Suture midface suspension：Case Study（2）
Two hang-back sutures are prepared for each side of the face. A piece of Gore-Tex is prepared to the size of 4 × 4 mm and a 4-0 prolene suture passed through this Gore-Tex piece. A 4-0 prolene and 3-0 vicryl suture are threaded through the eye of two Keith needles (Figure 3).
Each of the Keith needles are passed directly through the superior stab wound and advanced on the sub-SMAS（superficial musculoaponeurotic system）plane (Figures 4, 5). After the maxillary prominence, the first Keith needle is directed slightly superiorly and passed along the first marked line 1 cm lateral to the lateral canthus, coming out in the temporal incision site. The second needle is passed along the second marked line. After both Keith needles are retrieved from the temporal incision, the vicryl suture is gently pulled back and forth until it is externalised from the temporal incision, assuring there is no dimpling in the cheek. The 4-0 prolene suture is tied to the temporalis fascia adjusting the level of malar fat pad elevation. The second hang-back suture is passed in the same fashion starting from the lower stab incision in the nasolabial fold and the same procedure is repeated on the other side of the face. The temporal incision site is closed with a 5-0 chromic cat gut suture in a continuous fashion and the nasolabial stab wounds are closed with a single 6-0 cat gut suture.
Figure 3. A hang-back suture is prepared with a Gore-Tex piece on the prolene suture.
Figure 4. The Keith needle is shown on the marked line.
Figure 5. The Hang-back suture is passed through the SMAS plane.
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