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Sutures
Sutures
Suture lifts have gained popularity over the past 15 years. In theory, they are appealing because this is a minimally invasive procedure that can produce a significant, predictable lift that is tailored to the patientโs anatomy. Suture lifts of the midface have been popularized by Sasaki and Keller. For lax facial and neck skin, Sulamanidze introduced barbed sutures.40 These sutures went through several iterations in order to improve longevity. These sutures had bidirectional barbs and were nonabsorbable. Though it was an uncomplicated office procedure that produced immediate results with minimal downtime, the barbs didnโt maintain the lift for more than 12 months. In addition, there was an unacceptable rate of migration. The sutures evolved to a combination of absorbable PLLA cones with a nonabsorbable suture. The cones were felt to better lock into the dermis, and then create fibrosis and possibly collagen stimulation, while the primary nonabsorbable component would increase the longevity.41 The latest innovation, which has been studied in Europe, is completely absorbable bidirectional suture cones; these were introduced in the United States in
2016. These sutures only produce a mild lift, but may increase volume since they are biostimulatory.