Z. Paul Lorenc MD FACS,a David Goldberg MD JD,b Mark Nestor MD PhDc
aLorenc Aesthetic Plastic Surgery Center, New York, NY; Department of Plastic Surgery, Lenox Hill Hospital, New York, NY bSkin Laser & Surgery Specialists of NY/NJ; Icahn School of Medicine at Mount Sinai; New York, NY Fordham Law School, New York, NY cCenter for Clinical and Cosmetic Research, Center for Clinical Enhancement, Aventura, FL; Department of Dermatology and Cutaneous Surgery and the Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL
feel “clicks” under the skin), there may be some visible gathering in the skin, but this should dissipate within 2-3 days.After suture placement and tissue advancement, visible sutures are amputated. If a knot or cone appears when the suture is pulled taunt, it should be removed as well. A finger may be passed over the exit sites to ensure the suture end is below the surface of the skin.Additional Considerations for Suture Placement in the NeckPlacement of sutures in the neck is very different from placement in the mid-face, and the resident anatomy is much less forgiving. It is imperative that the physician has a thorough understanding of anatomy, including the platysma and other neck muscles, resident vasculature, as well as the course of the marginal mandibular nerve. Knowledge of fat distribution in the neck is also critical, as this represents the anatomical area in which the sutures are placed. Finally, it is critical that the treating physician be aware of all available treatment options for the neck, as well as the difference between apparent excess tissue caused by excess fat, excess skin laxity, or descent of the skin. Suspension sutures are best suited for patients who require tissue suspension.Patient Selection for Suture Placement in the NeckIn order to be a good candidate for suspension sutures in the neck, the patient must have redundant skin that is easily displaced by postero-lateral force applied during pretreatment evaluation. Sufficient subcutaneous fat must be present in order for the device not to be visible or palpable post procedure. The limitations imposed in the mid-face by excessively thick or damaged skin also apply in the neck.Notes on Technique for Suture Placement in the NeckIn addition to the application of SLVP principles and an understanding of the above-described techniques for suture placement, additional factors are important to achieve optimal outcomes in the neck.The vectors in the neck are more horizontal than those placed in the mid-face. Even so, they still follow the principals of SLVP. They must be placed in a straight line and at a 90° angle to the medial border of the platysma muscle, defined by the medial extent of the neck’s redundancy.The suture placement is more superficial than in the mid face.Use of neuromodulators to lessen the mimetic forces in the neck (medial platysma muscle) is routinely performed one week prior to absorbable suspension suture placement.Post-Procedure CareAquaphor may be used on puncture sites. Ice is applied in the office for 30 minutes and patients are encouraged to continue icing the treated area for 24 hours. Patients may wash their face and use makeup after 48 hours, but should avoid exercise, stay on a soft diet, avoid excessive facial motion, and keep their head elevated on two pillows for one week. Patients are seen at follow up after one week.For patients who have sutures placed in the neck, placement of Steri-Strips or an Ace bandage over the advanced tissue can ensure tissue integration in the correct place and serve to remind the patient to keep their neck relatively immobile and expressions to a minimum.
The lifting effect provided by the sutures, as well as the neo-collagenesis they incite, may last for up to 18-24 months depending on the characteristics of the patient’s skin.16 The authors have been using Silhouette InstaLift for mid-face lifting since its approval in November 2015 and together have treated more than 500 patients. The authors report that there have
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