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Page 4 of 6 de la Torre et al. Plast Aesthet Res 2020;7:11 I http://dx.doi.org/10.20517/2347-9264.2019.54

A B

C D

Figure 3. Long-term follow-up of a 57-year-old patient undergoing minimally invasive midface suspension procedure: A: preoperative
frontal view; B: postoperative frontal view (eight months); C: preoperative lateral view; D: postoperative lateral view (eight months). The
patient maintained satisfactory results at the 18-month follow-up visit.

extensive subperiosteal dissection have been described . These approaches may involve longer operative
[13]
times, general anesthesia, lengthy recovery periods, and a higher risk of complications. Additionally,
numerous studies describing thread lifts have been published. Thread lifts generally involve inserting a
unidirectional suture with cones or barbs subcutaneously [9,10,16,17] . The tissue is then manually inset over
the barbs or cones. The advantages of this technique are short procedure time and very limited dissection.
Disadvantages of thread lifts include minimal fat pad elevation, reaction and extrusion of sutures, and
temporary results.

The technique in this study involves making a small temporal incision and a small stab incision near the
nasolabial fold. The malar fat pad is elevated by suspending it to the deep temporal fascia using a standard
suture. Unlike thread lifts, which only elevate the skin, the technique in this study directly elevates the
malar fat pad. This distinction is important because the ideal way to address midfacial aging is by elevating
the malar fat pad to its original and youthful position over the malar eminence. In our series, we initially
used permanent nylon suture; however, with the success of the absorbable barbed suture, we initiated the
use of absorbable sutures. The monofilament sutures left a palpable area along the suture and a knot, which
the Vicryl suture avoided. Although the suture material dissolves within a few weeks, the results last longer.
Although nylon suture is frequently used for midface elevation, absorbable sutures including catgut, Vicryl,
and PDS have been used to elevate the face with success [18-21] . This may be because the malar fat pad is
anchored to the fixed tissue of the deep temporal fascia, unlike thread lifts, which typically involve floating
sutures. The difference in fixation may account for results which last longer than those from the modified
sutures since the malar fat pad is suspended to the deep temporal fascia. Although a stab incision is made
in a visible area of the face, in all patients, the scar was extremely well-tolerated and imperceptible.

Although this technique has several advantages and satisfactory results, it does have limitations. MIMS
is not ideals for patients with severe skin laxity; these patients are better served by traditional facelifts.