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For parents of young children, a trip to A&E where a smear of glue is applied to close a cut knee is a familiar scenario. But now a similar concept is being used in cosmetic eyelid surgery as an alternative to surgical stitches.Rather than sewing the wound, it is simply stuck together with an adhesive called fibrin glue. An added benefit is that because healing is quicker, scarring may be reduced.
‘Fibrin glue is not the superglue-type substance used to treat cuts in A&E,’ says Dr Julian De Silva, a facial plastic surgeon and pioneer of the method.
Before: Alexandra Hyde opted for surgery to remove some sagging skin around her eyes
After: The company director was delighted with the speed of recovery after the operation
‘Rather, it comprises two complex proteins called thrombin and fibrinogen, which are in the form of liquids stored as a frozen product. These are defrosted and mixed together before applying to a wound.’
This process occurs in a special syringe, which has two chambers rather than one. The thrombin converts the fibrinogen into fibrin, a protein that triggers the natural clotting process in blood and forms a plug over the wound.‘Fibrin glue has been used for years in neurosurgery,’ says Dr De Silva. ‘It’s an expensive product, so the use has to be justified.
‘However, it has been most effective in repairing minute leaks around the brain. In such an area, you cannot use stitches, so you need a very fine product that will work instead.’
The product has also been used to repair tears within the eye, and in spleen and liver trauma. Although it has been around since the 1940s, it is now being expanded into cosmetic fields, including blepharoplasty, or eyelid surgery. Blepharoplasty is the second most commonly performed cosmetic operation after breast augmentation, and its popularity continues to grow.
No stitch lift: Using fibrin glue saw recovery time shortened by several weeks
Dr De Silva conducted a five-year study on the subject and concluded that not only did the glue reduce immediate trauma to the eye area, but that some patients looked almost completely healed within a week, compared with up to six weeks for conventional stitches.
He started offering the procedure to his patients six months ago. ‘As we age, we all develop excess skin, soft tissue and bulging fat pads around the eyes, making them look smaller and less bright,’ he explains.
‘During the operation, an incision is made across the eyelid and some of the excess skin.
'Part of the underlying muscle called the orbicularis, which slackens with age, is removed, along with some of the fat. The remaining fat is sculpted into a smooth and youthful shape.’
Previously, to close a wound, up to 15 stitches have been needed. ‘Now I simply use glue under the surface of the tissue, bring the edges of the skin together and hold them together for approximately three minutes,’ he says.
‘Being comprised of natural products, the glue is reabsorbed back into the body. Many patients also dislike having stitches removed, especially around the eye. It’s uncomfortable and disconcerting.’
Operations take about 90 minutes under local anaesthetic, and patients are able to walk out and carry on with their daily activities.
Company director Alexandra Hyde, 53, is delighted with the results of her procedure. She says: ‘The stitchless approach meant that I went out without sunglasses five days after surgery, and after two weeks I felt comfortable enough to head up an important work meeting.’ She also found the recovery period completely painless.
There have been recent reports of glue being used in tummy tucks, but Dr De Silva says: ‘These use a combination of deep stitches and superficial glue. Glue on its own on the stomach would certainly not be enough to hold the skin together.’
However, Dr Sherrell Aston, chairman of the Department of Plastic Surgery at the Manhattan Eye, Ear and Throat Hospital, points out that surgical technique is much more important than the method of closure.
He says: ‘There may be a place for it in certain surgeries – blepharoplasty, and in face and brow-lifts – but it’s more down to personal preference on the part of the surgeon than any extraordinary results.
‘It is expensive, and may add a few hundred pounds to a procedure.’ Dr Aston also stresses he removes eyelid stitches after four days. ‘I don’t think you’ll find faster healing than that.
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