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Proud to bring you information via The Web since 1996

DONALD J. CAPUANO, M.D.
Plastic Surgeon

Board Certified in Plastic Surgery

The Barbi Face Lift™

A technique involving 'barbed' sutures to lift a face

 

Summary

The BarbiFaceLift™ compared to traditional face lift procedures, is a relatively safe, effective, reversible, complication free, and certainly less expensive alternative to open face lift procedures. Please note that this technique is not applicable to all who might 'need' a face-lift. This technique is currently most useful for individuals who have some facial 'ptosis' (drooping). Please see our consultation page.

   
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Important Points

From Doctor Capuano's viewpoint

The idea of a barbed suture is not new. During the 1900s such sutures were used in the repair of tendon injuries. The barbed sutures have been used in other countries such as Korea, Indonesia, Argentina, Brazil, and Canada for years to help lift and tighten various tissues, not just the face.The material that is used for the barbed suture has been FDA approved for use in the body for over fifty years. It is a polypropylene suture. Polypropylene has been used for operations in all specialties. The surgeries that involve opening of the carotid artery to remove plaque that could causes stroke, the incision in the artery was closed with this suture and suture material. During coronary artery bypass surgery, polypropylene sutures are used to suture the arteries together. During 'open face lifts', polypropylene sutures are used to tighten the deep tissues under the skin. In all instances noted, and in many, many other operations, these polypropylene sutures remain in the body.

So what's new(er)

What is new(er), at least in the USA, is crafting or engineering barbs in the suture.

And what is a barb and why does it work.

The simile I use for explaining what happens, is to imagine a telephone pole which has been chopped with an ax. The ax chopped only with a downward swing. The ax chopped into the pole from the bottom to top, around the pole at 1 foot intervals. Imagine climbing up the pole (ok for certain age groups !!),

but don't try to slide down the pole, because the barbs will get you !

This is how the barbs holds tissue. Is it fool proof? Of course not. Has it been shown to be effective ? Yes. The US experience is not as extensive as in other countries but testing has shown, and the innovator of the barbed suture in the US, Dr. Gregory Ruff, teaches that a barbed suture lift should last three to six years.

Is it the suture that holds the tissue over time.

We don't know. There is evidence to suggest that around the barbed suture a matrix, film, or coating of scar tissue forms. This may, over time, be the mechanism whereby the tissue of the face (forehead, neck – bosoms, buttocks, etc) can be held in place.

What happens if an infection occurs.

The suture can be removed according to those physicians who have removed them. And they can be replaced.

How is the procedure done.

In the office under a local anesthesia with medications on board, the threads are put in place. For those who THINK THAT they are unable to tolerate such a procedure in the office, the operating room at Park Ridge with a anesthesiologist are available. Dr Capuano is a board certified Plastic Surgeon (Certified by the American Board of Plastic Surgery), and has hospital privileges.

What are potential complications.

First because the procedure is only years old – we don't know all of them.

If we consider the complications of sutures in other parts of the body, and the way they are placed, we can get an idea of potential problems.

Bleeding can occur.

There are no really major vessels that should be involved. Pressure and ice will keep significant black and blue to a minimum. That is barring the fact that you do not have a bleeding disorder or are on medicines that can cause bleeding to be prolonged such as aspirin, anti arthritic meds, anti-platelet agents such as Plavix, or herbs such as garlic, St John's Wort etc.

Infection is also possible.

Infection should be rare and if it should occur, it should be a localized problem. If on the outside chance that you saw major redness and pain in the area of suture placement or if you develop a fever, you would need to call us.

NO ALLERGIES have been reported to this suture material – but …….

Fluid from a gland

The parotid gland could in theory be a problem. Removal and replacement of the suture might be necessary.

Injury to a nerve

Nerve injury should be transient (go away) if it should occur. No major nerve injury is anticipated. Temporary numbness or muscle weakness is not anticipated. It could occur.

Other 'way out' problems

We will attempt to update information, as it becomes available. For now though, the general information present is thought to be informative and true. We also suggest that other pages on the web regarding barbed threads and their uses be referenced periodically. As with any life experience – there can be problems. Doing nothing is an alternative..

Summary

The BarbiFaceLift™ compared to traditional face lift procedures, is a relatively safe, effective, reversible, complication free, and certainly less expensive alternative to open face lift procedures.

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Information from the web

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Please Note Well

                This information, found on the web, is for your general information. What is claimed – described – etc, can not be personally verified. We can only comment about our experience and the logic behind these procedures, as we know them. Remember – each individual is an individual – different in skin thickness, texture, sagging, bony anatomy, etc ,etc, etc. can make a significant difference in the results. What may be applicable to you may not be as described in any of these descriptions or media snippets.

                Thank you for your understanding.

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More Media Information

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Lunchtime Beauty Fix' Makes a Splash

USA Today (04/13/05); Barker, Olivia

Manhattan cosmetic dermasurgeon Nelson Lee Novick touts the benefits of the latest craze in cosmetic surgery, called the ThreadLift, Featherlift, or the One-Stitch Facelift, depending on the brand of the suture and the physician performing the procedure. ThreadLift involves pulling polypropylene threads through a patient's skin to raise sagging jowls, brows, and necks. Dubbed a minimally invasive face lift, it can be performed under local anesthesia in just 45 minutes, but carries with it a hefty cost of between $7,000 and $8,000 for a full face and neck procedure, compared to the average cost of a surgical face lift-- $9,000. Though the costs are similar, the after-effects are not. Unlike a face lift, ThreadLifts cause little swelling, bruising, scarring, and discomfort, and patients can return to work the same day. (Link to web site)

Posted 4/13/2005 9:20 PM Updated 4/14/2005 3:06 PM

'Lunchtime beauty fix' makes a splash
By Olivia Barker, USA TODAY
The latest cosmetic surgery procedure has a few strings attached.

"This is what Ponce de Leon had been looking for but didn't find," says Manhattan dermasurgeon Nelson Lee Novick.
3-D imaging by Robert W. Ahrens,USA TODAY

Doctors are pulling polypropylene threads through patients' skin to raise sagging jowls, brows and necks. Performed under local anesthesia in only 45 minutes, it's being touted as a minimally invasive face lift, or so say practitioners and recipients of what's variously known as the ThreadLift, the Featherlift or the One-Stitch Facelift, depending on the brand of the suture and who's pulling the strings.

Devotees of threading are as breathless about its potential as they were about Botox a decade ago.
How the lift works

A physician makes a 3-millimeter
incision at the hairline, jaw line or
ear and advances polypropylene
threads through the fatty layer
under the skin’S surface.


The barbed threads zigzag
or arc through the drooping
tissue, grabbing and lifting the
brow, cheek or neck, depending
on where the threads are inserted.

"This is what Ponce de Leon had been looking for but didn't find," says Nelson Lee Novick, a Manhattan cosmetic dermasurgeon who has ThreadLift appointments booked through 2006. "In one to two years, it will be the hottest lunchtime beauty fix probably of all time."

A ThreadLift typically lasts two to five years, but - depending on a patient's skin tone and how expressive they are - it can hold for as long as a traditional face lift, up to 10 years. Threading a full face and neck runs $7,000-$8,000, similar to what the American Society for Aesthetic Plastic Surgery reports as the 2004 national average cost of a face lift and forehead lift ($9,000).

But unlike going under the knife, there's little swelling, little bruising, little scarring and little discomfort, enabling patients to return to work the same day.

Still, no pain means little gain, caution some doctors. The results aren't drastic, says Brent Sigler, a cosmetic dermatologist in Lone Tree, Colo., who has performed the procedure on perhaps 50 mostly female patients in the past year.

Targeted to forty- and fiftysomethings who are just starting to lose elasticity, "this is something to buy some time" before getting a traditional surgical face lift, he says. Other, older ThreadLift patients are those who have already had a surgical face lift and are looking to tighten things up a bit.

But "what (Sigler) says is subtle I thought was dramatic," says Vicky Larson, 47, of Littleton, Colo. Her jowls elevated, her cheekbones revealed, strangers started mistaking her for her 27-year-old son's girlfriend.

"When you get into your 40s, no one takes a double look at you, or it doesn't happen as often," she says. "Now I get more double looks, and that's always ego-inflating."

Manhattanite Pam Chenkin didn't want the severe tautness associated with a standard face lift. "I watch TV talk shows and you can tell who's had work done. I didn't think that was necessary for my job," says Chenkin, 58, who's studying to be a high school teacher. "Teenagers judge you by your appearance, and I thought it would be a benefit to me not to look young but to be youthful appearing."

There can be complications. Threads have been known to work their way out of the skin, infections have occurred, and patients have complained that the web of polypropylene in their face is uncomfortably palpable.

Other drawbacks are relatively minor. Sleeping on your back for six weeks is a must, to avoiding shifting the threads. For the same reason, smiling, laughing, yawning and munching on foods with substantial girth, such as hamburgers, isn't allowed for the first couple of weeks.

"It's so hard," Larson says. "You can still giggle, but you don't realize how often we really do laugh during the course of a day."

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From Chattanooga Tennessee

TV News Station

44 YEAR OLD PATTI P----- IS READY FOR A LITTLE LIFT. BUT SHE DOESN'T WANT TO GO TO THE TROUBLE OF SURGERY TO GET IT.

SHE'LL BE IN AND OUT OF THE DOCTORS OFFICE IN ABOUT AN HOUR THANKS TO THESE THIN BLUE THREADS. THEY'RE THE SAME SUTURES DOCTORS USE TO STITCH UP WOUNDS - BUT SURGEON DR.GREGORY RUFF HAS CUSTOMIZED THEM FOR A NEW USE

TINY BARBS ON THE SUTURES ACT LIKE TISSUE GRABBING TEETH WHEN THREADED UNDER THE SKIN. IN THIS CASE - GRABBING THE FLESH IN PATTI'S NECK. PATTI IS GETTING WHAT AMOUNTS TO A FULL FACE LIFT - BUT THERE'S NOT A SCALPEL IN SIGHT - JUST A NEEDLE AND THREAD. SINCE PATTI IS ONLY UNDER LOCAL ANESTHETIC, SHE CAN GIVE ON THE SPOT INSTRUCTIONS ABOUT WHAT SHE WANTS. BARBED SUTURES ARE IN PLACE ON THE RIGHT SIDE OF PATTI'S FACE. IT'S NOW TIME FOR LIFTING AND SHAPING.

THE EFFECT IS SUBTLE, AND DR. RUFF SAYS, NOT FOR PATIENTS WHO NEED MAJOR WORK. IT'S NOT YET KNOWN HOW LONG THE LIFT WILL HOLD THERE IS A CHANCE THE SUTURE MIGHT BREAK AND NEED TO BE REPLACED. ISSUES - DR. RUFF SAYS NEED TO BE RESEARCHED IN CAREFULLY CONTROLLED STUDIES. THE DRASTIC CUT IN RECOVERY TIME. FOUR DAYS AFTER HER PROCEDURE - PATTI IS BACK IN THE OFFICE FOR A FOLLOW-UP. ALONG WITH THE EASE OF THE BARBED SUTURE PATTI SAYS SHE LOVES THE SUBTLE RESULTS. DR. RUFF SAYS PATIENTS CAN GET A MORE DRAMATIC RESULT BY USING MORE SUTURES. THE GOOD NEWS, IF YOU DON'T LIKE THE RESULTS, YOU CAN HAVE THE THREADS REMOVED. THE COST IS MUCH LESS THAN A TRADITIONAL FACELIFT WHICH CAN RUN SEVERAL THOUSAND DOLLARS. DR. RUFF SAYS PRICE DEPENDS ON HOW MUCH WORK A PATIENT IS HAVING DONE. SOME SURGEONS WHO PERFORM SIMILAR TECHNIQUES CHARGE ANYWHERE FROM THREE TO FIVE HUNDRED FOR EACH SUTURE. THE BARBED SUTURE IS NOT YET FDA APPROVED, SO YOU NEED TO DO YOUR HOMEWORK BEFORE YOU SIGN UP FOR THIS PROCEDURE. DOCTORS ARE ABLE TO USE THEM UNDER SPECIAL CONDITIONS. YOU NEED TO ASK ABOUT A DOCTORS EXPERIENCE AND RESULTS WITH THE SUTURES. ADDITIONAL INFORMATION: DR. RUFF SAYS THIS PROCEDURE IS IDEAL FOR YOUNGER AND MIDDLE AGED PATIENTS WHO ARE AT THE FIRST PLATEAU OF FACIAL AGING (35-45), AS WELL AS PREVIOUS SURGICAL FACELIFT PATIENTS THAT WOULD LIKE A TOUCH-UP. ONE TREATMENT PER AREA IS USUALLY ALL THAT IS REQUIRED TO ACHIEVE THE DESIRED RESULTS. DR. GREGORY RUFF INVENTED AND PATENTED THE BARBED SUTURE PROCEDURE IN 1993, TO SOLVE WOUND CLOSURE PROBLEMS. HE GOT THE IDEA FROM A PORCUPINE QUILL AND FORMED HIS OWN COMPANY QUILL MEDICAL. HIS BARBED SUTURE IS PENDING FDA APPROVAL. PATTI'S SUTURES ARE CUSTOM CONCEPT DEVICES MADE BY BARBING AN ETHICON SUTURE FROM JOHNSON AND JOHNSON

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(Dr Capuano Note – The FDA has approved these sutures for use in the mid portion of the face as of November 2004. Other uses – and they can be used in other parts of the face or body are called 'off label' use.

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PHILADELPHIA – Patients without time for a facelift or intimidated by surgery now have more minimally invasive options that produce effective results. Barbed sutures, ultrasonic body contouring and soft tissue fillers, three emerging trends in the plastic surgery industry, offer patients faster results without the downtime of surgery, according to a program held today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2004 conference in Philadelphia.

"Plastic surgery patients want shorter, minimally invasive procedures that produce results and have limited downtime," said Leroy Young, MD, chair of the ASPS Committee on Emerging Trends. "As plastic surgeons, we are always searching for cutting-edge technology to meet the demand of our patients. Barbed sutures, ultrasonic technology and wrinkle fillers fit the bill."

Barbed sutures are a bit like barbed wire that have little cuts in the side of the suture, allowing the barb to catch when it is passed through tissue. The catch allows the plastic surgeon to pull on the suture once it is in place and tighten the tissue. This surgical development is expected to increase the number of people having facial rejuvenation, according to Dr. Young, because the sutures themselves are minimally invasive, require almost no downtime and are low risk.

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