title: Facial rejuvenation and improvement of malar projection using sutures with absorbable cones: surgical technique and case series.
abstract: BACKGROUND
  Currently, the face can be reshaped with minimally invasive procedures. This report describes how the midface can be suspended by increasing the projection of the malar area, decreasing the nasolabial fold depth, and improving the jaw definition using 3-0 polypropylene sutures with absorbable cones (Silhouette Sutures).
  
  
  METHODS
  Preoperative skin marks were made to indicate the four points on each side of the face where the sutures would exit through the skin: 1 cm lateral to the middle of the nasolabial fold, at the corner of the mouth, and on the line from the lateral corner of the lips to the angle of the mandible. The sutures were inserted through a 1.5-cm incision positioned in the temporal area. After insertion of the needle, the sutures were fixed to a small polypropylene mesh over the deep temporal fascia.
  
  
  RESULTS
  A total of 316 patients were treated between January 2007 and December 2009. The results over a mean follow-up period of 18 months were good, with high patient satisfaction. All the complications experienced by 42 patients (13.3%) were minor and temporary including temporal area pain (7%), visible dermal pinching (3.5%), hematoma (1.3%), asymmetry (0.6%), and suture palpability (0.3%). There were no infections.
  
  
  CONCLUSIONS
  Face-lifts were performed for 257 women with a mean age of 47 years and 59 men with a mean age of 49.5 years. This procedure can be performed for various age groups to rejuvenate and reshape the middle face. Men whose scars cannot be easily hidden due to baldness are good candidates as well. The technique led to stable results and only minor, temporary complications, with a high level of satisfaction among patients and surgeons. The longevity of the results beyond the mean follow-up period of 18 months needs to be determined.
authors.affiliation: IDB, Barcelona, Spain. drdebenito@gmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: de Benito
authors.forename: Roberto
authors.initials: R
authors.lastname: Pizzamiglio
authors.forename: Dimitris
authors.initials: D
authors.lastname: Theodorou
authors.forename: Leyla
authors.initials: L
authors.lastname: Arvas
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures; D004954:Esthetics; D005152:Facial Muscles / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology; D012060:Rejuvenation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000295:instrumentation* / Q000379:methods; D018570:Risk Assessment; D015595:Skin Aging; D013030:Spain; D013537:Sutures; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D015050:Zygoma