need for natural looking and aesthetically balanced results. The Silhouette InstaLift™ absorbable suspension suture is not only the single available non-surgical tool for repositioning, but also serves to recontour and revolumize through the activities of the PLLA and PLGA within the suture/cones. Furthermore, absorbable suspension suture technology is a modality supportive of complementary treatments such as energy-based devices, fillers, and toxin, and is an important element of the holistic approach to rejuvenation that yields high patient satisfaction.

The Silhouette InstaLift™ Suture

The Silhouette InstaLift™ absorbable suspension suture is unique in that the cones are oriented in a bidirectional fashion along the suture (Figure 1) and that the device is entirely absorbable. Both the suture and the cones are composed of 18% poly lactic-co-glycolic acid (PLGA) and 82% poly-L lactic acid (PLLA). Use of absorbable suspension suture technology affords a non-surgical, segmental approach for the treatment of facial laxity that can correct inferior displacement by targeted repositioning of descended tissue. Recovery time following suture placement is minimal, and results are evident immediately. While the physical lifting capacity of the suture itself is diminished as the suture is absorbed, the complementary collagen-stimulating properties of PLLA/PLGA7,8 within the suture provides revolumization that permits a sustained recontouring of the treated area for 18 to 24 months following placement.9,10 In addition, adhesion or “holding” of tissue in the uplifted Figure 1