Technique of Gore Tex Suspension

Gore-Tex is obtained in sheets of 1- or 2-mm thickness and cut into strips 3 to 4 mm wide and 7 to 8 cm long. Incisions are planned at the lateral border of the obicularis oris muscle, which closely corresponds to the melolabial crease, and over the body of the zygoma at the junction of the cheek skin and lower eyelid skin. The zygoma is exposed superiorly and a deep subcutaneous tunnel connecting the two incisions is created and a strip of 2 mm Gore-Tex is passed. The inferior end of the strip is then sutured to the obicularis muscle with 4-0 or 5-0 permanent sutures (Mersilene, Ethobond, nylon, or Gore-Tex suture). The superior end of the strip is then placed on tension and the corner of the mouth elevated to the desired position. Some overcorrection should be included in the original positioning, but much less than the amount needed for fascia lata or temporalis muscle. The Gore-Tex strip is then secured to the zygoma with one or two 1.5-mm titanium screws passed through the Gore-Tex and into the underlying bone using the screw head to secure the Gore-Tex. This is facilitated by the use of self-tapping and self-drilling screws. For forehead suspension, a horizontal inferior incision is marked in a suprabrow crease approximately 5 to 10 mm above the brow just lateral to the midbrow point. The inferior incision is carried into the subcutaneous tissue and dissection directed inferiorly until the edge of the orbicularis oculi muscle is identified. Superiorly, a vertical incision is marked in the hairline (if available). The superior incision is carried through the galea aponeurosis and a suprape-riosteal dissection performed until the inferior incision is reached. A strip of 1-mm-thick Gore-Tex is then passed and the inferior end sutured to the orbicularis with any of the previously mentioned suture material. The superior end is then placed on traction and, when the brow has been elevated to its desired height, it is tacked to the underlying skull with a 1.5-mm-diameter and 4-mm-long titanium screw. The scalp incision is closed with staples and the skin incisions closed with fast-absorbing chromic.

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