Background: Surgeons use a variety of methods to secure tissue to bone in reconstructive and cosmetic procedures. Examples include wiresi, screwsii, postsiii, durable and resorbable suturesiv, bone tunnelsv, tissue adhesivesvi, and bone implants with a variety of means to hold tissuevii.
In contemporary cosmetic and reconstructive surgery, there is a trend toward repositioning and securing the underlying fascia layers rather than securing the epidermis or skinviii-x. This technique provides a more durable result, and at the same time provides a more “natural” look, avoiding the stereotypical “windblown look” of historical face-lifts.
Furthermore, a modest change in tissue position provides a significant aesthetic benefit. Several published studies (Hilger et. al, and Baden et. al) have shown that a 2-3 mm change in elevation provides a high degree of patient satisfaction with the aesthetic result.
Particularly in the setting of eyelid surgery (blepharoplasty), there is a need to elevate the brow while restoring a more natural appearance and in some cases improving the patient's visual field.
Medial Brow and Lateral Brow Change in Elevation
(Hilger et. al.)
Beyond forehead and brow procedures, there is a need for tissue elevation and securement in the mid-face and lower-face. Modifications of the current design may provide another option for mid and lower-face rejuvenation.
Other applications under investigation include tendon and ligament re-attachment in hand surgery, tissue securement in general surgery and facial trauma repair.
[i] Chasan, P.E., and Kupfer, D.M. Direct K-wire fixation technique during endoscopic brow lifts. Aesthetic Plast. Surg. 22: 338, 1998
[ii] Taylor, C.O., Green, J.G., and Wise, D.P. Endoscopic forehead lift: Technique and case presentations. J. Oral Maxillofac. Surg. 54: 569, 1996
[iii] Pozner, J.N. Simplified fixation for endoscopic brow lifts: Self tapping drill-free posts. Plastic Reconstr. Surg. 103: 1326, 1999
[iv] Loomis, M.G. Endoscopic brow fixation without bolsters of miniscrews. Plast. Reconstr. Surg. 98: 373, 1996
[v] Hoenig, J.F. Rigid anchoring of the forehead to the frontal bone in endoscopic facelifting: A new technique. Aesthetic Plast. Surg. 20: 213, 1996
[vi] Mixter, R.C. Endoscopic forehead fixation with histo-acryl. Plast. Reconstr. Surg. 101: 2006, 1998
[vii] Stevens, W. G., Apfelberg, D.B., Stoker, D. A., Schantz, S.A., Endotine: A new biodegradable fixation device for endoscopic forehead lifts. Aesth. Surg. J. 2003; 23:103-107.
[viii] Saylan, Z., Purse string-formed plication of the SMAS with fixation to the zygomatic bone. Plast. Reconstr. Surg. 110, 667, 2002
[ix] Serdev. N.P., International Journal of Cosmetic Surgery and Aesthetic Dermatology. September 2002, 4(3): 179-185.
[x] Cohen, S.R., Kikkawa, D.O., Korn, B.S., Orbitomalar suspention during high SMAS facelift. Oculoplastics
Facial Surgery Aesthetic Surgery Journal. 30(1) 22, 2010