Question from Long Island, NY: A doctor whom I have consulted uses: "the endotine midface device instead of non-absorbable sutures in mid-facelifts, lowering the risk of skin irregularities, dimpling and swelling and reducing procedure time. Once implanted, the device holds the lifted tissues in place as they complete the process of reattaching to the cheekbones. The device is then absorbed into the body until it is completely dissolved." What is your opinion?
Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:
Thanks for this interesting question!
The Midface Lift is a cheek lift to rejuvenate the aging and sagging soft tissues of the upper cheek and unfold the trough of the nasolabial fold. It is also useful in rejuvenating the tear-trough and the separating cheek-eyelid junction.
A Midface Lift can be performed at 2 different tissue levels from a variety of incisions according to the surgeons skill and what tissues are desired to be advanced.
Eyelid incision: this is a common incision to perform a lower blepharoplasty (eyelid lift) and fill the hollow of the tear-trough and cheek-eyelid junction with the fat chambers of the upper cheek. When this flap of fatty tissues is extended, it will unfold the furrow of the nasolabial fold. I use absorbable sutures along the orbital rim periosteum to suspend these tissues and if required a non-absorbable suture to suspend the corner eyelid if there is concern of pulling or rounding of the eyelid. Endotine, a absorbable device placed through a temple incision can be used to hold these soft tissues in place similarly to sutures.
Sub-periosteal incision: this approach allows elevation of the muscles as well as the fatty soft tissues of the cheek through a temple and/or intraoral incision. It is most commonly held in place with a Endotine device or barbed-thread.
Any suspension device, whether it be sutures, Endotine or barbed thread must last long enough for the normal process of scar to hold the advanced tissues in place until healed.
It is best to compare this surgeons evaluation of what tissues to lift and what techniques he / she are comfortable performing and recommendations with one or more well experienced, Board Certified Plastic or Facial ENT Surgeons.
I hope this has helped. All the best.
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