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    Fibrin glue remains practical tool in facelift surgery

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    Dr. Taylor
    Though it has gained a bad reputation in the past because of surgical complications associated with its use, fibrin glue remains a very practical and useful tool in cosmetic surgery, particularly in facelift surgery. When used appropriately and in the right quantities, fibrin glue can help optimize surgical results without the worry of complications, according to Clark O. Taylor, M.D.

    Fibrin glue is a fibrin sealant made up of an allograft of fibrinogen and thrombin. Traditionally, the glue has been employed as a tissue adhesive and has been useful in assisting intraoperative hemostasis, as the glue can help seal many of the very small traumatized blood vessels.

    More than this, however, fibrin glue has a special utility in facelift surgery by helping the skin flap adhere to the underlying tissues, says Dr. Taylor, director of the Cosmetic Surgical Arts Centre in Missoula, Mont.

    "I regularly use fibrin glue in my facelift and browlift surgeries, and in my experience, the glue can help optimize lifting results and facilitates the ease and time of the surgery," he says.

    TECHNIQUE SPECIFICS Dr. Taylor says he prefers to aerosolize the fibrin glue with the help of compressed air. At the termination of the facelift case, he positions and holds the skin flap into its final position with suspension sutures and completes the final trimming.

    Next, he raises the flap with retractors and, using a special syringe, he sprays the fibrin glue on the underside of the skin flap and into the base of the underlying tissue. He then places the subcuticular sutures while manual pressure is applied on the skin flap for approximately five minutes, allowing the fibrin glue to set.

    "The assistant should continue to manually hold down the skin flap while the sutures are placed so that you do not inadvertently pull up any edges of the skin flap. This really helps to find a perfect juxtapositioning of the tissue edges and optimizes the result," Dr. Taylor says.

    Using an appropriate amount of glue in the surgical site is instrumental in achieving a good surgical result, Dr. Taylor says. He typically sprays 1 cc of fibrin glue per side in facelift cases and 0.75 cc to 1 cc of fibrin glue in forehead lift cases.

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