27.5 Postoperative Care

Although suture facelift techniques are minimally invasive and performed through small incisions or punctures, postoperative care is important. The closed techniques described in this chapter do not involve dissection or undermining. The relatively atraumatic insertion of sutures, although advantageous in terms of downtime, means there is less inflammation and fibrosis around the sutures, which can dislodge or

migrate or potentially become disrupted in the tissues. Careless handling of the face or neck following a suture lift can disrupt the sutures or result in cheesewiring of the tissues through the sutures. Ideally, the treatment area should be taped and a head garment should be worn for 3–4 days to immobilize the tissues (Fig. 27.35). Patients should be instructed to avoid excessive facial animation, chewing gum and laughing for a week, and to be gentle when handling the face or neck for 4–6 weeks following the procedure.

This includes cleansing or applying makeup upward along the vector of lifting rather than downward against the sutures. Following the procedure, the author administers cephalexin for 5 days and tramadol for 3 days as needed if simple analgesia is insufficient to control discomfort. Normal sequelae following suture lifts include edema, ecchymosis, and point tenderness over the suture ends. To reduce swelling, the patient is advised to use cold packs and sleep with the head elevated for a few days. A clear instruction leaflet should be provided, including a contact telephone number in case the patient has any concerns following

the procedure (Table 27.5). A follow-up appointment is arranged in 1 week, at which time sutures, if present, are removed.

27.6 Complications

Patients tolerate suture lift procedures well under infiltrative local anesthesia with complementary regional nerve blocks, if required. These methods are preferred as they eliminate unnecessary risk associated with intravenous sedation or general anesthesia. Mild

edema, ecchymosis, tenderness, and transient bunching of overlying skin are common following suture lifts. Complications include infection, bleeding, palpability, visibility, skin irregularities, migration, extrusion, prolonged pain, nerve injury, and asymmetries

(Figs. 27.36 and 27.37) [38–40]. These complications should be prevented by proper placement of appropriate sutures using sterile techniques. If they do occur, they often resolve spontaneously or can easily be treated (Table 27.6).

Fig. 27.34 Coned (Silhouette) suture lift of the neck. (a) Markings are made behind the ear and along the neck under the mandible to a point about 2 cm proximal to the midline. A second point is marked 2 cm distal to the midline. (b) After local infiltration of lidocaine with epinephrine along the marked points, a 1 cm retroauricular incision is made and the Silhouette needle is passed subcutaneously toward the midline. (c) The needle exits at the first point proximal to the midline. (d) The needle is redirected so the blunt end advances across the midline toward

the point on the contralateral side. (e) A stab incision is made to allow the blunt end to emerge with suture attached. The suture is cut. (f) The end of the suture is grasped and pulled through until the first knot is visible. The suture is cut again just distal to the knot. (g) The half-circle needle is used to pass the proximal end through the mastoid fascia for anchorage. (h) A second suture is passed in the same way parallel to the first one. Both sutures are retracted to lift the neck, and tied to one another. The retroauricular incision is closed with interrupted sutures

f

g

h

Fig. 27.34 (continued)

27.7 Conclusions

There has been a dramatic increase in patient demand for nonsurgical cosmetic procedures in the last decade.

Fig. 27.35 Tape and head garment are used to immobilize the tissues for 3–4 days following a suture lift

Suture facelift techniques offer a quick, safe, and effective rejuvenation by elevating soft tissues and restoring the youthful contours of the face and neck. The aim is to lift tissues that have dropped, restore the beauty triangle by creating a heart-shaped face, and improve definition of the jawline and neck. Patients who benefit from suture facelift techniques have mild tissue laxity or ptosis and realistic expectations. The results are usually subtle and natural and often make the patient appear a few years younger. The author combines suture facelift techniques with other nonsurgical procedures such as botulinum toxins, fillers, and cheek and lip enhancement (Fig. 27.38). Combined approaches using different sutures and methods in the same patient is also appropriate and may provide superior results than one method alone. Longevity of results following a suture facelift is variable and depends on several factors, including the sutures used, the lifting technique,

1.Pressure hemostasis

2.Conservative for ecchymosis and hematoma

3.Drainage for large hematoma (rare)