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Tissue "glue" boosts facelift recovery, healing time
Nancy A. Melville
STAFF CORRESPONDENT
SANTA MONICA, CALIF.
Fibrin sealant, a type
of surgical "glue"
made from human
blood-clotting proteins, has been used
for serveral years
now to control bleeding during everything
from cardiopulDr. Abergel
monary bypasses to
conventional suturing and cautery.
Aesthetic surgeons are also increasingly
finding success with use of the sealant
as a type of Glue for the face that seals
capillary vessels and has been shown to
accelerate healing time and recovery.
Surgeons inject the sealant under the
skin during a facelift to help the skin
reattach to the muscle. Santa Monica,
Calif., cosmetic surgeon R. Patrick
Abergel, M.D., tells Cosmetic Surgery
Times that he has used the sealant on
several hundred patients and has consistently seen favorable results.
"Once we've done a liposculpture and
the skin has been lifted from the muscle,
we inject the fibrin with a syringe and
the minute it's injected, it's sealed," says
Dr. Abergel, a clinical professor at University of Southern California School of
Medicine. "By helping the skin reattach
to the muscle, the process reduces the
amount of swelling, and when we do a
facial sculpture, we see no bruising or
swelling," he adds.
SMOOTH RESULTS In addition to
helping with the healing process, Dr.
Abergel says he sees an improvement
with the results in appearance with the
use of the fibrin sealant. "I think it does
make results smoother because it immediately closes the dead space, or the
pocket of air that can be left when you
lift the skin in a surgery." he explains.
"That pocket can accumulate with fluid,
which can cause swelling and delay
healing, but the sealant helps eliminate
that."
Fibrin sealant is sold under various commercial names, including Tisseel (Baxter), Crosseal (Johnson & Johnson) and
FloSeal (Baxter). The product, originally
approved by the FDA in 1998, is actually
a two-component system that includes a
highly concentrated fibrinogen that acts
with other plasma proteins as a sealer,
combined with thrombin and calcium,
which act as hardeners.
Together, the components mimic the
final stage of the blood coagulation
process – fibrinogen is converted into
fibrin when applied to the tissue surface
with the thrombin. The process is crosslinked by factor Xllla and a mechanically
stable fibrin network is established.
SEALANT STUDIES Studies on fibrin sealant's efficacy include a prospective, randomized, double-blind trial in
which 20 patients receiving facelifts had
fibrin sealant on either the right or left
side of the face, with the contralateral
side serving as a control. Oliver and colleagues found that, after 24 hours of
monitoring post-op drainage, the sides
treated with fibrin sealant had a medial
drainage of 10 ml, while drainage on the
control side was 30 ml. The researchers
concluded that the reduction in post-operative drainage could help reduce pain
and bruising and the need for drains
could be avoided.
In addition to facial surgery, one of the
key uses plastic surgeons have found for
the fibrin sealant has been in bariatric
surgery, according to Susan Kaweski,
M.D., F.A.C.S., chairman of the Technology Assessment Committee for the
American Society of Plastic Surgeons.
formation than the high-concentration
fibrin group and controls (P < .032 ad P <
.018, respectively). In addition, post-operative drainage was significantly lower
in the low-dose group (P = 0). "The use
of slow-reacting, low-dose fibrin glue
demonstrated a protective effect against
the formation of seroma following abdominoplasty," according to the researchers. "The amount of
post-operative drainage was significantly
lower."
Combined with the benefits of improved
post-operative healing, the tissue glue
can be an important tool in plastic surgeons' armamentarium, Dr. Kaweski
says. "With decreased swelling and
bruising, you'll have a faster recovery
rate, and I think that's very important."
"In addition to helping
with the healing process…
he sees an improvement
with the results in
appearance with use
of the fibrin sealant."
"A lot of plastic surgeons removing excess skin after bariatric surgery are using
[fibrin sealant] in order to be able to seal
the wound and help prevent seroma formation." While the cost may be an issue
for some surgeons in choosing not to
use fibrin sealant, Dr. Kaweski says the
benefits can justify the expense.
"The cost may be an issue, but the cost
of having a seroma post-op could be
much more,' she says. "I'd rather spend
a little more and put the fibrin glue on
the area because, in the long run, the
seroma could cost a lot more money."
A recent study by Toman and colleagues
out of the University of Berlin, German,
looked at the role of fibrin sealant in
seroma formation among abdominoplasty patients and found significant improvement with the sealant. In the study,
two different thrombin concentrations (4
IE versus 500 IE thrombin/ml) were applied to two groups of 20 patients each,
and a control group of 20 patients undergoing abdominoplasty had no fibrin glue
adhesion.
The results showed that the group with
the slow-reacting fibrin sealant (4 IE)
had a significantly lower rate of seroma
Two patients before and after facial sculpture surgery in
which fibrin sealant was injected perioperatively. New
research seems to indicate fibrin sealant's role in reducing
seroma formation and post-operative drainage.
Photo credit: R. Patrick Abergel, M.D.
References
Oliver DW, Hamilton SA, Figle AA, Wood SH, Lamberty BG.
A prospective, randomized, double-blind trial of the use of fibrin
sealant for face lifts. Plast Reconstr Surg. 2001; 108:2101-2105.
Toman N, Buschmann A, Muehlberger T. [Fibrin glue and seroma
formation following abdominoplasty.] [Article in German.] Chirurg.
2007; 78:531-535.
Disclosures
Drs. Abergel and Kaweski have no disclosures
to report of relevance to this article.
For more information
R. Patrick Abergel; [email protected]
(310) 829-2005
Susan Kaweski; [email protected]