Suture Suspensions for Lifting or Volume Augmentation in Face and Body

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-Dimple formation in chin and smiling point etc.

In body areas
-Scarless breast lift by suture, (Figure 21) Operations are ambulatory without hospital stay. The techniques consist of passing closed sutures, by needle perforations only, to lift movable fascias and fix them to non-movable skeletal structures in several facial and body areas .
The author performs the following scarless closed approach suture lifts:

Abstract
Scarless closed approach suture liftings present skeletal fixation with skin punctures without incisions as a first alternative to classic excision lifts. The author started the anatomy study, instrument creation and thread selection in 1990 and the whole topographic anatomy, instrumentarium and technique understanding of this new method was ready in 1993. Needle preparation and selection of threads was experimental. Stretch, elasticity and cut through tests were performed for selecting threads. Thread long term absorption is crucial in this method. 54 patients were operated in 1993-1994 to correct early ptosis and flabbiness in areas of face and body and the results were published. Author's contribution is that his closed approach suture techniques lift SMAS and fascias without traditional incisions. Operations are ambulatory with excellent results, reported by the patients. The trauma is minimal and the follow-up period is no longer than a few hours to 3 days with fast, sometimes immediate return to work and social life. There are no visible scars; the needle perforations on the skin disappear within 2-3 days.

Results
Results in all patients were more than satisfactory. They were mostly amazed by the immediate beautification, rejuvenation and the great difference before and after without scars and with nearly immediate return to work and social meetings.
The cosmetic results were evaluated with preoperative and postoperative photographs and by patient satisfaction. Patients were satisfied with the results and all of them considered their results as excellent or good.
No other complications were observed, except some local infections in one of the perforation points in the early postop period, treated in a

Discussion
Nowadays these methods are preferable in the modern society where business does not allow long time of absence. Closed approach suture methods have shown priority over classic excision liftings requiring hours of operation, marked trauma, long postoperative swelling and downtime.
Serdev suture® liftings require about 15 min of operating time per side, no blood loss or transfusions, no stay at the clinic, no nursing care and not more than a day or two off work. Results are immediate with no downtime. Most of the patients work next day after operation that is most appreciated by the patients.

Conclusion
We can recommend the closed suture methods for young and mid age patients with congenital problems in aesthetic appearance and in cases of initial or moderate flabbiness and tissue sagging.

Contribution
Serdev Suture® Techniques are the first lifting method to replace scarring classic excision liftings as a complete method for scarless closed approach liftings on total face and body where movable fascias (holding skin by trabecular system) can be lifted and fixed to nonmovable periosteum, tendons and fascias.   -Length and thickness depending on application from 50 to 250 mm Surgical threads were selected and best results were obtained with the Bulgarian policaproamide sutures Polycon, which are ensuring semi-elastic fixation of movable to non-movable tissue, they do not cut through the tissue like other available non elastic surgical treads, the author has tried on experiment. Preferred thread qualities were -short elasticity, absorbable within two years -after final fibrosis formation, anti-microbial action. The author's tests have shown that only Polycon ensures these qualities. Polycon offers thread thickness depending on application -3/0, 0, 2, 4, 6, 8.