Nonsurgical tightening, lift options expanding

Chicago - According to one expert, new suture lift techniques represent the most intriguing advance among nonsurgical facelift and skin tightening procedures.

Suture lift options include the Contour Thread (Surgical Specialties) and a newer variation developed by Riverside, Calif.-based dermasurgeon Soren Eremia, M.D. Additionally, Cynthia Weinstein, M.B.B.S., F.A.C.D., F.R.A.C.P., (Victoria, Australia) uses standard sutures for nonsurgical facelifts. Other physicians use slightly modified traditional sutures.

"All these methods can elevate tissue underneath and elevate some of the skin. And they all involve some placement of tissue that is fixed to the deep temporal fascia. The deep temporal fascia provides a very good fixation point - it's very strong, and one can tighten the tissues significantly," says Ronald L. Moy, M.D., clinical professor at UCLA's David Geffen School of Medicine, as well as a Los Angeles-based private practitioner and past president of the American Society for Dermatologic Surgery.

Suture lift procedures require only small incisions.

"Then the sutures are placed in a variety of different ways using Dr. Eremia's, Dr. Weinstein's and the Contour Thread methods," he says. "Suture lifting is fairly noninvasive. One can perform these procedures under local anesthesia. There's not a lot of down time. I believe this is going to be one of the most exciting new areas. It's brand new, so there aren't a lot of long-term results compared to Thermage^® (Thermage Inc.) or regular facelifts. However, we've already seen excellent results with suture lifts. And more patients are asking about (this technique)," Dr. Moy says.

To date, he and two colleagues in his office have performed approximately 20 such procedures. Though he has yet to establish a preference among the three methods discussed, he says, "I believe the Contour method will be the most popular because it may be the easiest."

Contour threads, he says, differ slightly from the Featherlift (Aptos thread, Kolster Methods Inc./KM I) threads. Contour threads are Food and Drug Administration-approved, he explains, and because they're fixed to tissues one is able to tighten areas such as the cheek fat pad especially, but also the jowls and the brows.

As for the Thermage device, Dr. Moy says that it, like the Titan (Cutera), works most effectively when modest tightening (a few millimeters) is required.

He says, "The Thermage device represents the gold standard. It performs very well, although sometimes it can take a couple treatments. Also, new treatment parameters have been introduced that, in most cases, achieve immediate tightening. They're a little lower than the older parameters, and they involve multiple passes on the skin."

With the new parameters, Dr. Moy adds, "one can not only get tightening of the brow, jowl and neck, but one can also treat other areas of the body such as the abdominal skin and the arms. In fact, we're using it frequently in combination with liposuction."

The newer Titan employs infrared rather than radiofrequency heat.

"The infrared heat probably approaches what Thermage accomplishes," he says. "I'm not aware of any comparison studies, but it definitely can give modest to significant tightening."

Like the Thermage, the Titan also works on all body areas.

"One advantage is that the infrared heat doesn't hurt as much as radiofrequency heat. However, both devices, especially with the new Thermage parameters, are very safe. Complications are minimal," Dr. Moy says.

Evolving techniques

Surgical lift techniques also continue to undergo modifications.