As it flies out of the end of the double syringe, propelled by compressed air, the glue is nearly invisible as it coats the underside of the skin flap and the newly repositioned tissue below. The glue, recently approved by the Food and Drug Administration after testing in Evans and across the country, could help reduce bruising and downtime for patients after face-lift surgery.
The glue, called Artiss, is already approved for burn surgeries and has been used in plastic surgery off-label for about 10 years, said Dr. Achih Chen of the Georgia Center for Facial Plastic Surgery & Laser Aesthetics in Evans. Chen and the Evans center worked on 23 of the 75 patients included in the last clinical study of the glue.
The glue, used under the skin flap to help adhere it tighter to the tissue beneath, seemed to reduce the amount of fluid produced by the area of the face-lift after surgery by one-half to two-thirds in those patients, according to data submitted to the FDA. That tighter seal is the reason, Chen said.
“If you just lift (the skin flap) up and sew it down, you have this whole pocket that can collect fluid,” he said. “The benefit of gluing that flap down is that you don’t have this potential space to collect fluid and collect blood. And that’s how bruising occurs.”
That bruising is a major reason for facelift patients to have time away from work or other activities, particularly if they are trying to be discreet about the surgery. With traditional face-lift surgery, it can be as much as two weeks.
“That’s why a lot of patients don’t want face-lifts is they just don’t have the downtime,” Chen said. “So if you can give them something intermediate, where they have just a short bit of downtime, and you can prevent a lot of bruising, it becomes a much more viable procedure for them to have.”
The glue can also cut down on hematomas, a blood-filled swelling in the affected area that is another complication of the surgery. The glue cut the rate by half in clinical testing.
“It’s not a life-threatening problem, but it is a major nuisance for the patient,” Chen said. “Nobody wants to go back to the operating room” to remove the swelling.
After seeing most of her friends get procedures, patient Kathryn McDaniel, of Martinez, knew some of the pitfalls of the surgery.
“A month later or weeks later they’re still bruised,” she said, and she bruises easily. But after meeting with Chen, she was comfortable about moving ahead.
In the operating room at the Evans center, Chen created an incision down the right side of the face, hugging the hair line, around the ear and down the jaw. Working slowly at times with scissors, he carefully creates a flap of skin 6 centimeters by 10 centimeters to expose the tissue of the cheek below, which is called the superficial musculoaponeurotic system, or SMAS. Working carefully, he frees up that tissue, avoiding the dangers beneath.
“That’s part of the reason why not everybody wants to get underneath the deep plane (of tissue) when they do a face-lift, because the nerve to the face lies there,” Chen said as he worked. “But it gives you two ways to tighten” in both the cheek and the neck beneath.
A suture pulls the SMAS up tighter and higher to the cheek bone, tightening the neck area in turn, as Chen anchors it there. When he lays the skin flap back again, it overhangs the ear area. After sizing it up, he carefully trims as he adjusts it so it fits exactly. That’s important to avoid what Chen calls the “windswept look” of putting undue tension on the skin.
“As long as you adhere to those rules, you won’t have that face-lift look,” he said.
After it looks right, he pulls out the double syringe of Artiss glue, attaches it to a compressed air hose, douses the inside of the skin flap and the tissue underneath, then presses and holds it in place for three minutes.
For nearly a half-hour after that, Chen puts tiny stitch after tiny stitch along the incision, hiding them in the hairline and the edges of the ear, until it is closed. Deep furrows in the cheek and the jowls have disappeared into skin smoother than the untreated side, which he does next.
McDaniel said afterward she didn’t even need painkillers and that the only evidence was a tiny bruise along her jawline that she easily covered up. Two days later, she went grocery shopping and no one seemed to notice. Less than a week after, someone remarked on her new look and asked what she did.
“Before I could even get it out, they said, ‘Man, you must have had a good night’s sleep. You look so well-rested,’ ” McDaniel said.
That, she said, is the look you want.