Advertisement

Guided suturing technique for midface lift through minimal temporal incision

Published:April 07, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.061

      Summary

      Background

      The midface has been a difficult zone to manage in rejuvenating surgeries. The major challenge for midface lift is to achieve extensive dissection and elevate the composite tissues en bloc through minimal incisions.

      Methods

      In a total of 22 composite midface lift cases, a titanium cable wire was used. The wire was made into an elastic loop that guided three SMAS-suspending sutures out of the subcutaneous plane through a short incision at the temporal region. Then, each suture was fixated to the deep temporal fascia. Postoperative complications and the subjective assessment of the patients were evaluated.

      Results

      Surgeries were successfully commenced in all cases. Midface sagging, eye bags, and nasolabial folds all exhibited considerable improvements. Major complications such as nerve injury and alopecia were not observed. The patients were followed up for an average of 16.9 months. In general, 90% of the patients were satisfied with their outcome.

      Conclusion

      This guided suspension suturing technique effectuates a more convenient and efficient way to conduct multi-points anchorage of the composite malar flap. When properly executed, this technique allows the anchorage sutures to bite into the deeper layer of the SMAS that ensures firm suspensions in midface rejuvenation surgery,

      Keywords

      To read this article in full you will need to make a payment

      References

        • Hester T.R.
        • Codner M.A.
        • McCord C.D.
        • Nahai F.
        • Giannopoulos A.
        Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience.
        Plast Reconstr Surg. 2000;
        • Pascali M.
        • Botti C.
        • Cervelli V.
        • Botti G.
        Midface rejuvenation: a critical evaluation of a 7-year experience.
        Plast Reconstr Surg. 2015;
        • Hamra S.T.
        Composite rhytidectomy.
        Plast Reconstr Surg. 1992;
        • Choucair R.J.
        • Hamra S.T.
        Extended superficial musculaponeurotic system dissection and composite rhytidectomy.
        Clin Plast Surg. 2008;
        • Saltz R.
        • Ohana B.
        Thirteen years of experience with the endoscopic midface lift.
        Aesthetic Surg J. 2012;
        • Ramirez O.M.
        Endoscopic subperiosteal browlift and facelift.
        Clin Plast Surg. 1995;
        • Zou C.
        • Liu Y.
        • Wang X.
        • Wang T.
        • Wang J.
        Vertical midface lifting.
        Dermatol Surg. 2020; 1
        • Hamra S.T.
        Building the composite face lift.
        Plast Reconstr Surg. 2016;
        • Sykes J.M.
        Management of the Aging Face in the Asian Patient.
        Facial Plast Surg Clin North Am. 2007;
        • Mustoe T.A.
        • Cooter R.D.
        • Gold M.H.
        • Hobbs F.D.R.
        • Ramelet A.A.
        • Shakespeare P.G.
        • et al.
        International clinical recommendations on scar management.
        Plast Reconstr Surg. 2002;
        • Toledo L.S.
        Video-endoscopic facelift.
        Aesthet Plast Surg. 1994;
        • Tonnard P.
        • Verpaele A.
        • Monstrey S.
        • Van Landuyt K.
        • Blondeel P.
        • Hamdi M.
        • et al.
        Minimal access cranial suspension lift: a modified S-lift.
        Plast Reconstr Surg. 2002;
        • Jacono A.A.
        • Parikh S.S.
        The minimal access deep plane extended vertical facelift.
        Aesthet Surg J. 2011;
        • Bertossi D.
        • Botti G.
        • Gualdi A.
        • Fundarò P.
        • Nocini R.
        • Pirayesh A.
        • et al.
        Effectiveness, longevity, and complications of facelift by barbed suture insertion.
        Aesthet Surg J. 2019;
        • Stuzin J.M.
        • Baker T.J.
        • Gordon H.L.
        The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging.
        Plast Reconstr Surg. 1992; 89 (discussion 450-451): 441-449
        • Mendelson B.C.
        • Muzaffar A.R.
        • Adams Jr, W.P.
        Surgical anatomy of the midcheek and malar mounds.
        Plast Reconstr Surg. 2002; 110 (discussion 897-911): 885-896
        • Jacono A.
        • Bryant L.M.
        Extended deep plane facelift: incorporating facial retaining ligament release and composite flap shifts to maximize midface, jawline and neck rejuvenation.
        Clin Plast Surg. 2018;