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Response to the “Lunch Time”Suture Suspension Liftingof Drs. Atiyeh, Costagliola, Dibo and HayekDr. Javier de Benito M.D.Congratulations to Drs. Atiyeh, Costagliola, Dibo and Hayekfor their prescient condemnation of the so-called “Lunch timeface lift”. Theirs has been the experience of many others, aswell as our own, but it has also prompted me to respond withour thoughts about the topic, as well as a few words regardingthe continuing evolution of a satisfactory way to accomplishwhat has eluded us, as described by those authors.In the world of medicine, Plastic Surgery is the specialtythat is evolving the most, along with the changes that aretaking place in society over time.Accordingly, the modern philosophy of life - possibly drivenby new technologies, such as the Internet, the mobile phonesand so forth, in which everything should be achieved in theshortest possible time - has influenced the developmentof procedures and techniques, which can adapt to thesechanging patients’ needs.The most recent of these trends has been the demand forfacial rejuvenation with minimal recovery time, in order toprotect one’s professional and social lives. The challengingeconomic times we are facing require everyone to lookhis (or her) best, without withdrawing from the world forseveral weeks.These minimally and non-invasive techniques include the useof suspension sutures, which can tighten the skin of the facewith hardly any scar or undermining, unlike in a traditionalface lift. Initially, these threads enjoyed a huge success, asthey attracted a vast demand from patients. Unfortunately,the success was short lived, as the results often proved verydisappointing. The threads did tighten the skin momentarilybut the results did not last more than 6 to 9 months.Besides, as, in many cases, the threads extruded through theepidermis, they needed to be removed.However, a lot of important data was gathered throughthis experience. In the first place, the technique raisedexpectations among patients and medical doctors.It also demonstrated that a proper system was required, onewhich would not only tighten the skin but also the deeptissue and not carry the deficits attached to the barbs.Five years ago, sutures with knots and bio-absorbable conescame to the market. The Silhouette Sutures enable elevationof the malar fat pad and the jaw line, along with lifting andreducing the jowls.In addition, the passage of time offers the opportunity to usethe fibrotic tissue formed inside the cones and around theknots to retighten sutures in order to increase the longevityof the lift for many years.The sutures are made of polypropylene; the cones are hollowand made with an L-lactic acid and glycolide copolymer.Each of the six cones is located between two knots.They are the only suspension sutures that have been approvedby the Food and Drug Administration and obtained the CEmark.The sutures are placed in the subcutaneous tissue, abovethe SMAS and are anchored in the temporal area to themuscle and the deep temporal fascia by means of a smallpolypropylene mesh.Our experience is based on five years of using these suturesfor the midface, as published in the Annals of PlasticSurgery- ISSN 0148-7043/09/6205-0001, Volume 62,Number 5, Date: May 2009, Start page: 478, # of pages : 3- and in Aesthetic and Plastic Surgery Journal - ISSN: 0364-216X, Vol: 35, Issue: 2, Date: 2011-03-01, Start page: 248,# of pages: 6.To date these sutures have been used in over16,000 cases in fifty three countries and over 1,000 surgeonshave been trained. The simple concept of using absorbablecones instead of barbs has made the technique successfulWe performed a retightening in 27 % of the cases, more thantwo years after the initial procedure.This procedure can be carried out on its own in onehour, under local anesthesia or in adjunction with otherrejuvenation protocols such as an endoscopic brow lift, aneye lid correction or a neck lift.Also, the “Global Face Lift Pack” is the only non-invasiverejuvenation system that consists of applying the sutures,combining them with botulinum toxin in the area betweenthe eyes and the crow’s feet and, if required, to lift the edgeof the eyebrow, as well as remodeling with hyaluronic acidin patients who need greater volume in their facial tissue.This procedure is not indicated for patients with atrophicor very thin skin, neither for patients with abundant facialflaccidity who would require skin resection. The presenceof permanent fillers in the areas where the sutures are placedis also a contraindication.Post operatively, a soft food diet is recommended for threeto five days. During this period of time, it is also importantto avoid dynamic movements of the jaw and to sleep on theback. This will prevent the cones from moving away fromtheir anchoring position.Surgery is in a state of evolution. We feel the sutures withabsorbable cones will be a step forward in the armamentariumof Plastic Surgeons in pursuit of facial rejuvenation inspecific cases.Javier de Benito M.D.Director of Institute de Benito USPDexeus Barcelona32 IPRAS Journal www.ipras.org Issue 6