Management of face lifts with progressive tension sutures.

Abstract

Performance of deeper and more extensive dissections in face lift procedures has led to more complex procedures, a higher rate of reported complications, and more prolonged convalescence. We investigated the use of progressive tension sutures (PTSs) to achieve more controlled, safe, and secure skin flap management and improved aesthetic results. Defatting of the neck was performed by lipoplasty or direct excision. The face was dissected in a subcutaneous plane to enable individualized management of the deeper tissues. After employment of appropriate face lift techniques, the skin flaps were advanced and PTSs were placed from the deep surface of the skin flap to the underlying superficial musculoaponeurotic system and were also used to advance the lateral neck and postauricular skin flap. Early findings in a series of 10 patients followed up for at least 1 year showed excellent aesthetic results with no cases of skin flap necrosis or widening of scars, minimal swelling and ecchymosis, and no long-term complications. The use of PTSs, in combination with individualized management of the deep tissues, can reduce wound complications, decrease postoperative edema, and promote shorter recovery.