title: Midface lift technique with use of a biodegradable device for tissue elevation and fixation.
abstract: 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.
authors.forename: R Laurence
authors.initials: RL
authors.lastname: Berkowitz
authors.forename: David B
authors.initials: DB
authors.lastname: Apfelberg
authors.forename: Sherry
authors.initials: S
authors.lastname: Simeon