Scarless, closed approach Serdev Suture techniques for
augmentation and lifting of cheekbones were introduced by the author in 1994.
They use the mobile cheek SMAS flap or fascial tube of the buccal fat pad (also
called Bichat’s fat pad) to elevate and attach it to the immobile, stable
zygoma periosteum, and in selected rare cases - to the orbital rim periosteum,
or temporoparietal tendon insertion and underlying periosteum, or the upper
temporal line periosteum and temporal fascia. The idea is to lift the SMAS and
fat pad via its fascial tube at the level of the zygomatic bone; restore
cheekbone fullness; volumize and elevate the cheekbone; eliminate the tear
trough fold; improve facial expression; and achieve a youthful elongation of
the so-called “beauty triangle”. To achieve the cheekbone lift, the author uses
special semi-blunt and semi-elastic curved needles with lengths of 50 mm, 60 44
Miniinvasive Face and Body Lifts – Closed Suture Lifts or Barbed Thread Lifts
mm, 100 mm, and 140 mm with an eye at the tip, and prefers semi-elastic
Bulgarian polycaproamide (Polycon) USP 2 sutures with prolonged resorption (2-3
years). The Serdev Suture® lifting techniques are ambulatory, performed under
local anesthesia, very well tolerated by patients, produce immediate results,
with an extremely short post operative period, fast recovery and nearly
immediate return to social life.
Complications are under 0,1% and patient satisfaction is
high, especially in the aesthetic aspects of rejuvenation and beautification.
There were no known specific surgical methods
for simultaneous direct cheekbone
lifting, enhancement and volumising without the use of implants or transplants
before 1994. The superficial muscle-aponeurotic system, or SMAS, was described
by Mitz and Peyronie in 1976 and the SMAS facelift became the gold standard.
Earlier procedures developed into a large rotation-advancement skin flap for
indirect lifting of this area.
Classic rhytidectomy progressed into sub-fascial,
tri-plane, deep-plane, composite, subperiosteal, multiplane, “enbloc” and other
extended surgical methods, with a progressively increasing rate of
complications and downtime. Nowadays, minor operations with reduced risks and
faster recovery time have become more common, but the SMAS lifts without undermining
remain the best long-term suspension, affecting the overlying skin. Later
techniques, such as barbed “thread lifts”, are placed subdermally and naturally
cannot include the SMAS in the lift. They are free floating, not sutured, nor
stabilized by attachment to immobile anatomical structures. Therefore, in the
author’s opinion, they are different from suture lifts and cannot guarantee a
safe prolonged outcome.
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