New in My Practice: Devices

In each edition, Modern Aesthetics® asks top cosmetic physicians about the newest devices in their practices. This month, we chatted up Bradenton, FL dermatologist Susan Weinkle, MD. The topic? Sinclair Pharma US's Silhouette InstaLift and what it adds to her facial rejuvenation toolbox.

What is the Silhouette InstaLift?

Dr. Weinkle: Sinclair Pharma US's Silhouette InstaLift is relatively new to the aesthetic scene. It's a minimally invasive procedure that uses sutures to lift the underlying midface tissue and fixate the cheek in an elevated position. I have been using it since November 2015. The sutures are made of fully resorbable glycolide/L-lactide (PLGA) strand, which allows for smaller knots than other sutures. Each strand holds two sets of bi-directional absorbable hollow cones made of PLGA. It can be used to lift the midface, a drooping brow and/or jowling around the neck. The threads are passed into the droopy facial area with a special 23-gauge needle. They are placed below the dermis in the subcutaneous space so there are not a lot of vessels or nerves involved. After the tissue is lifted to the desired height, the bi-directional cones are engaged and fixated. By engaging the cone, you get suspension of tissue.

How do the results compare with facelifting?

Dr. Weinkle: This is not a facelift, but when it is performed on someone who needs a little lifting, the results are amazing. The procedure takes 30 minutes and is performed with local anesthesia. There is relatively no downtime except some temporary discomfort, swelling, and bruising. The results are not permanent, but may last up to two years. The body will gradually reabsorb the sutures. There is an immediate lifting effect and continued improvement over time as the PLGA cones stimulate fibroblasts to produce collagen. In the right patient, the Silhouette InstaLift may help prevent or dramatically postpone the need for a full facelift.

Importantly, the Silhouette InstaLift should never be compared to the thread lifts that were briefly popular in the late 1990s. Those involved permanent sutures and worked with barbs, not cones. There were a lot of complications, as well. This is a whole different ballgame.

How Are You Using The Device In Your Practice?

Dr. Weinkle: I have a strong filler practice, and I will say to a patient, “I really think you have enough volume, but we would like to lift the tissue and improve jowling.” I will put my hands on their skin and feel for which direction gets the most lift, and illustrate how they may look after an Instalift. It's not replacing injectables or other technology, but augmenting what is already in our toolbox. We have lasers, creams, injectables, and other energy-based minimally invasive treatments to address other signs of facial aging, but until now there has not been an option to lift tissue without surgery.

I will often combine the Silhouette Instalift with a botulinum toxin or filler injections during the same visit. It is very well tolerated and truly an exciting new tool that offers another approach to facial rejuvenation.

Any known contraindications?

Dr. Weinkle: It should not be used in patients with any known allergy or foreign body sensitivities to plastic biomaterial or if internal fixation is otherwise contraindicated, such as presence of an infection, the company states. It is also not appropriate in patients who have very thin soft tissue of the face, as the implant may be visible or palpable in these cases.

Is there a learning curve?

Dr. Weinkle: I have done about 25 of these procedures and I have grown confident in my approach. It does involve some manual dexterity. The good thing is that Sinclair Pharma US is not just putting this out there. There is hands-on training required for any physician who wishes to use the Silhouette InstaLift. Like everything else in life, practice makes perfect.