Suture midface suspension：Case Study（3）
Patients are given one gram of Cefazolin and the wound areas are dressed with an Antibiotic ointment（Tobradex® – tobramycin 0.3% and dexamethasone 0.1%）. All surgeries were performed on outpatients' basis and under topical anesthesia（combination of lidocaine and bupivacaine）.
Results
Facial symmetry and a satisfactory midface lift were obtained in all patients with this procedure (Figures 6, 7). Local soft tissue reaction in the stab wound sites were observed in 2 patients immediately after the operation probably due to the Gore-tex. This reaction subsided quickly with the use of a tapered dose of oral steroids（Methylprednisolone dose package）.
Figure 6. Pre-operative clinical photograph of the patient with midface descent.
Figure 7. Postoperative clinical photograph of the patient (figure 6) after suture midface suspension.
Discussion
Facelift surgery is a part of facial rejuvenation. The main goal of surgery for facelift is to achieve a vertical elevation. It is in constant evolution, but is somewhat limited since the aging changes in the lower face are not completely addressed by current surgical techniques[2,3].
A combination of Gravity and Loss of elasticity and tone causes facial aging[4]. The sagging of the Malar fat pad over the Nasolabial folds contributes to a deeper appearance of these folds with time. Especially in patients at around the 40 year-age group, other signs of facial aging are not yet prominent. As classic techniques of facelift result in only modest improvement of deep nasolabial folds, in these cases a less invasive technique directly addressing the problem would be the procedure of choice. Suture midface suspension is especially helpful for the patient who is primarily concerned with midface descent.
Facelift surgery has some potential complications. Probably the most important one is damage to the Facial nerve causing partial or complete Facial palsy. Parotid duct injury may also occur. Flap necrosis and Compromised wound healing causing Scar tissue on the face are also important complications especially for Smokers and Vegetarian patients. Using an inert suture material to suspend the malar tissues above the nasolabial sulcus solves the problem in a simple and less complicated way. Softening of the Nasolabial fold and Lifting the Malar fat pad can be achieved by these sutures.
On the other hand, suture midface suspension does not address all components of facial aging, such as fat atrophy. There is also a question of how long it lasts. The limitations of this technique should be explained to the patient before surgery.
A similar technique was previously described by Keller and associates[5] who evaluated 118 patients undergoing Percuatneous malar fat pad elevation; at 3 months, all but two patients had a significant elevation of the malar fat pad of 3–7 mm. This procedure was associated with very little morbidity.
Suture midface suspension has the following advantages over deep plane facelifts : minimally invasive technique, performed under local anesthesia and relatively short procedure. However this technique has the following potential disadvantages : since there is no periosteal release and undermining; the potential for significant and lasting elevation and repositioning of the malar mound may be limited; it is a blind procedure; hence it may carry the risk for neurovascular damage and finally stab incisions are done in visible, prominent areas. In addition skin irregularities (dimpling and bouncing) may appear at fixation points and sutures passed under the thin skin of the lateral canthal area may be palpable by the patients. Fixation to deep fascial plains such as Deep temporalis fascia and passing the sutures at the SMAS levels may prevent these possible complications.
Our follow-up showed a reasonable cheek elevation and patient satisfaction. The results were more dramatic with moderate nasolabial folds and less dramatic in older patients with heavy nasolabial folds. This is as a result of Inadequate suspension of the fat pad superiorly. We found this technique to be a useful adjunctive procedure in young patients who were undergoing surgery for facial rejuvenation and also in older patients who had previously undergone facelift surgeries. Further studies are warranties to evaluate the long term effect of suture midface suspension.
Acknowledgements
Supported by a grant from TUBITAK (Scientific and Technical Research Council of Turkey)
References
1、Hoening JA, Shorr N, Goldberg RA : The versatile soof lift in oculoplastic surgery. Facial Plast Clin North Am 1998, 6:205-219.
2、Hagerty R : Central suspension technique of the midface. Plast and Reconst Surg 1995, 96:728-730.
3、Owsley JQ, Fiala TG : Update : Lifting the malar fat pad for correction of prominent nasolabial folds. Plast and Reconst Surg 1997, 100:715-722. Publisher Full Text
4、Baylis H, Goldberg RA, Shorr N : The deep plane facelift: A 20- year evolution of technique. Ophthalmology 2000, 107:490-495. PubMed Abstract | Publisher Full Text
5、Keller GS, Namazie A, Blackwell K, Rawnsley J, Khan S : Elevation of the malar fat pad with a percutaneous technique. Arch Facial Plast Surg 2002, 4:20-25. PubMed Abstract | Publisher Full Text
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