Tendon harvest
For midface resuspension, a longer tendon is often required. As a result, the plantaris longus is the preferred option.
Options to identify the tendons include:
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Preoperative MRI
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Intraoperative exploration
Other tendon options include palmaris longus or long extensors of the toes (3rd or 4th).
The full length of the selected tendon is harvested.
Advantages of using a tendon graft
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Resists lengthening
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Lower relapse rate
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Small scar
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Very long sling (especially with plantaris longus)
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Minimal to no donor deficit
Disadvantages of using a tendon graft
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Separate donor site scar
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Tendon absent in some patients (plantaris longus, palmaris longus)
Other suspension options include acellular dermal matrix, fasciae latae, Gore-Tex or other alloplastic materials.