A novel bioabsorbable device for facial suspension and rejuvenation.

To evaluate the safety and efficacy of a novel bioabsorbable suspension device made of a polymer of polylactic acid and polyglycolic acid (Endotine Ribbon), we performed a retrospective multi-institutional case study of 21 patients who underwent minimally invasive or open rhytidectomy with the use of the device in an ambulatory surgery center setting. Twelve patients had an excellent result, 7 a good result, and 2 a fair result. Early complications were corrected with technical modifications. Patient satisfaction was high. The Ribbon is a safe and effective adjunct for performing both minimally invasive and open rhytidectomy and cervical lifting.

Preliminary evaluation of a fast-absorbing multipoint fixation device.

BACKGROUND: Since the Endotine forehead fixation device (Coapt Systems, Palo Alto, CA) was introduced in 2003, a small percentage of surgeons and patients have complained of persistent palpability and sensitivity related to its 12- to 15-month absorption time. Therefore, a refinement of the original design, the Ultratine (Coapt Systems), consisting of a polymer blend altered for faster absorption and biodegradability, was introduced in 2006. OBJECTIVE: The authors report early results of fixation using the Ultratine with respect to permanence of elevation and the duration of visibility, palpability, and sensitivity of the implant. METHODS: The authors conducted a retrospective review of patients who had undergone brow lift with Ultratine forehead fixation, along with concomitant cosmetic procedures. RESULTS: Ten patients were available for follow-up at 14 months postoperatively. In many cases, the implant biodegraded and absorbed at the 3- to 6-month intervals, and symptoms of visibility, palpability, and sensitivity were markedly improved over the original Endotine device. CONCLUSIONS: The Ultratine degradation profile produces secure, permanent fixation and elevation for endoscopic brow lifts while diminishing the long-lasting side effects of visibility, palpability, and sensitivity exhibited by a small proportion of patients with the original Endotine device. It is an option particularly for those patients who have thin scalps or fine hair. The Endotine may still be the best choice for patients with heavier brows; tighter, more immobile brows; and for secondary cases. It may also be preferable in cases of reverse brow procedures intended to lower the hairline.

Midface lift technique with use of a biodegradable device for tissue elevation and fixation.

BACKGROUND: Aesthetic surgeons have become increasingly aware that elevation of the midface is a significant component of facial rejuvenation. However, adequate fixation remains a problem in midface lift procedures, regardless of the approach. OBJECTIVE: The purpose of this study was to evaluate the efficacy and ease of application of the Endotine midface device (Coapt Systems, Palo Alto, CA), as well as patient and surgeon satisfaction with the results of treatment. METHODS: The Endotine device consists of a polylactide polymer that incorporates 5 tines, each 4.5 mm long, to distribute tension over a wide area, maximizing fixation strength and holding power. After the cheek tissue is engaged, upward tension is applied to the anchoring leash, which is then sutured to the deep temporal fascia. Between October 2003 and October 2004, 31 patients underwent Endotine fixation for midface lift. The patient group comprised 7 men and 24 women ranging in age from 40 to 65 years (mean age, 49.25 years). Four patients had midface lifts as the sole procedure, and 27 had adjunctive facial cosmetic procedures. Results evaluated included ease of use/difficulty of insertion, postsurgical pain, adequacy and stability of fixation, side effects and complications, and patient and surgeon satisfaction. RESULTS: All patients were judged to have satisfactory cheek elevation and enhanced contour without evidence of recurrent midface ptosis or loss of elevation/fixation. There were no postoperative complications of infection, hematoma, or dehiscence. In a subset of 11 patients, "pain in the treated area" averaged 2.7 (0 = no pain, 10 = extreme pain) at one month follow-up. Surgeon satisfaction with the fixation result averaged 4.9 (1 = very dissatisfied, 5 = very satisfied) at one month follow-up. Patient self-assessment of aesthetic outcome averaged 3.8 (1 = worse than baseline, 4 = dramatic improvement from baseline) at one month follow-up, and patient satisfaction assessment averaged 3.9 (1 = very dissatisfied, 4 = very satisfied) at one month follow-up. CONCLUSIONS: The midface Endotine device provided rapid, secure fixation in our small patient study group without complications, and eliminated the complicated and awkward suture techniques that have been an impediment to midface surgery. Larger clinical studies are in progress.

The endotine: a new biodegradable fixation device for endoscopic forehead lifts.

BACKGROUND: No single technique for fixation of the scalp after endoscopic forehead lift is universally accepted, and complications such as alopecia and regression of elevation have been reported with all techniques. OBJECTIVE: This report describes the preliminary results of a study of the Endotine 3.5 forehead device (Coapt Systems, Inc, Palo Alto, CA), a new biodegradable fixation device. METHODS: The Endotine 3.5 device consists of a post on the deep side for anchoring it in the skull and five tines on the superior side for engaging the deep scalp tissues. It was tested in 9 patients, with postoperative follow-up ranging from 6 to 8 months. The surgeon evaluated the device for difficulty/ease of use, palpability, postsurgical pain, and wound healing. RESULTS: The Endotine 3.5 device produced a secure fixation without problems or complications, although it was often palpable with moderate degrees of sensitivity. It could be applied in less than 2 minutes per side. CONCLUSIONS: Our preliminary findings indicate that the Endotine 3.5 forehead device provides rapid, secure fixation without the complications associated with other fixation techniques. After patients reported that it was still palpable up to 24 weeks after implantation, a second-generation polymer that dissolves more rapidly was fabricated. Further studies are under way to evaluate long-term efficacy. (Aesthetic Surg J 2003;23:103-107.).