Long-Term Ineffectiveness of Suspension Material and Musculofascial Suspensions

Warren, Ronald; Wilson, William S.; Hawtof, David B.

doi:10.1097/00006534-199306000-00019

Cited by 4 publications

(4 citation statements)

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“…It has been shown in an animal model that suspension sutures are of limited longterm effectiveness and have an early failure rate. 13 Early failures are frustrating for surgeons and patients, especially when early revision surgery is required. Revision procedures are potentially more problematic because these patients are at increased risk for soft-tissue fibrosis, increased SMAS attenuation, and secondary skin deformities.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Properties of Superficial Musculoaponeurotic System Tissue With vs Without Reinforcement With Poly-4-hydroxybutyric Acid Absorbable Mesh

Angelos

Brennan

Toriumi

2014

JAMA Facial Plast Surg

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IMPORTANCE It is unknown whether poly-4-hydroxybutyric acid (P4HB)-reinforced superficial musculoaponeurotic system tissue (SMAS) plication techniques will support SMAS imbrication and plication and potentially improve outcomes in rhytidectomy. OBJECTIVES To evaluate the biomechanical properties (tissue breaking strength, suture tearing force, and stress relaxation) of the SMAS with vs without reinforcement with P4HB absorbable mesh and to correlate these results with potential clinical applications. DESIGN, SETTING, AND SAMPLES In a cadaver study at an academic setting, 12 fresh frozen cadaver heads were used. Rhytidectomy incisions were made, and the SMAS was harvested and prepared for strength and stress testing using an Instron device. MAIN OUTCOMES AND MEASURES Tissue breaking strength and suture tearing force were analyzed. Stress relaxation test results were also assessed. The results of the SMAS samples alone were compared with those reinforced with P4HB absorbable mesh. RESULTS Overall, there were significant differences noted in tissue breaking strength and suture tearing force between the 2 groups. When the SMAS was reinforced with absorbable mesh, significant improvements were observed in tissue breaking strength (P < .001) and suture tearing force (P < .003). In addition, less variability was demonstrated in the maximum tensile load-bearing quality of the SMAS when the repair was reinforced with P4HB. CONCLUSIONS AND RELEVANCE Reinforcement with P4HB absorbable mesh improves tissue breaking strength and suture tearing force in cadaveric SMAS. It also reduces the variability in load vs displacement seen among samples tested. These data suggest that P4HB-reinforced SMAS imbrication would support higher loads and provide more consistent, long-lasting SMAS support among patients undergoing rhytidectomy. Further studies are needed to correlate these data with clinical outcomes in rhytidectomy. LEVEL OF EVIDENCE NA.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Properties of Superficial Musculoaponeurotic System Tissue With vs Without Reinforcement With Poly-4-hydroxybutyric Acid Absorbable Mesh

Angelos

Brennan

Toriumi

2014

JAMA Facial Plast Surg

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“…23 Also, using an animal model, Warren and associates found that nylon fascial plication sutures in the panniculus carnosus had a 100% failure rate after 4 months, demonstrating the difficulty in obtaining reliable fixation of the plicated fascia long-term. 24 Thus, the value of plication or suspension-based procedures remains unclear as a result of the uncertainty of long-term fixation.…”

Section: The Evolution Of the Facelift Techniquementioning

confidence: 99%

The SMAS-Platysma Facelift: Advantages of a Multivector Technique

Owsley¹,

Fiala²

2002

Seminars in Plastic Surgery

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“…Kamer and colleagues indirectly reviewed the longevity of superficial SMAS rhytidectomy and found that 11.4% of patients required a secondary tuck procedure within 18 months of the initial procedure . These findings are supported by an animal model which suggests that suspension sutures may have limited long‐term effectiveness and an early failure rate …”

Section: Introductionmentioning

confidence: 99%

“…6 These findings are supported by an animal model which suggests that suspension sutures may have limited long-term effectiveness and an early failure rate. 7 To address the issue of longevity, numerous suture techniques and materials have been proposed, from barbed sutures 8 to complex cable sutures 9 with varying degrees of success. The scope of this paper is not to evaluate the myriad of rhytidectomy techniques, but to focus on a novel SMAS suture suspension method.…”

mentioning

confidence: 99%

A novel variation of the suture suspension facelift

Ugradar

Isse

Goldberg

et al. 2020

J of Cosmetic Dermatology

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Background We propose a technical variation of the minimally invasive suture suspension facelift. Methods A novel variation of the minimally invasive facelift is proposed. The technique consists of two components. The anterior component addresses aging of the midface by anchoring the SMAS on to the sturdy retroauricular supra‐helical deep temporal fascia using approximately 6‐8 passes of a 4/0 Mersilene suture. The posterior component addresses cervical aging by securing the posterior edge of the platysma onto the sturdy mastoid fascia, using multiple loops of a 4/0 Mersilene suture. This technique was performed on 100 consecutive patients between 2005 and 2010. Results The technique was found to be safe due to the plane of dissection remaining superficial to the parotid gland in the anterior component. There were no instances of facial nerve injury or sensory disturbance. None of the patients required a secondary procedure within the first 18 months following the procedure. Conclusions This technique offers a safe and effective option for patients who seek a facelift, especially in combination with other procedures. It is envisaged that the use of multiple loops of suture to anchor mobile tissue onto fixed sturdy fascia will contribute to the longevity of the results. The limited skin undermining also makes this procedure a better choice for smokers.

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Long-Term Ineffectiveness of Suspension Material and Musculofascial Suspensions

Cited by 4 publications

References 0 publications

Biomechanical Properties of Superficial Musculoaponeurotic System Tissue With vs Without Reinforcement With Poly-4-hydroxybutyric Acid Absorbable Mesh

Biomechanical Properties of Superficial Musculoaponeurotic System Tissue With vs Without Reinforcement With Poly-4-hydroxybutyric Acid Absorbable Mesh

The SMAS-Platysma Facelift: Advantages of a Multivector Technique

A novel variation of the suture suspension facelift

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