Avoiding early revision rhytidectomy: a biomechanical comparison of tissue plication suture techniques.

BACKGROUND: Manipulation and suspension of the superficial musculoaponeurotic system (SMAS) is performed by 74% of rhytidectomy surgeons. Multiple variations in suture techniques are employed in this task, but they have never been evaluated for differences in their ability to withstand stress. OBJECTIVE: To compare the biomechanical properties of two different suture techniques that are used in SMAS plications during rhytidectomy: a double-layered running locking (DRL) stitch and multiple horizontal mattress stitches. METHODS: Fourteen horizontal mattress plications, in rows of six sutures, and comparable lengths of 16 DRL stitch plications of pig skin samples, were stressed using a tensometer with grip displacement increasing at a constant rate of 0.5 cm/Min. The required force to cause plication failure was recorded for each sample at three suture break points. RESULTS: There was no significant difference between the two groups in the force required to cause the initial suture failure. Unlike the horizontal mattress plication, an initial break seemed to cause minimal to no distortion of the DRL tissue plication. When results were normalized by the initial break forces to account for small variations in tissue properties, the force ratio required to cause a second suture break was significantly larger in the DRL group than in the horizontal mattress technique. This is evidenced by the average second to first break force ratios of 1.62 vs. 1.13 for the DRL and horizontal mattress stitches, respectively, with a P-value of .60. The mean ratios of third to first break forces for the DRL and horizontal mattress groups were 2.08 and 0.91, respectively, with a P-value of .08. CONCLUSION: The DRL stitch requires more force than the horizontal mattress stitch to cause significant failure of tissue plication. This technique may enable plastic surgeons to avoid early revision rhytidectomy due to suture failure, and to create a long-lasting, youthful cosmetic result.

Review of 1,000 consecutive short-scar rhytidectomies.

BACKGROUND: Short-scar rhytidectomies offer patients with mild to moderate facial aging an alternative to traditional face-lift surgery. Advantages of decreased recovery time, diminished risk, and decreased cost make this an attractive procedure to add to a cosmetic surgery practice. METHODS: This study is a review of 1,000 consecutive short-scar rhytidectomies performed over 36 months with at least 6 months of follow-up. All patients underwent short-scar rhytidectomy with SMAS suspension. Outcome parameters examined included complications or adverse events and any interventions necessary. RESULTS: The most common complication was suture extrusion, observed in 148 patients (14.8%). Ten patients had hematomas (1%), while postauricular nodules were observed in 8 patients (0.8%). Eight patients (0.8%) required liposuction under local anesthesia to address asymmetry due to under removal of fat in the submental region. Revision rhytidectomy was required in 5 patients (0.5%). Five patients (0.5%) had hypertrophic scarring, while 1 patient (0.1%) developed hyperpigmentation. There were no cases of nerve injury, infection, skin flap necrosis, skin puckering or depression, hair loss, or parotid injury. CONCLUSION: Short-scar rhytidectomy is an excellent procedure for good candidates with mild to moderate aging of the face. It has a very low complication rate and can be done safely in an office environment.

Does suture material and technique really matter? Lessons learned from 800 consecutive blepharoplasties.

OBJECTIVES: The purpose of this study was to evaluate established suture materials and techniques for blepharoplasty closure and evaluate for any differences in rates of complications between these groups. STUDY DESIGN AND METHODS: This was a prospective study of a large sequential series of patients undergoing upper blepharoplasty who were treated by the same senior author over a 5-year period. Patients were assigned one of four techniques for closure of the incision based on the senior author's experience. After 6 weeks, rates of complications and revisions were noted and addressed. Satisfaction rates were noted at 3 months. RESULTS: In the group whose incisions were closed with running subcuticular polypropylene (Prolene), 5 (2.5%) presented with milia, and 11 (5.5%) had a standing cone deformity (SCD). Use of running cutaneous locked Prolene resulted in 8 patients (17%) with milia and 2 patients (4.4%) requiring revision of a SCD. Use of a running 6-0 plain gut suture resulted in 12 patients (6.7%) with milia and 5 patients (2.8%) with unsightly scarring. In the group whose incisions were closed with running 6-0 fast-absorbing gut, 10 patients (2%) presented with milia, and there were no scar revisions. There were statistically significant differences between the groups with respect to formation of milia, scarring, and persistent erythema (P < .008). CONCLUSIONS: Blepharoplasty is a safe and effective procedure that can be performed successfully with several established techniques. In our experience, closure with two interrupted 6-0 Prolene sutures and a running 6-0 fast-absorbing gut resulted in the lowest rates of complications and revisions.

Direct excision of the turkey jowl deformity: a review of 100 consecutive cases.

OBJECTIVE: The aging of the neck is a combination of accumulated submental fat, platysmal banding, and redundant skin. Traditional face- and neck-lifting procedures successfully address these components. Unfortunately, the cost, both in terms of downtime and expense, often becomes prohibitive for a large section of the interested patient population. For select male patients, direct excision of the turkey jowl deformity with a straight-line closure offers a novel alternative. DESIGN: A review of 100 consecutive cases of direct excision of turkey jowl deformity procedures was performed. Minimal follow-up was 1 year. All surgical procedures were performed in the office setting with local anesthesia. RESULTS: Eight patients had extrusions of suture without recurrence of banding. Four patients required steroid injections for mild scar hypertrophy; 2 of these patients requested minor scar revisions 1 year later. There were no cases of postoperative bleeding, infection, or nerve injury. All 100 patients were satisfied with the overall cosmesis, and none had revision jowl surgery. CONCLUSIONS: Direct excision of the turkey jowl with a straight-line closure offers a major improvement in the aging neck with minimal downtime, expense, and complication rate. This procedure can be easily accomplished and safely performed in an office environment.

Surgical access to the internal nasal valve.

OBJECTIVES: To measure the width of the nasal septum in the region of the internal nasal valve using radiographic images to support use of open septorhinoplasty for alteration of the internal nasal valve and to compare short-term patient satisfaction for open septorhinoplasty vs endonasal septoplasty. STUDY DESIGN: Radiographic study and chart review. METHODS: The width of the nasal septum at the level of the inferior turbinates and at the level of maximum septal thickness was measured on computed tomographic scans of 70 patients. Patient satisfaction 12 weeks after treatment was assessed in 113 patients who underwent septoplasty or open septorhinoplasty for nasal obstruction and septal and internal nasal valve abnormalities. RESULTS: Measures from the computed tomographic scans revealed that the nasal septum was significantly wider at the internal nasal valve than at the inferior aspect of the septum. All 34 patients who underwent septoplasty and all 79 patients who underwent open septorhinoplasty were satisfied with the results at 12 weeks after surgery. CONCLUSIONS: Anatomic evidence supports the need to address the superior septum. Although this may be facilitated by an open septorhinoplasty approach, short-term results showed no difference in patient satisfaction with this technique compared with septoplasty. The differences between the techniques may be evident on long-term follow-up.