Research Article - (2013) Volume 2, Issue 4
Scarless closed approach suture liftings present skeletal fixation with skin punctures without incisions as a first alternative to classic excision lifts. The author started the anatomy study, instrument creation and thread selection in 1990 and the whole topographic anatomy, instrumentarium and technique understanding of this new method was ready in 1993. Needle preparation and selection of threads was experimental. Stretch, elasticity and cut through tests were performed for selecting threads. Thread long term absorption is crucial in this method. 54 patients were operated in 1993-1994 to correct early ptosis and flabbiness in areas of face and body and the results were published. Author’s contribution is that his closed approach suture techniques lift SMAS and fascias without traditional incisions. Operations are ambulatory with excellent results, reported by the patients. The trauma is minimal and the follow-up period is no longer than a few hours to 3 days with fast, sometimes immediate return to work and social life. There are no visible scars; the needle perforations on the skin disappear within 2-3 days.
Keywords: Suture lifting, Brow lift, SMAS
Operations are ambulatory without hospital stay. The techniques consist of passing closed sutures, by needle perforations only, to lift movable fascias and fix them to non-movable skeletal structures in several facial and body areas [1-23].
We perform the following scarless closed approach suture lifts:
In face areas
- Ambulatory temporal and supra-temporal SMAS Lift; (Figures 1-3)
Figures 1,2: Temporal (upper SMAS to upper temporal line and temporal fascia) and Figure 3. supra-temporal (upper SMAS to upper temporal line) suture SMAS lifts.
- Brow lift, (Figures 4-6)
Figures 4-6: Scarless brow suture lifts (orbito-cutaneous brow fascia discovered by the author to upper temporal line periosteum at 1,5 cm or at hair line).
- Lateral canthus lifting
- Glabella muscle ligation
- Mid face SMAS suture lift, (Figures 7 and 8)
Figures 7,8: Mid-face suture lifts (SMAS zygomatic extension to upper temporal line periosteum or to temporo-parietal tendon).
- Cheekbone SMAS lift and volume creation, (Figures 9 and 10)
Figures 9,10: Cheekbone lifts (Bichat fat pad fascial tube to zygomaperiosteum) and augmentation using own patient tissue without implants.
- Lower SMAS face and neck lift, (Figures 11-13)
Figures 11-13: Lower SMAS-platysma face and neck lifts (platysma fixation to mastoid).
- Chin enhancement, form and position correction by suture; (Figures 14-16)
Figures 14-16: Chin enhancements, form and position corrections with or without fixation to the menton.
- Nasal tip refinement; nasal tip rotation; nasal alar base narrowing; (Figure 17)
Figure 17: Sutures in rhinoplasty: for tip rotation (medial crura of greater alar cartilages to nasal bone periosteum), tip refinement (suturing together all 4 crura of both greater alar cartilages at the dom), allar base narrowing (suturing the alar base incl. accessory alar cartilages).
- Scarless Serdev suture® method in prominent ears, (Figures 18-20)
Figures 18-20: Otoplasties in prominent ears (closed approach perihondrium suture to obtain the antihelix fold) etc.
- Dimple formation in chin and smiling point etc.
In body areas
- Scarless breast lift by suture, (Figure 21)
Figure 21: Scarless breast lifts (fixation of breast fascia to clavicle and/or pectoralis major tendon).
- Scarless buttock lift by suture, (Figures 22-24)
Figures 22-24: Buttock lifts (fixation of the fibrous tissue to the sacro-cutaneus fascia, found by the author).
- Scarless Serdev suture to reposition breast implants in symmastia and false position
- Abdominal flaccidity tightening, (Figure 25)
Figure 25: Abdominal flaccidity tightening (lineaalba shortening, superficial fascia to costal line, spinailiaca superior anterior).
- Inner thigh lift (Figure 26)
Figure 26: Inner thigh lift.
Results in all our patients are more than satisfactory. Patients are mostly amazed by the immediate beautification, rejuvenation and the great difference before and after without scars and with nearly immediate return to work and social meetings.
The cosmetic results were evaluated with preoperative and postoperative photographs and by patient satisfaction. Patients were satisfied with the results and all of them considered their results as excellent or good.
We have observed no other complications, except some local infections in one of the perforation points in the early postop period, treated in a day or two. No nerve damage by the suture was observed. Cheekbone sutures were removed in one Asian patient due to patient’s aesthetic considerations.
Nowadays these methods are preferable in the modern society where business does not allow long time of absence. Closed approach suture methods have shown priority over classic excision liftings requiring hours of operation, marked trauma, long postoperative swelling and downtime.
Serdev suture® liftings require about 15 min of operating time per side, no blood loss or transfusions, no stay at the clinic, no nursing care and not more than a day or two off work. Results are immediate with no downtime. Most of the patients work next day after operation that is most appreciated by the patients.
We can recommend the closed suture methods for young and mid age patients with congenital problems in aesthetic appearance and in cases of initial or moderate flabbiness and tissue sagging.
Serdev Suture® Techniques are the first lifting method to replace scarring classic excision liftings as a complete method for scarless closed approach liftings on total face and body where movable fascias (holding skin by trabecular system) can be lifted and fixed to nonmovable periosteum, tendons and fascias.
Author’s suture techniques contributions
- A new method for closed approach face and body lifting - a new alternative to classic excision lifts
- Scarless, skin punctures only - no incisions and excisions
- Mini-invasive, no downtime
- Beautification and rejuvenation
- When needed tissue augmentation is performed using patient’s tissue - a new alternative with out implants
- Can be used in cosmetic, aesthetic and plastic-reconstructive surgery
Downtime is shortened from weeks into some days. No bruising, no danger of hematoma formation, no nerve damage, no scars.
The suture methods became possible after creating special curved semi-elastic, semi-blunt needles.
Serdev Needles were specially designed and developed for best use and have the following qualities:
- Elastic curve (the curve can not be changed when using pressure)
- Smooth surface (does not cut periosteum)
- Cone semi-blunt tip (trauma is minimized)
- Length and thickness depending on application from 50 to 250 mm
Surgical threads were selected and best results were obtained with the Bulgarian policaproamide sutures Polycon, which are ensuring semi-elastic fixation of movable to non-movable tissue, they do not cut through the tissue like other available non elastic surgical treads, we have tried on experiment. Preferred thread qualities were - short elasticity, absorbable within two years - after final fibrosis formation, anti-microbial action. Our test have shown that only Polycon ensures that qualities. Polycon offers thread thickness depending on application - 3/0, 0, 2, 4, 6, 8.
