Patent Publication Number: US-2017348090-A1

Title: Minimally invasive tissue support

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority under 35 U.S.C. §120 as a continuation application of U.S. application Ser. No. 13/784,691 filed on Mar. 4, 2013, which is in turn a continuation application of U.S. patent application Ser. No. 13/476,942 filed on May 21, 2012 and currently pending, which is a continuation application of U.S. patent application Ser. No. 12/400,751 filed on Mar. 9, 2009 and now abandoned, which claims the benefit under 35 U.S.C. §119(e) as a nonprovisional application of U.S. Prov. Pat. App. No. 61/034,935 filed on Mar. 7, 2008 and U.S. Prov. Pat. App. No. 61/106,522 filed on Oct. 17, 2008. This application also claims the benefit as a continuation-in-part application of U.S. patent application Ser. No. 13/609,069 filed on Sep. 10, 2012 and currently pending, which is a continuation application of U.S. patent application Ser. No. 13/284,832 filed on Oct. 28, 2011 and now abandoned, which is a continuation application of U.S. patent application Ser. No. 11/866,985 filed on Oct. 3, 2007 and now abandoned, which claims the benefit as a nonprovisional application of U.S. Prov. Pat. App. No. 60/828,006 filed on Oct. 3, 2006 and U.S. Prov. Pat. App. No. 60/933,179 filed on Jun. 4, 2007. All of the aforementioned priority applications are hereby incorporated by reference in their entireties. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
    
    
     BACKGROUND 
     Field of the Invention 
     Embodiments of the invention are useful in the field of minimally invasive surgical devices and methods, and in particular, devices and methods for use in mastopexy. 
     Description of the Related Art 
     Ptosis is a condition in a tissue or organ of the body in which the tissue or organ sags, or falls, with respect to its previous position in the body. A variety of surgical and nonsurgical procedures and devices have been developed to restore tissues and organs to a previous position. In particular, cosmetic surgery is frequently directed at restoring tissues to a pre-sag position. 
     For example, in mastopexy, mammary ptosis is corrected using a surgical procedure, without altering breast volume. In augmentation, breast volume is increased, while in reduction surgery, breast volume is decreased. Procedures can include combinations of mastopexy and augmentation or reduction procedures as well. 
     SUMMARY OF THE INVENTION 
     Embodiments disclosed herein are directed to minimally invasive methods and apparatus of tissue support. In some embodiments, there is provided a device, for use in supporting a tissue in a patient&#39;s body, comprising; a support member, adapted to engage at least a portion of a tissue, the support member comprising a first end and a second end, the support member further comprising a plurality of support elements; and first and second suspension members, the first suspension member being coupled to the first end of the support member, the second suspension member being coupled to the second end of the support member; wherein at least one of the first and second suspension members is configured to be secured to a location in the patient&#39;s body; wherein the plurality of support elements is configured to distribute a load, from the tissue engaged by the support member, imposed on the support member; and wherein at least one of the first and second suspension members is configured to transmit a force through the support member, the force effective to move the engaged portion of the tissue from a first position to a second position. 
     In some embodiments, the first suspension member is coupled to each support element at a first end of each support element, and the second suspension member is coupled to each support element at a second end of each support element. 
     In some embodiments, the second position is superior to the first position. In some embodiments, the second position is at least one of posterior, medial, and lateral, relative to the first position. In some embodiments, the second position is posterior to the first position. 
     In some embodiments, each of the plurality of support elements is elongate and has a length extending along an arc, or line, that extends between the first end of the support member and the second end of the support member; wherein a first of the plurality of support elements is spaced apart from a second of the plurality of support elements along at least about 10% of a length of the first of the plurality of support elements; and wherein the length of the plurality of support elements extends from the first end of the support member to the second end of the support member. 
     In some embodiments, a first of the plurality of support elements is spaced apart from a second of the plurality of support elements along at least about 30% of a length of the first of the plurality of support elements; and wherein the length of the plurality of support elements extends from the first end of the support member to the second end of the support member. 
     In some embodiments, at least one of the support elements is fusiform shaped. 
     In some embodiments, at least one suspension member is configured to be secured to at least one of muscle, fascia, bone, ligament, tendon, and skin. In some embodiments, the portion of the tissue being engaged comprises at least one of breast tissue, buttock tissue, facial tissue, arm tissue, abdominal tissue, and leg tissue. 
     In some embodiments, each support element comprises at least one of an elongate member and a mesh. 
     In some embodiments, each of the plurality of support elements is coupled to a separator, effective to maintain spacing between adjacent support elements. 
     In some embodiments, the support member comprises an engagement member, effective to limit movement of the support member relative to the engaged portion of the tissue. In some embodiments, the engagement member comprises at least one of a barb, a hook, and a suture. 
     In some embodiments, at least a portion of the device comprises a biodegradable material. In some embodiments, the device further comprises a coating effective to enhance at least one of biocompatibility and healing. Further, the device could be used as a wound closure device or trauma device, in which some applications would warrant a full biodegradable device. Other instances would warrant partial biodegradable devices. And yet other instances, a durable device would be desirable. 
     In some embodiments, there is provided a device, for use in supporting a tissue in a patient&#39;s body, comprising; a support member, adapted to engage at least a portion of a tissue, the support member comprising a first end, a second end, and an inflatable portion therebetween; wherein, upon inflation, the inflatable portion is effective to increase an apparent volume of the tissue; first and second suspension members, the first suspension member being coupled to the first end of the support member, and the second suspension member being coupled to the second end of the support member; wherein at least one of the first and second suspension members is configured to be secured to a location in the patient&#39;s body; wherein the support member is configured to distribute a load imposed on the support member from the tissue engaged by the support member; and wherein at least one of the first and second suspension members is configured to transmit a force through the support member, the force effective to move the engaged portion of the tissue from a first position to a second position. 
     In some embodiments, the second position is superior to the first position. In some embodiments, the second position is at least one of posterior, medial, and lateral, relative to the first position. In some embodiments, the second position is inferior to the first position, and in some embodiments, the second position is at least one of posterior, medial, and lateral, relative to the first position. 
     In some embodiments, the tissue being supported comprises at least one of breast tissue, buttock tissue, facial tissue, arm tissue, abdominal tissue, and leg tissue. 
     In some embodiments, the inflatable portion comprises pleats. In some embodiments, the device further comprises a port for inflating the inflatable portion. In some embodiments, the port is in or on at least one of the suspension members. 
     In some embodiments, there is provided a device, for use in supporting tissue, comprising; a support member, adapted to engage at least a portion of a tissue, the support member comprising a first end and a second end; wherein the support member is configured to distribute a load imposed on the support member from the tissue engaged by the support member; and first and second suspension members, the first suspension member being coupled to the first end of the support member and the second suspension member being coupled to the second end of the support member; wherein at least one suspension member is configured to be secured to a location at least about 5 cm away from the engaged portion of the tissue; wherein at least one of the first suspension member, the second suspension member, and the support member comprises an elastic element; wherein at least one of the first and second suspension members is configured to transmit a force through the support member, the force effective to move the engaged portion of the tissue from a first position to a second position; and wherein the elastic element is configured to permit movement of the engaged portion of the tissue from the second position toward the first position. 
     In some embodiments, the second position is superior to the first position. In some embodiments, the second position is at least one of posterior, medial, and lateral, relative to the first position. 
     In some embodiments, the portion of the tissue being engaged comprises at least one of breast tissue, buttock tissue, facial tissue, arm tissue, abdominal tissue, and leg tissue. 
     In some embodiments, the elastic element comprises at least one of an elastomeric core and an elastomeric cover. In some embodiments, the elastic element comprises a spring. 
     In some embodiments, the at least one suspension member comprises a braided portion. In some embodiments, at least a portion of the elastic element has a nonlinear elastic constant. 
     In some embodiments, the device further comprises a channel member through which at least a portion of a suspension member passes, when the device is implanted in the body; wherein the channel member is configured to limit contact of surrounding tissue by the portion of the suspension member. In some embodiments, the channel member is tubular. 
     In some embodiments, there is provided a device, for use in supporting a tissue in a patient&#39;s body, comprising; a support member, adapted to engage at least a portion of a tissue, the support member comprising a first end and a second end; wherein the support member is configured to distribute a load imposed on the support member from the tissue engaged by the support member; first and second suspension members, the first suspension member being coupled to the first end of the support member, and the second suspension member being coupled to the second end of the support member; and a disconnect member, configured to release tension in the suspension member when a load on the device exceeds a threshold load; wherein at least one of the suspension members is configured to be secured to a location in the patient&#39;s body; and wherein at least one of the suspension members is configured to transmit a force through the support member, the force effective to move an engaged portion of the tissue of the patient from a first position to a second position. 
     In some embodiments, the second position is superior to the first position. In some embodiments, the second position is at least one of posterior, medial, and lateral, relative to the first position. In some embodiments, the portion of the tissue being engaged comprises at least one of breast tissue, buttock tissue, facial tissue, arm tissue, abdominal tissue, and leg tissue. 
     In some embodiments, the disconnect member is configured to separate a first portion of at least one of the suspension members from a second portion of the at least one of the suspension members in response to the load that exceeds the threshold. In some embodiments, the disconnect member is configured to separate at least one of the suspension members from the support member in response to the load that exceeds the threshold. 
     In some embodiments, there is provided a device, for use in supporting a tissue in a patient&#39;s body, comprising: an elongate suspension member, having a first end and a second end, and a length extending therebetween; wherein the suspension member is configured to engage, and exert traction on, a tissue, resulting in the tissue moving from a first position to a second position; wherein at least a portion of suspension member is configured to shorten along the length of the suspension member in response to delivery of an energy to the suspension member; wherein the suspension member further comprises at least one engagement member, configured to engage at least a portion of the tissue; an elongate energy delivery member, coupled to at least a portion of the suspension member; wherein at least a portion of the elongate energy delivery member extends alongside at least a portion of the length of the suspension member; and wherein the elongate energy delivery member is configured to deliver the energy to the suspension member. 
     In some embodiments, the energy comprises at least one of electromagnetic energy, acoustic energy, and thermal energy. In some embodiments, the at least a portion of the elongate suspension member comprises collagen. In some embodiments, the at least a portion of the elongate suspension member comprises at least one of a shape memory alloy and a shape memory polymer. In some embodiments, the at least a portion of the elongate suspension member comprises a swellable material. In some embodiments, the swellable material comprises a hydrogel. In some embodiments, the at least a portion of the elongate suspension member comprises a braid. 
     In some embodiments, there is provided a method, for supporting a breast in a body of a patient, comprising: providing a supporting device having a first end, a second end, and a support member positioned between the first end and second end; advancing the first end of the supporting device into a breast, through a first incision that is located on one of a medial and a lateral side of the breast; withdrawing the first end of the supporting device from the breast through a second incision, located on the other of the medial and the lateral side of the breast, until the support member is positioned within breast tissue between the first incision and second incision; advancing the first end of the supporting device, from a position within the breast adjacent the second incision, to a first location, and the second end of the supporting device, from a position within the breast adjacent the first incision, to a second location; wherein both of the first and second locations are superior to the first and second incisions; drawing the breast tissue toward the first and second locations; and anchoring the first and second ends of the supporting device at the first and second locations, respectively. 
     In some embodiments, the first and second locations are substantially the same location. 
     In some embodiments, the method further comprises coupling a portion of the first end to a portion of the second end, inside the body. In some embodiments, anchoring comprises coupling the first and second ends to at least one of bone, muscle, fascia, tendon, ligament, and skin. 
     In some embodiments, there is provided a method, for supporting a tissue in a body of a patient, comprising: placing a supporting device into the body, the supporting device comprising: a support member, adapted to engage at least a portion of a tissue, the support member comprising a first end and a second end; wherein the support member is configured to distribute a load imposed on the support member from the tissue engaged by the support member; at least one suspension member coupled to the support member; engaging the at least a portion of the tissue with the support member; applying tension to the at least one suspension member, thereby moving the engaged portion of the tissue from a first position to a second position; securing the at least one suspension member to a location in the body, such that the engaged portion of the tissue is effectively maintained in the second position; and inflating at least a portion of the supporting device to increase an apparent volume of the tissue. 
     In some embodiments, the portion of the tissue being engaged comprises at least one of breast tissue, buttock tissue, facial tissue, arm tissue, abdominal tissue, and leg tissue. 
     In some embodiments, there is provided a method, for supporting a tissue in a body of a patient, comprising: placing a supporting device into the body, the supporting device comprising: a support member, adapted to engage at least portion of a tissue, the support member comprising a first end and a second end; wherein the support member is configured to distribute a load imposed on the support member from the tissue engaged by the support member; and at least one suspension member coupled to the support member; placing the support member so as to effectively engage at least a portion of the tissue; applying tension to the at least one suspension member, thereby moving the engaged portion of the tissue from a first position to a second position; securing the at least one suspension member to a location in the body, such that the engaged portion of the tissue is effectively maintained substantially in the second position; and wherein the supporting device is configured, in response to a load that exceeds a threshold, to release tension in the at least one suspension member. 
     In some embodiments, the supporting device is configured to uncouple a first portion of at least one of the suspension members from a second portion of the at least one of the suspension members in response to the load that exceeds the threshold. In some embodiments, the supporting device is configured to uncouple at least one of the suspension members from the support member in response to the load that exceeds the threshold. In some embodiments, the at least one suspension member increases in length when the load exceeds the threshold. 
     In some embodiments, there is provided a method for use in supporting breast tissue in a patient&#39;s body, comprising: providing a support member, adapted to engage breast tissue, the support member comprising a first end and a second end; wherein the support member is configured to distribute a load imposed on the support member from the breast tissue engaged by the support member; and providing first and second suspension members, the first suspension member being coupled to the first end of the support member and the second suspension member being coupled to the second end of the support member; wherein, when implanted, the first suspension member, extends superiorly from the first end of the support member, and the second suspension member, extends superiorly from the second end of the support member; anchoring the first suspension member at a first location, and the second suspension member at a second location; wherein the first and second locations are located superiorly to the engaged breast tissue; wherein a distance between the first and second locations is greater than a greatest distance between the first and second ends of the support member. 
     In some embodiments, there is provided a method, for use in supporting a tissue in a patient&#39;s body, comprising: providing an elongate suspension member, having a first end and a second end, and a length extending therebetween; wherein the suspension member is configured to engage, and exert traction on, a tissue, resulting in the tissue moving from a first position to a second position; wherein at least a portion of suspension member is configured to shorten along the length of the suspension member in response to delivery of an energy to the suspension member; wherein the suspension member further comprises at least one engagement member, configured to engage at least a portion of the tissue; providing an elongate energy delivery member, coupled to at least a portion of the suspension member; wherein at least a portion of the energy delivery member extends alongside at least a portion of the length of the suspension member; and wherein the energy delivery member is configured to deliver the energy to the suspension member; delivering the energy to the energy delivery member, thereby shortening the suspension member. In some embodiments, delivering energy comprises delivering at least one of electromagnetic energy, acoustic energy, and thermal energy. 
     Some embodiments describe a device including an elongate member and a plurality of side members, each of which has a first end and a second end. In some embodiments, each of the plurality of side members being coupled to, or integral with, the elongate member at the first end. In some embodiments, each of the plurality of side members subtending an acute angle with respect to the elongate member when the device is in an expanded state. Some embodiments provide that advancement of the device in a first direction results in a securing of the device in a tissue. In certain embodiments, after the securing, advancement of the device in a second direction, opposite the first direction, through the tissue results in the device changing from the expanded state to a collapsed state as the second end of each of the plurality of side members moves closer to the elongate member, permitting passage of the device through the tissue in the second direction. 
     In some embodiments, the device includes an elongate member having a lumen passing therethrough, the elongate member configured to hold the device when the device is in the collapsed state, for delivery of the device into the tissue. 
     Some embodiments describe a device, for use in supporting a tissue in a patient&#39;s body, including a support member, adapted to engage at least a portion of a tissue, the support member comprising a first portion and a second portion; and first and second suspension members, the first suspension member coupled to, and movable with respect to, the first portion of the support member, the second suspension member coupled to, and movable with respect to, the second portion of the support member. In some embodiments, at least one of the first and second suspension members is configured to be secured to a location in the patient&#39;s body. In some embodiments, at least one of the first and second suspension members is configured to transmit a force through the support member, the force effective to move the engaged portion of the tissue from a first position to a second position. 
     In some embodiments, the first suspension member is slidable with respect to the first portion of the support member, and the second suspension member is slidable with respect to the second portion of the support member. In some embodiments, the device further includes an anchor member coupled to, or integral with, at least one of the first and second suspension members. 
     In some embodiments, the anchor member includes an elongate member and a plurality of side members, each of which has a first end and a second end; each of the plurality of side members being coupled to, or integral with, the elongate member at the first end; and each of the plurality of side members subtending an acute angle with respect to the elongate member when the anchor member is in an expanded state. In some embodiments, advancement of the anchor member in a first direction results in a securing of the anchor member in a tissue. In some embodiments, after the securing, advancement of the anchor member in a second direction, opposite the first direction, through the tissue results in the anchor member changing from the expanded state to a collapsed state as the second end of each of the plurality of side members moves closer to the elongate member, permitting passage of the anchor member through the tissue in the second direction. In some embodiments, the anchor member comprises at least one of a hook, a dart, a barb, and a clasp. 
     Some embodiments provide minimally invasive methods, for elevating soft tissue in a body, that include providing a supporting device, comprising a first portion, a second portion, and a support member positioned between the first portion and second portion; advancing the first portion of the supporting device into the body, through a single incision, to a first location in the body; advancing the second portion of the supporting device into the body, through the incision, to a second location in the body; securing the first portion of the supporting device at the first location; and shifting soft tissue in the body with the support member. 
     In some embodiments, the shifting comprises elevating the soft tissue superiorly. In some embodiments, both of the first and second locations are located superior to the incision. In some embodiments, at least one of the first and second locations is located superior to the incision. In some embodiments, the method further includes drawing the soft tissue toward at least one of the first and second locations. 
     Some embodiments provide that the soft tissue comprises breast tissue. In some embodiments, the first and second locations are substantially the same location. In some embodiments, at least one of the first and second locations is at a fascia. In some embodiments, at least one of the first and second locations is at a muscle. In some embodiments, at least one of the first and second locations is at a clavicle. In some embodiments, at least one of the first and second locations is at a rib. In some embodiments, the securing comprises suturing the first portion. In some embodiments, the securing comprises positioning an anchoring member at the first location. In some embodiments, the anchoring member comprises at least one of a hook, a dart, a barb, and a clasp. In some embodiments, securing the second portion of the supporting device at the second location. 
     In some embodiments, the incision is made during a first time period, and the first and second portions are secured during a second time period, and no additional incision is made in the body between the first and second time periods, and no additional incision is made in the body during the second time period. In some embodiments, a distance between the first and second locations is greater than a longest dimension of the support member. In some embodiments, the first and second portions comprise suspension elements. In some embodiments, the incision is no greater than about 1.0 centimeter in length. In some embodiments, the incision is no greater than about 0.5 centimeters in length. In some embodiments, the incision is substantially parasagittal in orientation. In some embodiments, the incision is transverse to a long axis of the body. 
     Some embodiments provide methods, of dissecting breast tissue, including inserting a distal end of an elongate member into one of a medial and a lateral aspect of a breast; after the inserting, advancing the distal end inferiorly within the breast; and after the advancing the distal end inferiorly, advancing the distal end superiorly within the breast to the other of the medial and lateral aspect, and then out of the breast, such that the distal end and a proximal end of the elongate member are outside the breast and a central portion of the elongate member, between the distal end and the proximal end, is within the breast. 
     In some embodiments, the advancing the distal end inferiorly comprises advancing the distal end to a point inferior to the areola of the breast. In some embodiments, the advancing the distal end inferiorly comprises dissecting breast tissue. In some embodiments, the elongate member comprises a needle. In some embodiments, the elongate member is arcuate. In some embodiments, the elongate member comprises a sheath. In some embodiments, the distal end is sharp. In some embodiments, the method further includes advancing a support member along the elongate member. In some embodiments, the method further includes shifting breast tissue with the support member. In some embodiments, the method further includes creating a channel in the breast tissue that extends from a point at which the elongate member is inserted into the breast; and expanding a cross-sectional dimension of the channel. In some embodiments, the expanding the cross-sectional dimension of the channel comprises expanding an expandable member within the channel. In some embodiments, the expandable member comprises distal end having a polygonal structure. In some embodiments, the polygonal structure comprises a quadrilateral. 
     For purposes of summarizing the disclosure, certain aspects, advantages, and novel features of the disclosure have been described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment of the disclosure. Thus, the disclosure may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A general architecture that implements various features of the disclosure will now be described with reference to the drawings. The drawings and the associated descriptions are provided to illustrate embodiments of the disclosure and not to limit the scope of the disclosure. Throughout the drawings, reference numbers are re-used to indicate correspondence between referenced elements. 
         FIG. 1  illustrates an embodiment of a suture with molded barbs. 
         FIG. 2A  illustrates an embodiment of a suture with a filamentous core and a braided portion. 
         FIG. 2B  illustrates an embodiment of a suture like that shown in  FIG. 2A , where filaments extend outward to form barbs. 
         FIG. 3  illustrates an embodiment of a suture with a separately attached barb element. 
         FIG. 4  illustrates the stress strain relationship among various suture types. 
         FIG. 5A  illustrates an embodiment of a braided suture. 
         FIG. 5B  illustrates an embodiment of the suture shown in  FIG. 5A , with the braided portion removed to reveal the core. 
         FIG. 6A  is a cross-sectional view of an embodiment of a braided suture that includes a membrane lying between the braid and the suture core. 
         FIG. 6B  is a side view of the suture illustrated in  FIG. 6A . 
         FIG. 7A  is a cross-sectional view of an embodiment of a braided suture impregnated with an elastomeric coating. 
         FIG. 7B  is a perspective view of the suture illustrated in  FIG. 7A . 
         FIG. 8A  illustrates an embodiment of a braided suture with a hydrogel core in a pre-activation (elongated) configuration. 
         FIG. 8B  illustrates an embodiment of a braided suture with a hydrogel core in a post-activation (shortened) configuration. 
         FIG. 9  illustrates an embodiment of a suture in which shortening of the suture is provided by a shape memory material. 
         FIG. 10A  is a cross-sectional view of an embodiment of a suture having a widened portion to spread out loading and limit cheese wiring of the suture through tissue. 
         FIG. 10B  is a side view of the suture shown in  FIG. 10A . 
         FIG. 11A  illustrates side view of an embodiment of a suture having a widened portion to spread out loading in an extended conformation, where the widened portion is expandable. 
         FIG. 11B  illustrates a suture like that shown in  FIG. 11A  that has been rolled up for delivery. 
         FIG. 11C  illustrates an end view of suture like that shown in  FIG. 11A  that has been expanded. 
         FIG. 11D  illustrates an end view of a suture like that shown in  FIG. 11A  that has been expanded and then flattened. 
         FIG. 12A  illustrates side view of an embodiment of a suture having a widened portion, and further comprising support members. 
         FIG. 12B  illustrates a suture like that shown in  FIG. 12  that has been rolled up for delivery. 
         FIG. 12C  illustrates a cross-sectional view of a suture like that shown in  FIG. 12  that has been expanded. 
         FIG. 12D  illustrates an end view suture like that shown in  FIG. 11A  that has been expanded and then flattened. 
         FIG. 13A  illustrates a perspective view of a suture with a braided region that shortens and widens when attached sutures are placed under tension, in an extended conformation. 
         FIG. 13B  illustrates a perspective view of a suture like that shown in  FIG. 13A  in the shortened conformation 
         FIG. 14A  is a cross-sectional view of a suture with a flat support region rolled into a circular cross-section for easy placement in the patient. 
         FIG. 14B  is a side view of the suture shown in  FIG. 14A . 
         FIG. 15A  is a cross-sectional view of a suture with a support region comprising multiple strands that provide tissue support. 
         FIG. 15B  is a side view of the suture shown in  FIG. 15A . 
         FIG. 16A  illustrates a needle and sheath arrangement for use in delivering a suture. 
         FIG. 16B  illustrates a suture having bidirectionally oriented barbs. 
         FIG. 16C  illustrates a sheathed suture with barbs to engage tissue to assist in deployment. 
         FIG. 16D  illustrates the suture of  FIG. 16C  with an end extended from the sheath as during deployment. 
         FIG. 16E  illustrates an embodiment of a sheathed suture and deployment sheath where the end of the suture can be bent backwards as part of the method of deployment. 
         FIG. 16F  illustrates an embodiment of a sheathed suture where deployment is aided by a pushable tube. 
         FIG. 17A  illustrates an embodiment of a curved needle for use in deploying a suture along a curved path. 
         FIG. 17B  illustrates a tube configured to hold a needle, and which has a larger radius of curvature than the needle of  FIG. 17A . 
         FIG. 17C  illustrates a coaxial needle combination where the tip of the inner needle is pulled back from the end of the outer needle. 
         FIG. 17D  illustrates a coaxial needle combination where the tip of the inner needle is inserted nearly to the end of the outer needle. 
         FIG. 18  illustrates an embodiment of a device for deploying and tensioning a suture, as well as for connecting suture ends. 
         FIG. 19  is a side view illustrating a placement of sutures to perform a breast lifting procedure. 
         FIG. 20  is a front view illustrating a placement of sutures to perform a breast lift procedure. 
         FIG. 21  is a side view of a breast and an embodiment of a support system comprising a support member and vertically oriented suspension members. 
         FIG. 22  is a side view of a breast and an embodiment of a support system comprising a support member and suspension members oriented vertically and non-vertically. 
         FIG. 23  is a side view of a breast and an embodiment of a support system comprising two types of elastomeric components, and a safety mechanism to prevent overloading of the tissue. 
         FIG. 24  is a side view of a breast and an embodiment of a support system comprising continuous length suspension members, and a length adjustment mechanism. 
         FIG. 25  is a side view of a breast and an embodiment of a support system where the support member comprises inflation chambers. 
         FIG. 26  is a side view of a breast and an embodiment of a tool for inserting and spreading or flattening a support member in the tissue. 
         FIG. 27  is a side view of a breast and an embodiment of a support member comprising barbs. 
         FIG. 28  is a side view of a breast and an embodiment of a support system comprising a nipple repositioning element. 
         FIG. 29A  is an embodiment of a support member, associated suspension members, and needles for insertion. 
         FIG. 29B  is a photograph of an embodiment of a support member and attached suspension member. 
         FIG. 30  illustrates an embodiment of a support system including channels for the suspension members, and spring elements. 
         FIG. 31  illustrates an embodiment of a support system comprising separators to maintain spacing between adjacent support members. 
         FIG. 32A-B  illustrate an embodiment of a support system including an additional structural support member. 
         FIGS. 33A-33F  illustrates a method of surgical placement of an embodiment in a breast lift procedure. 
         FIG. 34A-34B  illustrates the use of an embodiment of a suture to perform a neck lift procedure. 
         FIG. 35  illustrates the use of an embodiment of a suture to perform an abdominal wall tightening procedure. 
         FIG. 36A-36B  illustrates the use of an embodiment of a suture to perform a facelift procedure. 
         FIGS. 37A-37B  depict embodiments of an needle that can be used as a guide. 
         FIGS. 38A-38D  depict embodiments of needles that can be used to create a dissecting plane. 
         FIGS. 39A-39C  depict embodiments of dissecting needles that are used in conjunction with an implantable sling. 
         FIGS. 40A-40D  depict embodiments for dissecting tissue or creating a dissecting plane. 
         FIGS. 41A-41B  depict embodiments of a retractable dissector. 
         FIGS. 42A-42F  depict embodiments of a conforming sheath that is configured to create a dissecting plane. 
         FIGS. 43A-43C  depict embodiments of a safety suture loop installer. 
         FIGS. 44A-44B  depict embodiments of a depth gauge introducer. 
         FIGS. 45A-45C  depict embodiments of an expandable sling guide. 
         FIGS. 46A-46B  depict embodiments of a retracting “diamond” dissector. 
         FIGS. 47A-47B  depict embodiments of a retracting “diamond” dissector with sling mount. 
         FIGS. 48A-48B  depict embodiments of a retracting dissector with sheath control. 
         FIGS. 49A-49B  depict embodiments of a self-dissecting sling. 
         FIGS. 50A-50B  depict embodiments of needles that are used in conjunction with a dissecting tool and a sling. 
         FIGS. 51A-51B  depict embodiments of a needle having bistable configurations. 
         FIG. 52  depicts embodiments of a detectable sling-suture connector. 
         FIGS. 53A-53B  depict embodiments of sling exit points for procedures as described herein. 
         FIGS. 54A-54C  depict embodiments of a variable length port. 
         FIGS. 55A-55C  depict embodiments of a suture clamp. 
         FIGS. 56A-56B  depict embodiments of a hooked slide. 
         FIG. 57  depicts embodiments of a multiple dart suture. 
         FIGS. 58A-58D  depict embodiments of an anchor clasp. 
         FIGS. 59A-59B  depict embodiments of zip tie sling closures. 
         FIGS. 60A-60C  depict embodiments of zip tie sling closures. 
         FIGS. 61A-61B  depict embodiments of friction fit anchor. 
         FIG. 62  depicts embodiments of an anchor spring. 
         FIGS. 63A-63C  depict embodiments of an anchor spring device. 
         FIG. 63D  depicts embodiments of a sling weave anchor spring device. 
         FIG. 64  depicts embodiments of a double anchor spring. 
         FIGS. 65A-65E  depict embodiments of a barbed anchor release device. 
         FIGS. 66A-66B  depict embodiments of a key hole anchor. 
         FIGS. 67A-67B  depict embodiments of a “V”-shaped anchor. 
         FIGS. 68A-68B  depict embodiments of a tongue depressor anchor. 
         FIGS. 69A-69F  depict embodiments of a wall anchor used in connection with the systems and methods described herein. 
         FIG. 70  depicts embodiments of a suture in-weave anchor. 
         FIG. 71  depicts embodiments of a hybrid anchor. 
         FIGS. 72A-72B  depict embodiments of a trap anchor. 
         FIGS. 73A-73B  depict embodiments of a bent barbed anchor. 
         FIGS. 74A-74B  depict embodiments of a barbed plate. 
         FIGS. 75A-75B  depict embodiments of a barbed plate. 
         FIGS. 76A-76B  depict embodiments of a staple anchor. 
         FIGS. 77A-77B  depict embodiments of a staple anchor. 
         FIGS. 78A-78E  depict embodiments of a staple anchor deployment device. 
         FIG. 79  depicts embodiments of a supraareolar device. 
         FIG. 80  depicts embodiments of a sling positioning procedure. 
         FIG. 81  depicts embodiments of a belt buckle securing device. 
         FIG. 82  depicts embodiments of an angled anchor deployment. 
         FIGS. 83A-83B  depict embodiments of profiled springs. 
         FIGS. 84A-84B  depict embodiments of profiled springs. 
         FIGS. 85A-85B  depict embodiments of profiled springs. 
         FIGS. 86A-86C  depict embodiments of an interrupted lumen. 
         FIGS. 87A-87C  depict embodiments of an attached lumen delivery system. 
         FIG. 88  depicts embodiments of a tubular spring. 
         FIGS. 89A-89C  depict embodiments of a slide sheath deployment system. 
         FIGS. 90A-90B  depict embodiments of a corkscrew deployment device. 
         FIG. 90C  depicts embodiments of a corkscrew plate. 
         FIG. 91  depicts embodiments of a barbed multifilament suture. 
         FIG. 92  depicts embodiments of an umbrella suture. 
         FIG. 93  depicts embodiments of an advancing corkscrew. 
         FIGS. 94A-94B  depict embodiments of a hanger anchor. 
         FIG. 95  depicts embodiments of a braid overlay corkscrew. 
         FIG. 96  depicts embodiments of a leaf anchor. 
         FIG. 97  depicts embodiments of an umbrella anchor. 
         FIGS. 98A-98B  depict embodiments of a washer anchor. 
         FIG. 99  depicts embodiments of a T-bar anchor support. 
         FIG. 100  depicts embodiments of a fascia puncture deployment system. 
         FIG. 101  schematically depicts an embodiment of a tissue anchor. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     As used herein, the term “suture” is to be construed broadly. In general, the term “suture” refers to suspension members, while “support system” generally refers to complex, multi-component devices that can include, without limitation, at least one support member, and associated components such as suspension members, elastic elements, safety mechanisms, and anchoring portions. A support member can comprise, in some embodiments, a plurality of support elements. 
     In some embodiments, a suture  10  comprising barbs  20  is provided, as shown in  FIG. 1 . In some embodiments, the core  30  has a relatively high tensile strength. High tensile strength can be achieved by using a polymeric material in a manufacturing process that results in a structure where the polymer chains are substantially oriented parallel to the longitudinal axis of the suture. 
     The core  30  of the suture  10  can be partially or completely surrounded by a like, or different material, forming the barbs  20 . The properties of the suture materials can be selected on the basis of desired absorption rates, tissue in-growth, as well as a consideration of mechanical needs. 
     In some embodiments, the suture  10  is formed by extruding the core material to form a filament. The core  30  can then be placed in a mold that provides the barb shapes, and the mold cavity filled with material that when solid forms the outer layer of the suture, and the barbs  20 . 
     In some embodiments, the core  30  can comprise multiple filaments  33 , as shown in  FIG. 2A . A multiple filament design allows the suture  10  to attain a higher ratio of axial tensile strength compared to bending stiffness (i.e., resistance to bending). A portion of the filaments  33  can protrude, as shown in  FIG. 2B . These protruding filaments can extend a predetermined distance, for example between about 0.2 and 2 mm. In some embodiments, the ends of the protruding filaments are configured in the shape of barbs  20 . The suture can be coated with another material or can be left uncoated. 
     In some embodiments of a suture  10 , like that shown in  FIG. 3 , barbs  50  can be attached to the core  30  as separate members. These attached barbs  50  can be secured by bonding, gluing, or welding of the barb  50  to the outer surface of the suture core  30 . 
     Elastic Properties 
     In conventional suture designs, an elastic suture typically displays only modest extensibility. Ideally, an elastic suture used in securing a healing wound should have sufficient elasticity to accommodate the swelling of tissue that occurs as part of the normal inflammatory response at the onset of healing. Additionally, the suture should continue to provide support to the tissue or wound, once inflammation and swelling have substantially subsided. 
     When sutures are used to support tissue, as in plastic surgery procedures, different elastic properties may be desirable. For example, during the first part of the healing process, it is possible for the sutures to pull out from the tissue in response to a modest amount of longitudinally applied force. Thus, a more elastic suture can yield enough to prevent pull-out, yet recover to its initial length, thus providing a gradual and more effective remodeling of tissue over time. 
     In some embodiments, a suture designed for use in plastic surgery procedures, for example in a facelift procedure, is capable of extending in length to 10-25%, while retaining the ability to fully recover to substantially its initial length. An example of the stress-strain curves for various types of sutures is provided in  FIG. 4 . Embodiments of the present disclosure ( FIG. 4 , dotted line), sutures are able to accommodate significant strain while displaying less stress than traditional high tensile strength sutures ( FIG. 4 , solid line), or even traditional elastic sutures ( FIG. 4 , dashed line). Thus, examples of the disclosed suture are capable of acting like a constant force spring, where force (i.e., strain) is relatively constant over a wide range of deflections. 
     In some embodiments, where a large mass of relatively immobile tissue is to be supported, for example in a breast lift application, it can be advantageous to provide a suture with a more progressive spring rate. In these embodiments, the stress-strain properties of the suture or support system can be optimized to simulate the natural biomechanical properties of the tissue. For example, in the case of a system for supporting the breast, the force/deflection characteristics of the support system can be designed to simulate that of Cooper&#39;s ligaments, or the combination of Cooper&#39;s ligaments and tissue that make up the outer structure of the breast. 
     Commonly used suture materials do not normally exhibit the properties of high elongation that are desirable in plastic surgery procedures. Natural materials, such as collagen, do however provide a highly extensible matrix that is useful in embodiments of the present disclosure. Collagen based sutures are often referred to as “gut” sutures. The source of collagen is varied and can include, without limitation, intestinal submucosa, pericardium, and tendon, from animals including humans, cow, pig, horse, donkey, kangaroo, and ostriches, etc. 
     Where the source of collagen is a native tissue, the tissue can be fixed in order to cross-link the collagen. Common fixatives include glutaraldehyde. Where greater extensibility is desired, chromic acid can be used as the fixative. Still other fixatives can be used, and the choice of fixative is not considered to be limiting to the scope of the present disclosure. For example, tissues can be fixed using radiation, dehydration, or heat. 
     In some embodiments, the suture can comprise a core made from a highly elastic synthetic polymer. Some suture materials can be made from formulations that are elastic in compression but have low strength in tension, for example hydrogel polymers. In some embodiments, the biocompatible gelling material is a solution containing water-insoluble polymers, for example non-cross-linked acrylonitrile polymers or their co-polymers, polyvinyl acetate, a linear or low-branched polymer or copolymer of 2-hydroxyethyl-acrylate and methyl acrylate, poly-n-vinyliminocarbonile and dimethylsulfoxide or other polar or readily water miscible solvents, for example as disclosed in U.S. Pat. No. 4,631,188 to Stoy et al., the contents of which are herein incorporated by reference in their entirety. These exemplary polymers solidify when placed in contact with living tissue as a result of absorption of water from the tissue and gradual release of the solvent into the surrounding tissue. 
     In obtaining copolymers, use can be made of additional monomers, such as acrylamide (including N-substituted), acryl hydrazide (including N-substituted), acrylic acid and acrylates, glutarimide and vinyl sulfone. Solvents can include glycerol and its mono- or diacetates, methanol, ethanol, propanol and iso-propanol, dimethylformamide, glycols, and other suitable solvents. 
     In some embodiments, the core  30  can be covered with a braided portion  40  as shown in  FIG. 5A . The braid can be made from traditional high tensile strength suture materials. Here, the angle of the braid can be selected such that the braided structure can elongate from its free state. Elongating the braid results in a decrease in the diameter of the lumen of the braid, and in turn results in compression of the core  30 , which in turn resists further deformation of he braid. An embodiment of a suture core with the braid  40  relaxed is shown in  FIG. 5B . As indicted above, in embodiments employing a hydrogel polymer core, the core material will be weak in tension, but will effectively resist compression. 
     In some embodiments, the core  30  can be separated from the braided portion  40  by a membrane  60  that prevents the individual braid filaments from cutting into the core material, as shown in  FIGS. 6A  and B. Again the angle of the braids, relative to the longitudinal axis of the core (0 in  FIG. 6B ), can be selected such that the braid can be elongated. 
     In some embodiments of a highly elastic suture, the suture includes a core  30 , a braided portion,  40 , all of which is impregnated with an elastomer  70 . In some embodiments the elastomeric portion can comprise a “core” of one or more components the device. In some embodiments, an elastomeric material can be used to cover device components. In some embodiments, an elastomeric material can cover other portions of the device, providing an “elastomeric cover.” For example, during manufacture, the suture can be forced into a foreshortened configuration and then impregnated with an elastomeric coating. The elastomer  70  can substantially impregnate the weave of the braid  40  and is effective to behave mechanically like an additional “core.” The elastomer is also effective to provide resistance to elongation. Neither the composition of the elastomer, nor methods of coupling or applying it to other components of the suture are limiting. Conveniently, in some embodiments, the elastomer can comprise without limitation, silicone, thermoset polyurethane, glycolide-co-caprolactone, copolymers of lactic acid and sebacic acid, and the like, as well as combinations of more than one elastomeric material. 
     Shrinkable Sutures 
     In some surgical applications, an advantage is provided by embodiments that are able to gradually shrink in length over time, or which can be made to shrink at a later time, in response to an activation provided by a physician. 
     In some embodiments, a shrinkable suture  80  comprises a core  30  surrounded with a filamentous braid, as shown in  FIG. 8A . Here the angle of the braid is such that as the core is allowed to expand in diameter it applies a force to the braid which shortens in length as a result, as shown in  FIG. 8B . Shortening of the braided portion results in an overall shortening of the entire suture. The core material can comprise a hydrogel or other suitable swellable material. 
     In some embodiments, a shrinkable suture comprises a bioabsorbable core, surrounded by a shape memory or other form of bias member. When placed in the patient, the bioabsorbable core  35  is absorbed over time. As the bioabsorbable core is absorbed it will weaken, with the result being that the force generated by the bias member, will dominate the biomechanical property of the suture. 
     In some embodiments, an example of which is shown in  FIG. 9 , the shrinkable suture  80  is configured to shrink in response to an activation energy or signal. In one case, a shrinkable suture comprises a shrinkable core  35  that heals into the tissue into which the suture is placed. In some embodiments, the shrinkable core  35  comprises collagen. The shrinkable suture  80  further comprises an energy transfer member  85  for delivering energy to the shrinkable core  35 . In some embodiments, the energy transfer member  85  comprises a wire that can be heated by RF energy, or via a directly applied electrical current. Upon heating, the wire transfers energy to the shrinkable core  35 , which in turn results in heating of the shrinkable core  35 . In response to the thermal energy, the shrinkable core  35  in turn shrinks, creating tension in the tissue into which the shrinkable suture  80  is embedded. In the case of a shrinkable core comprised of an unfixed tissue, a temperature of 42° C. can be effective to result in shrinkage. In some applications it can also be desirable to cool the tissue immediately after the heat shrinkage step in order to minimize damage to surrounding tissue. 
     In some embodiments of a shrinkable suture, the suture comprises a first material  185  having a relaxed length and a deformed length, where the deformed length is longer that the relaxed length. In some cases the deformed length is 10-30% greater than the relaxed length. In some embodiments, the suture is extended to its deformed length, and that configuration held by a second material  135  that resists relaxation. Conveniently, the second material  135  can be biodegradable, such that when the suture is placed in the body, the second material is absorbed over time. Once enough of the second material has been absorbed, the first material  185  assumes its relaxed length, and the suture shortens. 
     In some embodiments, the first material can comprise Nitinol or any other suitably elastic material, as shown in  FIG. 9 . In some embodiments the first material  185  can comprise a shape memory material, that can be activated after a period of time to assume a memorized length that results in shortening of the suture, or an increase in tension imparted by the suture on the surrounding tissue. Activation can be performed after a period of time sufficient for the second material  135  to be absorbed by the body. 
     Tissue Ingrowth 
     Healing typically occurs in three stages: inflammation, tissue formation, and matrix formation and remodeling. Matrix formation and remodeling can persist for as long as 6-12 months after wounding. Sutures used for temporarily holding tissues together are generally designed to minimize inflammation. Sutures designed to support tissue, such as those used in plastic surgery lift procedures, should also encourage tissue ingrowth, so that eventually the suture is further supported by a column of native collagen-containing scar tissue. 
     A variety of methods can be used to promote tissue ingrowth. When sutures made from naturally occurring material are used, this can include, methods of fixation of the suture material(s). For example, glutaraldehyde, EDC or epoxy fixatives result in sutures with more tissue ingrowth potential than do other fixatives. Where synthetic suture materials are used, braiding can be used to enhance tissue ingrowth. In some cases, synthetic materials can be manufactured such that they are porous. Implants with porosity greater than about 50 to 75 gm will generally permit tissue infiltration and vascularization. Porosity can be varied the construction of the suture, for example by providing a multifilament suture with a loose braid, or with twisted filaments. 
     Absorbability 
     All embodiments described herein can be fashioned from bioabsorbable materials. Materials can include those from natural sources such as gut, and other like materials, or synthetic materials. A variety of polymers can be used to produce bioabsorbable sutures including, without limitation, poly(glycolic acid), poly(glactin), poly(para-dioxanone), poly(trimethylenecarbonate), or poly(caprolactone). Different combinations of materials can be used to produce sutures that display different rates of absorption in vivo. In some embodiments, sutures can comprise both absorbable and non-absorbable materials. 
     Preventing “Cheese-Wire” Effect 
     For supporting tissues, especially larger masses of tissue, such as the breast or buttocks, some embodiments can be designed to prevent what is known as the “cheese-wire” effect; i.e., cutting through tissue by the suture or support member due to movement of the suture or support relative to the adjacent tissue. Cheese-wiring is particularly evident when using very thin sutures, or ones with abrasive surfaces. In some embodiments, using a suture made from a natural material can be effective to reduce the cheese-wire effect, due to their relatively large cross section and smooth surface, and because they better heal into the surrounding tissue. 
     In some embodiments, a suture or a support system can comprise a region with a wide cross section  90  in at least one direction, as shown in  FIGS. 10A  and B. Thinner ends  95  can be provided to improve ease of securing the suture in place in the patient. In some embodiments, the suture can be configured as a thin-walled tube, analogous to an angioplasty balloon. 
     The suture can be folded down into other configurations. For example, a folded suture  100  can be produced by drawing the unfolded suture, shown in  FIG. 11A , through a folding die, as in  FIG. 11B . Once the suture is placed in a desired position, it can be configured to assume a shape that provides a wider support area effective to support tissue, while limiting the extent to which the suture will cut into the tissue. In one method, the folded suture  100  shown in  FIG. 11B  is expanded to form an inflated or expanded suture  110 , shown in  FIG. 11C , which is then deflated in order to provide a flattened suture  120 , shown in  FIG. 11D . 
     The suture can optionally include supports  130  running either internally or externally, to provide additional tensile strength, as shown in  FIG. 12A . In some embodiments, the supports comprises wires running along the longitudinal axis of the suture. Other supporting elements other than wires can also be used. 
     A suture with supports  130  can be reconfigured as described above. For example, as with the suture shown in  FIG. 11 , a portion of a supported suture can comprise an inflatable region. As above, the suture  90  can be folded  100 , by drawing through a folding die, as in  FIG. 12B . The folded suture can be expanded  110 , as in  FIG. 12C , and then flattened  120 , as in  FIG. 12D . 
     In some embodiments, the device can be inflated with an inflation media. In some embodiments, the inflation media can be removed and the device deflated, or the inflation media can remain, in which case the device remains inflated. In some embodiments, the device can be inflated with a fluid (i.e., gas or liquid) that later changes viscosity, converts to a gel, or solidifies. In some embodiments, the device can be expanded mechanically by use of a dilation tool. The dilation tool, in some embodiments, comprises a wire or plurality of wires that can also be used to form the device into the flattened configuration  120 . 
     In some embodiments, wires  140  are connected to opposite ends, of a braided section  40 , as shown in  FIG. 13 . Tensioning  145  of the wires will result in shortening and widening of the braided region, resulting in a wider support area. 
     In some embodiments, an expandable suture can be fashioned from a small diameter, expandable tube. In some embodiments, a second suture passes through the lumen of the tubular suture, and is attached to a plug having a significantly larger diameter than the inner diameter of the tubular suture. Once the tubular suture is in place in the patient, the plug is drawn through the tubular suture, resulting in expansion of the tubular suture diameter. In some embodiments, the tubular suture diameter can be expanded by 500%. By optimizing the wall thickness of the tubular suture, the suture once expanded, will tend to assume a flattened configuration. 
     In some embodiments, a suture can be expanded with a heated fluid. Increasing the temperature of the suture can provide several advantages, including, and without limitation, allowing easier expansion of the suture, accelerating tissue-ingrowth, and inducing shrinkage of collagen in the region surrounding the suture. 
     In some embodiments, a suture  150  is provided as a flat strip of material, which can then be rolled up into a smaller diameter for easier insertion into the patient, as shown in  FIGS. 14A  and B. After insertion, the suture can be unrolled back to the flattened configuration to provide more effective tissue support. In some embodiments, at least the flat portion of the suture comprises a shape memory material, such that it spontaneously assumes a flattened configuration upon release from a delivery device, for example a sheath, specialized needle, or trocar. 
     In some embodiments, a suture can comprise a plurality of wires  170  coupled to either an anchor point, or a gathering point  175  short of an anchor point, as shown in  FIG. 15 . Providing a multiplicity of wires effectively spread out the weight of the tissue being support, thereby reducing the tendency for a single wire to cut into tissue. 
     In delivering embodiments of a suture as described herein, the suture  10  can be provided attached to a needle  180 , or inserted inside a protective delivery sheath  190 , as shown in  FIG. 16A . Delivery of a barbed suture inside a trocar, sheath, or catheter, for example, allows efficient delivery of the suture regardless of the orientation of barbs. In some designs, delivery of barbed sutures by needle required that the barbs be oriented such that the suture can glide into the tissue into which it is inserted (i.e., the barbs face away from the direction of insertion). These designs also require that the skin be punctured a second time in order to access the implanted needle, so that it can be trimmed from the suture and removed following suture placement. 
     In embodiments of the present disclosure where the suture can be delivered within a trocar or sheath, some techniques permit delivery of the suture with only a single skin puncture. This can reduce the risk of complications due to infection, reduce the amount of pain involved in a procedure, and allow for more rapid recovery of the patient. In addition, use of a the delivery sheath can prevent engagement of the tissue by the barbs until the sheath is removed, as so sutures with bidirectionally oriented barbs  200  can be easily delivered. 
     For example, with current sutures, performing a facelift procedure requires sutures enter near the hair line and exit through the cheek near the nasolabial fold. After the procedure, the patient is left with sutures that protrude from the face, which is aesthetically unappealing. In response, the suture ends are trimmed such that they lie just below the surface of the skin. In some case, however, the ends can erode through and reappear on above the surface of the skin. Trocar or sheath delivery avoids these problems. 
     In some embodiments, one of which is shown in  FIG. 16C , a delivery sheath  210  for a suture  10  includes a small opening through which a portion of the suture can protrude. A region at or near the tip of the suture can comprise a barbed end  220 . During placement of the suture, the suture can be substantially fully enclosed within the sheath, such that the barbs do not grasp tissue while the sheath and suture are being advanced, as shown in  FIG. 16C . After the suture end is in a desired location, the barbed end  220  of the suture  10  can be advanced out of the sheath  210 , allowing the barbs to engage adjacent tissue  225 . Once engaged, the barbs will effectively anchor the end of the suture substantially in place, while the sheath is withdrawn, exposing the remainder of the suture, as shown in  FIG. 16D . The suture can include additional barbs  20  in addition to those located at or near the end, to further anchor the suture in place once the delivery sheath has been removed. 
     In some embodiments, a trocar  240  that is open at both ends  240  can be provided to deliver the suture  10 . A barbed suture can be passed through the trocar, the barbs oriented so that the suture, once exposed to adjacent tissue, resists movement relative to the trocar. In some embodiments, a length of the barbed suture extends out from the end of the trocar, as shown in  FIG. 16E . The length of suture extending from the suture can be from about 0.5 cm to about 5 cm, although this is not considered limiting. Pushing on the trocar results in the exposed portion of the suture doubling back on itself, such that the barbs will engage the adjacent tissue, as shown in  FIG. 16E . Once the end of the suture is set in place, the trocar can be withdrawn, leaving the suture in place. Tensioning can be performed in a similar manner as that used with other barbed suture embodiments described herein. 
     The distal end of the trocar can be cut at an angle or ground such that the end of the trocar forms a point, while providing room for bending of the suture. In an exemplary embodiment, a trocar has a 0.5 mm OD and a 0.3 mm ID, and is about 225 mm long. A suture of slightly less than 0.3 mm diameter fits easily within the trocar. 
     In some embodiments, coaxial arrangement of a support material surrounding the suture can be used to improve pushability of the suture, as shown in  FIG. 16F . The support member  250  can be coupled to the proximal end of the suture to aid in delivering the suture with a pushing force. After delivery, cutting the end of the suture distal of the coupling would release the support from the suture, and allow withdrawal of the support and trocar, leaving the suture in place. The support member can be made from a variety of materials including, without limitation, Nitinol, surgical steel, or polymers such as PEEK, polyimide, polyethylene, polypropylene, or composite material suitable for use in medical devices such as catheters. 
     In some embodiments, the delivery system includes a multi-part needle, as shown in  FIG. 17A-D . In some embodiments, the needle has two components, a needle  260  having a first radius of curvature, and a hypodermic tube  270  having a second radius of curvature. The first radius will be greater than the second radius. For example, the first radius of curvature of the needle can be 5 cm, while the radius of curvature of the tube can be 15 cm. The needle and tube are coaxially arranged such that the needle is slidably held within the tube. 
     In using this system, the surgeon can continually alter the path of the suture by simply regulating how much of the needle  260  is held within the hypodermic tube  270 . Where less of the needle is within the tube, the radius of curvature will be dominated by the shape of the tube and have, in this example a radius of 15 cm. Where more of the needle is within the tube, the needle will force the tube to take on a shape with a smaller radius, and thus follow a track of smaller radius, for example a radius of 5 cm. Thus, the surgeon can advance a suture over a more or less curved path, as shown in  FIGS. 17C  and D. 
     It will be readily understood that the radii recited above are provided only as examples, and various combinations of needles and tubes with varying radii can be used. In addition, the system can include a needle and a plurality of tubes, such that the device could be telescoped in order to provide even finer control of the suture path through tissue. 
     Coaxial, multiaxial, steerable designs can also be applied to the trocars and catheters as described above. In addition, the systems can also include guide wires that the trocar or catheter passes over. Guide wires can include a needle tip and be steerable, providing an even smaller radius pathway through tissue. 
     To aid the physician in placing sutures, the suture can include identifiers to mark barbed regions, or the length of the suture contained within a trocar, for example. In one embodiment, the suture is color coded with a particular color indicating a barbed region, while a different color can be used to indicate a non-barbed region. In some embodiments, other colors or marking can be used to indicate regions with distinctive mechanical properties. For example, and without being limiting, a third color can be used to indicate a region of increased elasticity. 
     During the surgical procedure, visualization can be accomplished by direct or indirect methods, including ultrasound, MRI, CT, or using an endoscopic tool and camera combination, among other imaging modalities. Sutures, needles, and trocars, can include markers as are known in the art for visualization when using radiographic imaging modalities. Such markers can be made, without limitation, from metals such as gold, platinum, stainless steel, and other suitable metallic alloys or even non-metallic materials. Such markers can be included during the manufacturing process. 
     An advantage provided by some suture embodiments, as described herein, is the ability to adjust or re-tension the suture after placement. Adjustment permits the surgeon to maintain a particular tissue configuration and appearance over time. In some cases, such as where the suture does not include barbs, or where the suture does not protrude through the skin and is therefore relatively inaccessible, an additional adjustment mechanism can be included with the suture, in order to provide a way in which to vary tension of the suture during the course of the healing process, and even afterward. 
     In some embodiments, the adjustment mechanism comprises a knot and a ratchet mechanism. In some embodiments, the adjustment mechanism can comprise a tang in a groove, analogous to a zip tie device. Where possible, embodiments comprising a knot are designed to be low-profile, such that the adjuster does not produce a bump, or erode through the skin. 
     In some embodiments, the ends of a single suture, or the ends of two separate sutures, can be joined by a linking device, where a first end is a tube  290 , and a second end has a substantially round cross-section  300 , as shown in  FIG. 18 . The second end is inserted into the tubular section of the first end. A skived area near the first end allows the second end to protrude. 
     A variety of methods of securing the first and second ends can be used. In some embodiments the ends can be secured by an adhesive that is cured in response to heat, pressure, moisture, or a chemical catalyst. In some embodiments, the tubular section can be made to be shrinkable, or alternatively be made from a shape memory material. In some embodiments, the second ends includes barbs that engage the first end, or a feature on the first end such as a pocket. In some embodiments the barbs can be on the first end, in the lumen of the tubular portion, and engage the second end which can be barbed or not. The second end can further comprise a textured surface, or multiple regions of varying diameter to better engage the first end. In some embodiments, a tubular section engages two separate sutures having substantially round cross sections. In some embodiments, the tubular connector section can be deformable, and will adapt to the cross-sectional shapes of the sutures to be joined. Conveniently, the tubular member  290  can include an anchor  294 , for securing the joining device in place in the patient. A suture end can also include an anchor  292 . 
     A number of embodiments of the present disclosure are compatible for use in performing breast lift procedures. In some embodiments, the support member can be composed of Proline, a non-elastic polymer line. The support member can be placed underneath the breast tissue, and secured by means of a knot or a fastener to a body landmark such as a tendon, bone, or the like. As described above, the system can include suspension members that are either elastic or non-elastic. The system can further include a safety disconnect, permitting the suspension members to release when under an increased load, in order to prevent damage to the breast tissue by the support system. 
     Use in Breast Procedures 
     In some embodiments, sutures of the present disclosure are used to perform a minimally invasive breast lift, as shown in  FIG. 19 . In one method, suspension members  330  are inserted through the skin and advanced at a depth of between about 2.5 and 25 mm under the skin surface. The suture is passed through the Cooper&#39;s ligaments and fatty tissue. One or more loops of suture material are looped under the breast  320 , and suture ends are attached to an area in the chest  342 , serving as anchor points for the suspension members  330 . The sutures are tensioned in order to simulate support provided by natural, healthy Cooper&#39;s ligaments, as shown in  FIGS. 19 and 20 , and are effective to lift the breast  320  (compare left and right panels in  FIG. 19 ). 
     In some embodiments, the attachment to the chest areas comprises a loop of suture material threaded around a portion of the pectoral muscle, fascia, sternum, a rib, or a ligament, or combinations thereof. The loop is inserted through the skin with a small caliber needle, and positioned below the top edge of the breast, so that the suture support is not visible through the skin. A curved needle attached to the suture can be used to insert the suture material. In some embodiments, the needle comprises two parts that are axially movable relative to each other, and which have different curvatures, such that the surgeon can adjust the curvature of the needle is it is being inserted. In some embodiments, the suture is delivered within a sheath. 
     In some embodiments, the anchor can comprise a bone screw, attached to bone or cartilage in the sternum or rib cage. 
     In some embodiments, a suture  330  can run from the anchor point  342 , along one side of the breast  320 , under the breast, and up the other side back to the anchor point  342 . A number of sutures  330  placed in this way will be effective to cradle and lift the breast from below. In some embodiments the sutures  330  could run down either side of the breast and attach at support points  340  either under or to one side of the breast. A number of possible ways of placing and orienting sutures will be possible in achieving lifting of the breast while maintaining breast symmetry and aesthetic appearance. These various arrangements and combinations will be apparent to those of skill in the art. 
     In some embodiments, the suture lines can be extended transcutaneously around the nipple area to preferentially reposition this portion of the breast. This corrects the situation where the nipple turns downwards in response to age or as a result of breastfeeding. Looping a suture line around the nipple provides for support of the nipple, without having to support the entire weight of the breast. Where a nipple repositioning technique is used, the suture can be anchored using the methods as described above. 
     In some embodiments, lifting of the pectoral muscle is used to adjust the physical appearance of the breast. A method to modify the muscle tissue by shortening it can comprise cutting the muscle and drawing it together, or drawing it together using a series of threads similar to a corset. Lacing the tissue together results in lifting of the breast tissue resulting in a more youthful appearance, and a reduction in breast ptosis. 
     In some embodiments, shortening of the muscle fibers is accomplished by internal anchors deployed into the muscle fibers. Drawing the anchors together in turn draws the muscle tissue together. The anchors can be connected by suspension members comprising elastic or inelastic materials. Elastic material can be used to allow for normal loading conditions such as physical movement and activity. Additionally, elastic materials can result in further lifting of the breast tissue. 
     Elastic material examples can include, without limitation, silicone core braided materials similar to a “shock cord” construction, polypropylene mesh as used in hernia mesh, NiTi alloy wires or braids, coiled type springs, and similar materials and combinations known in the art. In some embodiments the materials distribute the entire load throughout the length of the suspension line limiting longitudinal movement. In some embodiments, the suture lines comprise relatively inelastic materials including, without limitation, polypropylene suture, NiTi wire, stainless steel wire, polypropylene mesh and the like. These materials can be attached to anchors such as barbs, hooks, flared materials such as NiTi elements and the like. 
     This system can be foreshortened during initial implantation or post implantation with mechanisms such as, and without limitation, screws, loops, cams and rotary pulleys, or any other means effective to shorten thread or wire-like elements. The muscle can be additionally suspended by hernia mesh material and tied to land marks such as, without limitation, bone, fascia, tendon, and other areas that would bear the loading conditions. In some embodiments an exemplary diameter of a suspension line can range from about 0.005 inches to about 0.090 inches. In some embodiments the diameter of a suspension line would be about 0.030 inches. 
     In some embodiments the material permits tissue ingrowth, and thus moves with the native tissue, reducing irritation and cutting of the tissue. The material can be coated with a therapeutic agent to enhance tissue ingrowth, and in some embodiments the suture material is manufactured to include the therapeutic agent. In some embodiments, the therapeutic agent is added just prior to implantation, either by impregnation, by coating, or by a combination of the two processes. 
     In some embodiments, coatings or treatments can include an inhibitory agent to limit or prevent tissue ingrowth such that the material will not adhere to the surrounding tissue. In some embodiments a suspension line runs through a cylinder of fluid that allows movement between the suspension line and the tissue. 
     In some embodiments the support system comprises suspension members  330  are provided that are oriented in a substantially vertical orientation, as shown in  FIG. 21 , and attach to an anchor point  340  above the breast. The support members  360  are coupled to the suture lines  330 . In some embodiments, angles for suspension members other than vertical are used to customize the shape of the breast or where the procedure is used to correct breast asymmetries. As shown in  FIG. 22 , angled suture lines  380  can provide lifting or additional lateral adjustment, in addition to what can be provided using vertically oriented suspension members. For example, by placing the support lines angled either to the right or left of vertical, the nipple and/or breast may be adjusted medially or laterally as desired by the surgeon, in addition to vertical repositioning. In some embodiments, a vertical support line and secondary tensioning line can be used, and the vertical lines can thus be pulled laterally, redirecting the force vector supporting the breast tissue. In some embodiments, it can be useful to provide laterally oriented suspension members alone, such as where lateral repositioning is required, but lifting is not desired or otherwise indicated. 
     In some embodiments, the support system comprises components with non-linear elastic constants (e.g., a secondary elastomer to increase the load bearing at the bottom of the stroke). This allows for normal support while standing, and provides additional load bearing capacity during activities such as walking. running, and jumping. In some embodiments, components that allow for complex loading are designed using larger cross sectional areas or by providing components fashioned from more than one material, where the individual materials have distinct elongation characteristics. In some embodiments first  400  and/or second  410  elastic components can be used to provide more complex mechanical behavior, as shown in  FIG. 23 . In some embodiments, the first and/or second elastic components can comprise springs. In some embodiments, the first and second elastic components can have the same or different elastic constants. In some embodiments, the first and/or second elastic components can be positioned anywhere along the length of a suspension member. 
     Safety Disconnect 
     In some embodiments, a safety release  390 , shown in  FIG. 23 , provides a mechanism to protect the attachment area or the supported tissue from damage caused by support system components when large loads are imposed on the tissue and/or the support system. For example, excessive load can occur during excessive motion or concurrent with a trauma. The safety release  390  is designed to separate the support member  360  from the suspension members upon exceeding a defined loading. 
     In some embodiments, the safety release  390  comprises a region engineered to fail at a predetermined limit. In some embodiments the mechanism comprises a necked section to allow for yielding. In some embodiments, a slip disconnection that decouples, or a joint that unlatches can be examples of effective safety releases. In some cases the safety release mechanism can be designed such that it can be reconnected or repaired following release. The loading limit effective to result in release of the suspension members from the support member can range, for example, from about 0.5 kg to about 8 kg, and in particular from about 1 kg to about 3 kg of force. 
     In some embodiments, selecting the elastic characteristics of the support member to carry partial or complete loading can allow for a least amount of tissue movement relative to the suspension element. In some embodiments, the entire length of the support system can assume the stress where the least amount of movement is shared throughout the entire system. Continuous length elastic elements  420  can be used to support the loading to lessen the stress concentrations in one area of the implant, as shown in  FIG. 24 . In some embodiments, the system can also include an adjustment mechanism  350 , useful to vary the tension exerted on the tissue by the support system either at the time of implantation, or later once the healing process is complete or near complete. Adjustments could also be made over extended times in order to maintain the supported tissue in a desired position. 
     Support Member With Inflation Pleats 
     In some embodiments, the support member can include additional load carrying or shock absorption capability. For example, hydraulic (gas or liquid) elements can provide a resilient cushion in order to compensate for various loading conditions, such as jogging and other sporting activities, or to absorb some of the effects of trauma. In some embodiments, shock absorption is provided by a support member comprising inflation chambers  430 . The chambers can be configured to compress during heavy loading, with compression providing the resiliency to return the device to a pre-loading configuration once the activity or other source of loading has ended. Similarly, the system can include a charged system, analogous to an automotive shock absorber, to dampen loading, and where the charge would allow for recoil loading. 
     The chambers can have a wall thickness in a range, for example, from about 5 μm to about 250 μm, depending upon the material, the inflation pressure to be used, and the degree of resiliency desired. There can be a single chamber or multiple chambers. Material choice, chamber wall thickness, and/or inflation pressure can provide customized mechanical properties to support members. In some embodiments, the length of the chambers ranges from about 5 cm to about 15 cm, and width ranges from 0.5 cm to about 4.0 cm. In some embodiments, the length of the inflation chamber is about 10 cm, and the width is about 3 cm. Precise shapes and dimension can be varied depending on the particular anatomical makeup of the patient, or on the kind of support or aesthetic results desired. 
     In some embodiments, the chamber(s) can be filled with a media that solidifies or gels. In some cases, the media remains in a liquid form. Composition of the media can include, without limitation, silicone, saline, epoxy, and any other safe implantable fluids, solids, or gases that will be substantially retained within the chamber(s). 
     In some embodiments, addition of one or more volume elements supported by suspension elements can be used to augment low volume breast tissue and enhance the final outcome with respect to a patient&#39;s fullness. The volume element can comprise a prior art augmentation device such as a silicone or saline implant or it can use a dermal filler to soften the look of the breast. In some embodiments, support members comprising chambers  430 , an example of which is illustrated in  FIG. 25 , can be adapted to provide volume enhancement. Fillers can include, without limitation, commercially available materials such as Radiance, Juvederm or other suitable filler materials. Additionally, the patient&#39;s own cells or other tissue could be used to offset the decrease or need for additional filling. These cells could be harvested and replaced or harvested and processed by centrifuging or filtering to collect cells suitable for implantation. 
     In some embodiments, different connection points for suspension and support members can be used to adjust the position of each breast separately, or to allow shape changes that improve the cosmetic appearance of the breasts, for example to provide symmetry. 
     Folded Support Member For Easier Insertion 
     As described above, in some embodiments the support system is folded prior to delivery. Folding reduces the device profile, such that a smaller incision can be used to provide an entry point when introducing a support suture or system into the body. The smaller incision in turn limits the size of the scar resulting from the implant procedure. A number of manipulations well known in the art including, without limitation, rolling, folding and twisting of the support member, can be used to reduce the device profile prior to delivery. 
     Post-insertion, the mesh support member can be opened and flattened for final placement. In some embodiments, the unfolding process is performed using specialized instruments, such as a small tool  440  in similar in shape to a “hockey stick” as shown in FIG.  26 . Spoon shaped tools are also effectively used to unfold and place the device in the desired location. 
     Support System Including Barbed Elements 
     In some embodiments, the support member  360 , the suspension members, or both, can comprise engagement members, for example, barbs  20 , as shown in  FIG. 27 . Barbs are effective to improve engagement of the adjacent tissue and reduce movement of the support system relative to the tissue. Barbs can be fashioned from materials similar to those used to construct the support member or suspension members, including, without limitation, stainless steel, Nitinol and any other biocompatible materials. 
     In some embodiments, the barbs can be from about 0.25 mm to about 2 mm in diameter, and from about 0.25 mm to about 5 mm in length. In some embodiments the barbs are 0.5 mm in diameter, and about 2.5 mm in length. These are examples of barb dimensions and other dimension of barbs can be used without limitation. Barbs can be oriented all in the same direction or they can be oriented in alternate directions in order to provide resistance to both proximal and distal movement. 
     Other Suspension Elements 
     In some embodiments, the device can comprise a nipple suspension element  450  to raise the nipple and/or reposition it with respect to the support members, as shown in  FIG. 28 . Positioning the nipple using a separate element allows for separate positioning of the breast relative to the nipple. Including addition suspension or tensioning elements provides the ability to make vertical and/or horizontal adjustments to the nipple. 
     Additional Support System Components 
     In some embodiments, the support system can comprise a webbed, or mesh, support member  360 , suspension members  330 , and attached needles  260  for insertion into the patient, as shown in  FIGS. 29A  and B. In some embodiments, the suspension members and support members can comprise a contiguous structure. In some embodiments, the suspension members and support member can comprise separate pieces that are assembled prior to use. 
     Conveniently, in some embodiments, the support member can be fashioned in the shape of a sling or hammock, an example of which is shown in  FIG. 29B . As used herein, the term “sling” or “hammock” is intended to include, without limitation, a wide variety of shapes and sizes, materials and treatments. A sling (or hammock) can be rectangular, other shapes are also contemplated included oval, circular, elliptical, and tear drop shaped. In some embodiments, the sling can be made of a mesh material. The mesh material can comprise one or more woven or inter-linked filaments or fibers that form multiple fiber junctions throughout the mesh. The fiber junctions can be formed via weaving, bonding, ultrasonic welding or other junction forming techniques, and combinations thereof. 
     In addition to suspension members and a support member, a support system can comprise additional components. For example, channels  460  can be used to hide the wire or springs  470 , which can be effective to eliminate irritation to the surrounding tissue, as shown in  FIG. 30 . These channels may be open or closed to either allow or limit contact with body fluids. In some embodiments, the channel may utilize a perforated channel to allow fluid to flow or move within or around a wire or spring. In some embodiments, fluids in channels can serve as a lubricant for suspension members within channels. 
     Where multiple support members are used, separation of the elements can be provided, as shown in  FIG. 31 , by separators  480 . One or more separators  480  between support members  360  can be effective to limit motion of support members relative to each other. Separators can resist movement of elements toward or away from each other by geometric column strength or tensile stress, respectively. In some embodiments, separators  480  can be measure about 0.25 mm to about 2.5 mm in diameter with a length of 0.5 mm to about 8 mm. It will be understood that these dimensions are exemplary only, and other dimensions of separators can be successfully used. A variety of materials can be used to make separators, including without limitation, plastics, polymers, metals, and these materials can be permanent or absorbable. 
     Maintaining a defined separation of support members during or post implantation provides for more even suspension of tissue with loading distributed across the effective area encompassed by the support member(s). Embodiments of support members can be provided as a mesh material with different patterns depending on the loading or stress expected. Additionally, support members can be fashioned with a preset shape effective to resist collapse when the ends are tensioned as during loading. 
     A wire mesh work made from NiTi or stainless steel can allow for a flatter looking implant during loading, whereas a limp thread element may provide little support on the sides of the breast when loaded. This allows for a rounder shape definition rather than squeezing at each side of the breast during loading. The wire elements can be pre-shaped and memory set to allow for normal motion and tissue manipulation. 
     For example, as shown in  FIG. 32A , a wire support  490  included in the support member  360  mesh can increase strength and provide means for coupling the support member to other components of the system. By adding additional components to the support member, properties of strength or elasticity can be imparted, depending on the choice of materials, for example, and without being limiting, elastomers, pre-shaped shape memory elements, springs and the like. These additional elements can be located above or below the mesh or embedded into the mesh for motion encapsulation.  FIG. 32B  illustrates an embodiment of a wire support  490 , separated from the support member  360 . 
     Insertion Method 
     In some embodiments, there is also provided a method of insertion of the device, as shown in  FIG. 33A-F . In one embodiment, insertion is performed by a needle  260  inserted at the base of the breast  320 , exiting the other side of the base, and pulling the support member  360  through the tissue between the glandular structure and the subcutaneous fat ( FIG. 33A ). Once the support member  360  is positioned correctly, the needle  260  can be passed back into the same needle hole and vertically to the anchoring position ( FIG. 33B ). As the needle is passed back into the fascia of the pectoral muscle, the piercing of the fascia is captured and the needle is once again pulled out of the transcutaneous needle hole ( FIG. 33C ). In the same fashion the other support line can be passed and the fascia again can be captured and tied to the other support member where a knot pusher can be used to slide the knot  345  deep beneath the skin where it can be hidden to avoid producing a bump that might otherwise show on the surface of the skin ( FIG. 33D ). Anchoring of the support system can be achieved by looping or otherwise tying the ends of the suspension members to a suitable anatomical feature, such as a bone  500 , for example ( FIGS. 33E  &amp; F). 
     Some embodiments of a method of insertion of support system include an initial pathway being introduced under the skin with a guidewire system, and providing a tubular sheath for guidance, along with the ability to exchange wires. A tubular sheath allows the surgeon to maintain access to a common pathway for device installation and manipulation. The guidewire can be introduced under the skin through a small trocar or needle where the softer tubular sheath is exchanged out, and other elements can be passed through such as thread, suspension elements, and the like. A larger incision at the lower portion of the breast can be used to introduce a wider support member, for example a sling or hammock as has been described herein. This can include an incision to introduce the wide sling at one or both sides of the breast. Additionally, these techniques could be all completed in an open procedure as normally seen in a mastopexy operation. 
     Additional Exemplary Procedures 
     Embodiments of sutures as presently disclosed can be used to resuspend loose tissue in the neck region. A suture can be inserted using a similar technique as that used for a breast lift. The suture can also be configured to spread out support over multiple lines, or using slings or other types of configurations as described above, so as to prevent the cheese wiring effect that can occur when using a single thin-lined sutures. Designs applicable for use in breast lift procedures, are thus equally applicable for use in a neck lift procedure. 
     As shown in  FIG. 34 , in one method, the suture  510  is inserted under the skin surface and advanced below the surface following a line extending along the crease in the skin where the underside of the jaw area meets the neck. In some embodiments of a neck lift method, the upper portion of the suture  510  is turned upward and extended posteriorly to the jaw bone. The suture can be anchored  340  with a loop of suture material to the connective tissue located behind the jaw bone and just below the ear. 
     Embodiments of barbed sutures can be used effectively to lift tissue in the lower thigh area that has sagged down above the knee, as can occur during aging. Sutures with barbs at either end can be inserted from above the skirt line and used to pull the skin from the lower thigh up towards the tissue in the upper thigh area. The barbs located in the part of the suture located in the upper thigh region can be anchored to the dermis, or to tendons, ligaments, bone, or muscle, further below the surface. The portion of the suture located in the lower thigh area can engage the dermis or fascia, or other tissue, typically at a depth of 0.2 to 20 mm below the skin surface. A method similar to that used to lift thigh tissue can be used in the region of the upper arm. 
     Embodiments comprising barbed sutures can also be used to engage muscle. For example, in some embodiments, sutures can be placed in the abdominal region, and then tensioned to pull the abdominal muscles back into position. In some embodiments, the method can further providing a support system comprising a series of tabs  530  and sutures  540 . In these embodiments, additional tension can to be applied to the sutures, while at the same time avoiding pulling the suture through or otherwise tearing the tissue to which they are attached, or through which they have been threaded. By weaving a series of line from one tab to the other, the muscles can be further supported, for example as illustrated in  FIG. 35 . The tabs can be inserted by a small incision, and placed under the skin. Suture material can be pre-loaded into each tab, and sutures connected to each other by a transcutaneous knot or series of knots. 
     As shown in  FIG. 36 , embodiments comprising barbed sutures can also be used to improve upon prior art methods of performing facelift procedures. In the prior art methods, shown in  FIG. 36A , sutures  550  are inserted under the skin near the front of the cheek, pass up towards the hairline, where they exit out of the skin. This method leaves exposed suture ends  560  near the front of the face, which are unsightly. Although these ends can be trimmed such that the ends lie under the surface of the skin, over time it is possible for these ends to erode through the skin and reappear. 
     In contrast, in some embodiments of the present disclosure, the suture  550  is fashioned to have barbs at a first end of the suture. The barbs are effective to engage the tissue and resist movement (or to create tension) once in place. The first end can be delivered into the facial area through a trocar. In some methods, the insertion point of the trocar can be above the hairline. Once the first end is in the desired position the trocar can be removed wherein the barbs are exposed to, and ultimately engage, the surrounding tissue. Tension can be applied to better secure the barbed end of the suture within the tissue. The suture can optionally include markings that inform the surgeon how deeply the suture has been placed. If placement is unsatisfactory, the same trocar, or a second trocar, can be inserted over the suture to facilitate removal and/or relocation. The method obviates the need for an insertion point near the front of the face, and further avoids having suture ends exposed in the facial region, as occurs with the prior art method. 
     Once the first end is in place, the second end of the suture can be anchored in the scalp, or other suitable region. The second end can also include barbs to improve anchoring. To place the second end, the end can connected to a long needle. The needle can be inserted through the same hole where the trocar was inserted and then advanced up the scalp. In some embodiments, the distance is from about 3 inches to about 7 inches, although this is not limiting. The suture can be exited through the skin, and satisfactory tension on the suture can be achieved by pulling on the exposed end. In some embodiments, the free end near the hairline can be trimmed to below the surface of the skin. In some embodiments it can be useful to re-tension the sutures after the barbed portions have healed into the tissue. In these cases, a short portion of the second end of the suture can be left protruding from the scalp to enable the surgeon to access it more easily at a later date. The end can be covered with a small adhesive bandage, or with a liquid bandage in order to protect the end. 
     Use of the above described techniques can be useful if providing lifting for this buttocks region. In the buttocks, single or multiple support systems can be used. The system can designed to provide for additional load bearing, while preventing cutting or tearing of supported tissue during movement associated with normal activity. One end of the support system can be attached to the outer hip, while the opposite end can be attached to the upper hip bone. Anchoring in this way provides that the support can function effectively under either static or dynamic loading conditions. In some embodiments, the use of crescent shaped support straps can be used to accommodate the majority of the tissue to be supported. Additional branch suspension members can be included to allow for further lifting and shaping of the tissue. Barbed sutures can be used to improve anchoring within tissues. 
     Extended Needle 
       FIGS. 37A-37B  depict embodiments of an needle  600  that can be used as a guide, as well as to control tools and implants, over, along, and/or through a dissecting path  605 . The extended needle will be a full size needle  600  that extends out both exit points on the breast for manipulation by the hand.  FIG. 37A  depicts a bent needle  600 , and  FIG. 37B  depicts a bent needle  600  in the breast  610 , showing exit points  615  in the medial and lateral aspects of the breast. The exit points are depicted as positioned slightly above the areola, but the exit points  615  could also be below, level with, or above the areola, depending on the desired modification of the soft tissue of the breast. 
     Double Extended Needle 
       FIGS. 38A-38D  depict embodiments of needles  650  that can be used to create a dissecting plane. The purpose of the double extended needle is to create a dissecting plane within the breast. The device consists of two extended length needles. In application, the two needles extend out of both exit points  655  of the breast  660  along the same plane. The two needles  650  will cross at either exit points, creating an expandable area between the two needles  650 . The area can be manipulated via a ‘scissor’ action at either exit point.  FIG. 38B  depicts relative motion between the two needles to create a dissecting plane. In some embodiments, the motion of the two needles  650  is substantially radial with respect to a longitudinal axis of one or both of the needles. 
     Double Extended Needle with Sling Guide 
       FIGS. 39A-39C  depict embodiments of dissecting needles  700  that are used in conjunction with an implantable sling  710 . The double extended needle with sling guide includes two extended needles  700  and a sling  710 , which has four loops  715  for attachment, used to guide the sling  710  along the dissecting plane. The four loops  715  will be at either corner of the sling. The two left loops, along the long length of the sling, will be inserted on one needle  700 , and the two opposite side loops on the sling will be inserted onto the second needle  700 . Before insertion there will be two needles with a collapsed sling. Once inserted, the needles can be manipulated at the exit points in a “scissor” cut to create a distinct area plane. Once the needles are expanded, the sling will also be expanded. The needles can then be removed, leaving the extended sling of proper orientation within the created dissecting plane. 
     Some embodiments include an internal sheath that is configured to allow the items (e.g., tools, implants, etc.) to be positioned before extending the needles to create the dissecting plane area. The insertion assembly consists of the double extended needle with sling guide having an external sheath. The sheath may be removed once assembly is installed and before any manipulation of the items within the breast. 
     “Hockey Stick” Dissector 
       FIGS. 40A-40D  depict embodiments for dissecting tissue or creating a dissecting plane. The purpose of the “Hockey Stick” dissector  750  is to create a dissecting plane with back and forth motion for sling insertion. The dissector will be straight with an “L” Shaped end  755 . The end will be looped and used to feed the sling through. 
     As illustrated in  FIGS. 40A-40D , the dissector  750  can be inserted into an exit point  760  in the breast and advanced into the breast to create a dissecting plane. In some embodiments, this can be accomplished with a sling  765  inserted through the looped end  755  of the dissector, as illustrated in  FIG. 40C . With the dissector  750  within the breast tissue, the sling  765  can be advanced to a second exit point  760 . 
       FIGS. 41A-41B  depict embodiments of a retractable dissector  800 . The purpose of the retractable “Hockey Stick” dissector  800  is to create a dissecting plane for the sling without interfering with the sling-suture connection. The dissector  800  will be retracted into a sheath  805 . Once the sheath  805  is removed, the end  815  of the dissector  800  will open enough to slide over the sling-suture connection for removal. In some embodiments, the dissector comprises a material having shape-memory material and is oriented, when unrestrained, in the open configuration illustrated in  FIG. 41B .  FIG. 41A  depicts a dissector  800  retracted into a delivery sheath  805 , and  FIG. 41B  depicts the dissector  800  extended from a distal end  810  of the delivery sheath  805 . 
     Conforming Sheath 
       FIGS. 42A-42F  depict embodiments of a conforming sheath  850  that is configured to create a dissecting plane for the sling to be maneuvered within. The conforming sheath, when pulled at both ends ( FIGS. 42A, 42D ), maintains a circular shape with a small diameter. Once inserted in the breast, extending out both exit holes, can be pushed at both ends ( FIGS. 42B, 42E ) to conform to a varying shape. The varying shape, in some embodiments, will be oval, having a much wider base than height. Expansion of the sheath creates a plane through which a sling can be inserted and advanced. Once the sling is in position within the breast, the conforming sheath may be removed. By pulling at only one end ( FIGS. 42C, 42F ), the sheath will maintain its extended shape over the sling and only contract at exit point  855 . 
     Safety Suture Loop Installer 
       FIGS. 43A-43C  depict embodiments of a safety suture loop installer  900 . The purpose of the safety suture loop installer is to automatically install a safety suture loop  905  around an exit braid to maintain controllability once the braid is reinserted. The installer is a double layer introducer. The safety suture loop  905  is fed through the first layer between the outer layer  910  and inner layer  915 . The needle  920  with a braid is then fed through the center layer. Once the braid is installed, the center layer is removed, leaving the needle  920  within the outer layer  910 . The introducer is then removed and the safety suture loop  905  is installed around the braid. 
     Depth Gauge Introducer 
       FIGS. 44A-44B  depict embodiments of a depth gauge introducer  980 . The purpose of the depth gauge introducer  980  is to create a method of knowing the depth of the introducer. The device will be an introducer  980  having a disk  985  at specified height around the trunk  990  of the introducer  980 . The introducer  980  will be inserted into the skin and further insertion will be stopped at the disk  985 . During surgery, the user can use to depth gauge introducer to maintain the entrance port into the breast (or other soft) tissue at the specified height, or depth within the tissue, Xin. 
     Sling Guide 
       FIGS. 45A-45C  depict embodiments of an expandable sling guide  1000 . The purpose of the sling guide  1000  is to guide the sling  1005  over the pre-inserted extended needle  1010 . The guide  1000  can have an exit control  1015  used to contract a series of loops  1020  on the guide  1000 . The loops  1020  can be contracted for insertion at the exit hole and can extend up once inserted ( FIG. 45B ). The contracting portion will also be used, once inside the breast, to create a dissecting plane. Once the sling  1005  is in place, the sling guide  1000  can be removed, leaving the specified form for the sling  1005 . 
     Retracting “Diamond” Dissector 
       FIGS. 46A-46B  depict embodiments of a retracting “diamond” dissector  1050 . The purpose of the retracting dissector  1050  is to easily create a dissecting plane within the breast. The retracting dissector  1050  will, in some embodiments, have a button  1055  at one end  1060 , outside of the breast. The button  1055  can be pressed to extend the retracting dissector  1050  into a narrow and sleek shape ( FIG. 46A ). Once the button  1055  is released, the dissector  1050  is extended out to a flat and wide shape ( FIG. 46B ) having an increased cross-sectional measurement or dimension. Depression of the button  1055  can be used to create a back and forth “cutting” action. 
     Retracting ‘Diamond’ Dissector with Sling Mount 
       FIGS. 47A-47B  depict embodiments of a retracting “diamond” dissector  1100  with sling mount. The purpose of this device  1100  is to create a dissecting plane while installing the sling  1105 . The device  1100  will have a control button  1110  at exit point that will extend a flat and wide portion  1120  to create a dissecting plane. The button  1110  can be depressed to create a back and forth action to “cut” the plane. The portion will have a sling  1105  attached to it that will contract and expand with the “diamond” portion of the device. 
     In operation, the device can be advanced from the distal end of an elongate body  1115  that is inserted into the tissue of the patient. As the button  1110  is depressed, the flat and wide portion  1120  can change between a compressed configuration and an expanded configuration. This change can permit advancement through the tissue in the compressed configuration and expansion of a channel (or dissecting plane) in the tissue by expanding the device  1100 . In some embodiments, the device  1100  can be retractable into the elongate body  1115  ( FIG. 47B ). In some embodiments, the device  1100  can have a plurality of flat and wide portions  1120 , as depicted in  FIG. 47A , that cooperate to secure the sling  1105 . In some embodiments, the plurality of portions  1120  can hold or secure the sling  1105  therebetween, for example by pinching the sling between the plurality of portions  1120 , during operation and/or advancement through tissue. 
     Retracting Dissector with Sheath Control 
       FIGS. 48A-48B  depict embodiments of a retracting dissector  1150  with sheath control. The purpose of this device  1150  is to create a dissecting plane that can be done via sheath  1155  control. The dissector  1150  includes a “diamond” shaped point  1160  that changes from a compressed configuration, having a first cross-sectional dimension, to an expanded configuration, having a second cross-sectional dimension that is greater than the first cross-sectional dimension, when unrestrained. 
     The sheath  1155  can be introduced into a plane within tissue and by selectively advancing the dissector  1150  relative to the sheath  1155 , the dissecting plane can be advanced and expanded. As the dissector  1150  is advanced out of the sheath  1155 , the dissector  1150  preferably separates tissue in an axial and lateral direction, as shown in  FIG. 48B . After the dissector  1150  is expanded, the sheath  1155  can be advanced over the dissector  1150  to compress and substantially contain the dissector within the sheath  1155  (for example, within a lumen of the sheath  1155 ). The user is then able to feed the sheath  1155  back and forth over the dissector  1150  as the dissector  1150  moves through the tissue, expanding and advancing the dissecting plane. 
     Self-Dissecting Sling 
       FIGS. 49A-49B  depict embodiments of a self-dissecting sling  1200 . The purpose of the self-dissecting sling  1200  is to have one apparatus which can be placed but also has the ability to be maneuvered. The sling  1200  will have a rigid implant  1205  woven into the sling at the sling-suture connection  1210 . As the sling  1200  is advanced through a channel in tissue, the rigid implant  1205  can be used to increase a cross-sectional dimension of the channel by separating tissue. 
     In some embodiments, the rigid portion  1205  will have a “V” shape. Some embodiments provide that the rigid portion  1205  can be contracted for introduction into the tissue channel. For example, the point  1215  of the rigid portion  1205  can act as a dissecting tool, and the two tail ends  1220  of the “V” can be brought together and narrowed for insertion in the exit points of the tissue. After the rigid portion  1205  is introduced with in the tissue, it can assume its expanded configuration to increase a cross-sectional dimension of the channel by separating tissue by allowing the two tail ends  1220  of the “V” to expand outward away from each other. In some embodiments, the sling  1200  can be drawn through the tissue by pulling, and in some embodiments, the sling  1200  can be advanced by pushing the sling through the tissue. 
     “Railroad Tracks” 
       FIGS. 50A-50B  depict embodiments of a “railroad track” dissecting device  1250  that includes a plurality (for example, two) needles  1255 , or elongate members, that are used in conjunction with a dissecting tool  1260  and a sling  1265 . The purpose of the device  1250  is to create a dissecting plane and to install the sling  1265  at the same time. The sling  1265  can be connected or coupled to two needles  1255  that will be inserted into the breast. After the needles are introduced, or inserted, in the tissue, the “Railroad Tracks” operation is created by sliding a dissector  1260  along each of the needles  1255 . The dissector  1260  preferably has a substantially rigid configuration that will separate the needles  1255  from each other as it is advanced along the needles. 
     In some embodiments, the dissector  1260  is connected or coupled to the needles  1255  (for example, by eyelets  1270  that extend around each needle  1255 ). As the dissector  1260  separates the needles  1255 , the needles  1255  expand the channel of tissue to increase a cross-sectional dimension of the channel. In some embodiments, as the needles  1255  are separated, the needles, which can be coupled to the sling  1265 , spreads the sling  1265  within the channel to increase the cross-sectional dimension, or width, of the sling  1265  within the tissue. In some embodiments, the dissector  1260  is expandable at least to a cross-sectional dimension of a width of the sling  1265 , such that the dissector  1260  separates the needles  1255 , when advanced along the needles  1255 , by substantially the width of the sling  1265 . Following creation and/or expansion of the plane within the tissue by the device  1250 , the dissector  1260  can then be removed. 
     “Wrist Slap” Needle 
       FIGS. 51A-51B  depict embodiments of a needle  1300  having bistable configurations. The wrist slap needle has multi-purpose use. The needle  1300  will have a natural bent curvature, as illustrated in  FIG. 51B . When a force is applied in the upward direction  1305 , the needle  1300  will then flatten to a straight needle, shown in  FIG. 51A . Pressure, or force, can then be applied in the opposite, or downward, direction  1310  to change to needle  1300  to having a bent curvature. Ideally, this tool can be used as a curved needle during sling application, or introduction, and then flattened to a straight needle for use with an anchor (e.g., a fascia anchor). 
     Detectable Sling-Suture Connectors 
       FIG. 52  depicts embodiments of a detectable sling-suture connector  1350 . The purpose of this concept is to have manageability over the location of the sling  1355  within the breast. By applying sling-suture connectors  1350  that can be detected from outside of the breast, those points can then be determined externally for position modification of the sling  1355 . In some embodiments, the points of the connectors  1350  can be palpable externally. In certain embodiments, the points can be echogenic. In some embodiments, the points emit light, and are visible to the eye. 
     Sling Exit Points 
       FIGS. 53A-53B  depict embodiments of sling exit points for procedures as described herein. Having predefined sling exit points will ensure proper positioning of the sling and breast lift and direction. There are a possible of 6 exit holes for the breast; three on the outer breast and three on the inner breast. The three on either side will lie above, across, or below the nipple. The direction of the needle will be a combination of one point on the outer breast to one point on the inner breast, varying the three points on either side.  FIG. 53B  depicts a table of possible connectors between the six points. 
     One Exit Hole Breast Lift 
     Depicted herein are several embodiments relating to systems, devices, and methods for performing a breast lift through one incision. While the disclosure below refers specifically, by way of example, to breast lifts, the disclosure can be applicable to lifts, shifting, or moving any soft tissue. Additionally, the embodiments described below can be used in conjunction with other embodiments described in this disclosure. 
     The one exit hole breast lift consists of an insertion point located at the bottom of the breast, approximately halfway from the inframammary fold to the bottom of the areola. This one exit point allows each of the two or more breast needles, or other tools, to be directed up to the anchor point, one up medially and the other laterally. The location of the hole is dependent of the required trajectory of lift. For most vertical lifts, the hole would be located at about the halfway point of the breast diameter, however, if the lift required is one which the breast and nipple should be pulled together toward the sternal notch then the hole may be located along the line connecting the nipple to the sternal notch or mid-clavicle, or positioned slightly laterally. With the assistance of a sling port, the same hole may be used for both breast needles. For the procedure including an anchor knot located at the second or third rib, the medial breast needle is directed first and comes out at the medial anchor point. The anchor needle is then inserted to grab a bite of fascia. The lateral breast needle may then be inserted in the exit hole using a sling port, exiting out the lateral anchor hole. The sling may then be pulled inside the breast, and adjusted appropriately from the two sutures exiting the lateral anchor hole. 
     The one exit hole breast lift may also be used in conjunction with a distal anchor, which may be deployed from the one exit hole. Once the anchors are secure at either side of the top of the breast, the sling may be inserted and lifted in order to lift the breast. The suture would then be secured leaving a single closure point at the bottom of the breast. 
     In some embodiments, the length of the device used in connection with the One Exit Hole Breast Lift embodiments is long enough to simultaneously insert both anchors and still have maneuverable access to the sling. This length may vary dependent on the site of application and the tissue being lifted. In addition, a diameter of the access port should be wide enough, in some embodiments, to encompass two springs at the same time and also the sling doubled over with two suture stands. In some embodiments, the diameter of the port accommodates the larger of the two. 
     Variable Length Port 
       FIGS. 54A-54C  depict embodiments of a variable length port  1400 . The variable length port is designed to change length in order to better assist with implantation of the device, primarily to accommodate different breast sizes. There is a round disk  1405  that will sit against the skin. Also, there is a fixed length sheath  1410  with a handle  1415  that the needle can slide into. The port  1400  contains a component  1420  similar to a tuohy borst adapter, in which there is a screw lock  1425  allowing the sheath  1410  to move up and down then lock into the desired depth. 
     Some embodiments provide that the material of the port would be made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The sheath  1410  preferably includes an internal lumen  1430  that has a diameter preferably large enough, in some embodiments, to allow for anchor delivery system and sling component. This diameter may be dependent on the implant location and specification, but it should range, in most embodiments, from about 5 French to about 24 French. The length of the device may also be dependent on the implant location, but it should be limited, in most embodiments, to range from about 0.25 inches to about 4 inches. In some embodiments, the length may be less than about 0.25 inches or greater than about 4 inches. The diameter of the sheath  1410 , in some embodiments, will be less than about 2 inches on its largest dimension, dependent on the shape of the disk  1405 , whether circular or oval, but wide enough to place the sheath  1410 , for example, in the center. 
     Suture Clamp 
       FIGS. 55A-55C  depict embodiments of a suture clamp  1450 . The suture clamp  1450  is preferably a non-resorbable, two component anchoring system with small holes  1455  for tissue ingrowth. The top component  1460  contains the anchoring device which will secure into the fascia or adipose. The device top component  1460  will have a line of suture feeding through a bottom opening  1465  coming out of, for example, two holes  1470  on either side. The two suture pieces will meet together at a bottom portion  1473  of the top component  1460  and feed into the center  1475  of the bottom component  1480  of the device  1450  which has a hole  1485  down the center  1475 . A sheath with a diameter of the bottom portion  1473  of the top component  1460  may be used to drive the top component  1460  of the device  1450 . Once in desired location, the suture may be pulled on to allow for the locking grooves  1490  of the device to secure into the tissue. Using a smaller diameter tube, the bottom component  1480  of the device may be pushed up into the bottom portion  1473  of the already installed anchor. The bottom component  1480  preferably includes grooves  1495  that secure the bottom component  1480  within the top component  1460  and clamp down of the suture. After connection of the top component  1460  and bottom component  1480  of the Anchor clamp  1450 , the sheaths may be removed. 
     The material of the clamp  1450  would be made, in some embodiments, of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the device, is some embodiments, will be between about 0.125 inches and about 2 inches dependent on the location of implantation. In some embodiments, the length may be less than about 0.125 inches or more than about 2 inches. In some embodiments, the device will be less than or equal to about 0.75 inches in diameter. The bottom portion  1473  will preferably be wide enough to accommodate the bottom component  1480  of the clamp  1450  and two layers of suture material. This range will be, for example, between about 0.1875 inches and about 0.75 inches. 
     Hooked Slide 
       FIGS. 56A-56B  depict embodiments of a hooked slide  1500 . The hooked slide  1500  is a non-resorbable device with small holes  1505  for tissue ingrowth connected to the suture used as an anchoring tool. The slide  1500  would preferably be covered by a sheath and fed up to anchor point in fascia by a hook. Once at the desired location, the sheath and hook can be removed, leaving the hooked slide  1500  in place. A lower hole  1510  is provided for a suture connection. The hooked slide  1500  contains a pointed top portion  1515  to facilitate advancing the slide  1500  through the tissue. Downward directing hooks  1520  are on either slide, therefore, allowing ease of insertion. Once at correct location, the downward hooks  1520  will increase stabilization of the slide  1500  within the tissue. In addition, some embodiments provide that there are upward facing hooks  1525  to secure the device  1500 , allowing the entire device to be restrained from both directions. 
     The material of the hooked slide  1500  would preferably be of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the hooked slide  1500  will preferably be between about 0.125 inches and about 2 inches with a thickness between about 1/32 inches and about 0.1875 inches. In some embodiments, the thickness can be less than about 1/32 inches or greater than about 0.1875 inches. In some embodiments, the device will be between about 0.0625 inches and about 0.75 inches wide. 
     Multiple Dart Suture 
       FIG. 57  depicts embodiments of a multiple dart suture  1550 . The multiple dart suture  1550  is one that has multiple barbed ends  1555  connected, for example via a suture  1558 , at each side of the sling  1560 . These would be inserted up through the sling exit ports. Using a sheath each individual suture will be fed up to the anchor point and released. The sheath may be moved for each portion to allow for a range of securing sites. 
     The anchor material and size can be dependent of anchor that is attached. The overall length of the dart sutures  1550  is preferably enough to allow for individual insertion of each device component while having access to the other components out of the exit hole. 
     Anchor Clasp 
       FIGS. 58A-58D  depict embodiments of an anchor clasp  1600 . This device would be used as a method of securing two sutures at the anchoring site. The device  1600  preferably allows reversible securing of the sutures, allowing for later adjustments, if needed. One suture  1605  would have a perpendicular rod  1608  (polymer based). The second  1610  would have a ring  1609  attached to the end  1615  of the suture  1610 . Once the two components are to be secured together, the rod  1608  would be substantially aligned with an axis passing through a center  1620  of the ring  1609  and inserted through the ring center  1620 . Once through the ring  1609 , the rod  1608  would be repositioned to be substantially perpendicular to the axis of the ring, ensuring, when properly sized, the inability to release through the ring  1620 . 
     The material of the suture could be made of an implantable grade resorbable or non-resorbable polymer material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, and Polycarbonate. An additional component of the perpendicular rod  1608  and ring  1609  may be made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. 
     The length of the rod  1608  would be, in some embodiments, larger than the internal dimension (ID) of the ring  1609  by about 1/32 inch up to about 0.0625 inch over the outer dimension (OD) of the ring  1609  dependent of the application and location of implantation. The ring  1609  may have an ID ranging from about 0.0625 inch to about 0.5 inch and an OD from about 1/32 inch to about 0.0625 inch. In some embodiments, the ID can be less than about 0.0625 inch or greater than about 0.5 inch, and in some embodiments, the ring OD can be less than about 1/32 inch or greater than about 0.0625 inch. The ring  1609  is preferably large enough to pass the suture  1605  and the rod  1608  simultaneously. 
     Zip Tie Sling Closure 
       FIGS. 59A-59B and 60A-60C  depict embodiments of a zip tie sling closures. The purpose of the non-resorbable zip tie closure is to assist in the securing of the sling rather than using a knot with small holes throughout for tissue ingrowth.  FIGS. 59A-59B  illustrates a first version of a closure  1650  that is preferably optimally used for braid-in-braid securing, where there is only one strand of suture to lock. Version one  1650  of the closure is preferably a substantially cylindrical member having a lumen  1655  extending between ends  1660 ,  1665  of the closure. The interior wall  1668  of the lumen preferably includes a plurality of inwardly projecting members  1670  for securing and/or engaging a suture that is extended through the lumen. The second version of the closure  1675 ,  FIGS. 60A-60C , is preferably a small button-like device that has two holes  1680  for either suture on the sling within the device suture would only be able to enter one way. Once inside, the suture would not release but only be able to pull through the direction it entered because of inwardly projecting members  1685  around each hole that engage the suture extending through the hole. This feature would also allow for future adjustment lifts. In some embodiments, the closures can be combined, where version one  1650  sits on top of version two  1675  as a single piece, to provide addition securing. 
     The material of the closure is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. For the first version  1650 , the length of the device  1650  will preferably be within about 0.125 inch to about 0.375 inch. The ID of the tube or cylinder, without the inner teeth or inwardly projecting members  1670 , can be that of double the diameter (or cross-sectional dimension) of the suture under compression. The teeth or members  1670  can be small enough to allow two strands of suture to pass through but large enough to induce significant friction if pulled in the opposite side of entry. 
     For the second version  1675 , the diameter of each suture hole  1680  is preferably equal to or less than the suture diameter (or cross-sectional dimension) not under compression, so as to allow the suture to pass through easily but allow the teeth or members  1685  to grab. A stationary angle  1690  of the teeth  1685  is less than about 90° but flexible enough to expand to about 90° to allow for suture passage. 
     Friction Fit Anchor 
       FIGS. 61A-61B  depict embodiments of a friction fit anchor  1700 . The non-resorbable anchor  1700  contains three holes  1705  at a bottom  1710  of anchor  1700  and with small holes  1715  throughout for tissue ingrowth. The suture is weaved between these three holes  1705  loosely, allowing access for three loops at the exit point. The last suture loop  1720  leads directly to the sling. The anchor  1700  is driven into place and once at the optimal location, suture tightening begins. In order to tighten the suture, each loop is pulled until all obtain a friction fit within the holes  1705 . This will allow the suture to maintain in place without movement. 
     The material of the anchor  1700  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor  1700  is preferably between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device is preferably between about 0.0625″ and about 0.75″ wide. The diameter of the suture holes  1705  can approximate the diameter of the suture used. 
     Anchor Spring 
       FIG. 62  depicts embodiments of an anchor spring  1750 . The non-resorbable anchor spring  1750  is an anchor  1755  with a line of suture  1760  coming from the end  1765  of the anchor  1755 . The suture will preferably be a specified length and preferably contains a spring  1770 . At the opposite end of the anchor  1755  and spring  1770 , there will be a loop  1775  to allow for another line of suture to feed through. The anchor  1750  will be deployed independent of the sling, allowing for multiple anchors to be used and more variations in lift. 
     In some embodiments, the anchor spring  1750  without suture would be one with the silicone spring directly overmolded onto the anchor  1755 . This would eliminate the need to connect the suture to the anchor  1755 , feed the spring  1770  inside, and then loop at the end  1765 . 
     In some embodiments, the material of the anchor spring  1750  may be made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 2″ with a thickness, in some embodiments, of between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. The diameter of the suture hole approximates, in some embodiments, the diameter of the suture used. 
     The length of the suture extension that contains the spring  1770  will preferably be between about 0.25″ and about 6″ depending on the location of implantation. The loop and the bottom may be created from overlapping the suture within itself or by applying a separate component that will be made of the same previously list materials. The ring or loop may have an ID of about 0.015″ up to about 0.25″ and a diameter from about 1/32″ to about 0.0625″. The spring will preferably be made of an implantable grade flexible polymer including, but not limited to, silicone that can be shorter than the overall length of the suture attachment portion but, in some embodiments, greater than about 0.0625″. 
     Anchor Spring Device 
       FIGS. 63A-63C  depict embodiments of an anchor spring device. The anchor spring device consists of two or even four anchor springs  1750 . Each of the springs  1750  has the suture  1780  looped through hole  1775  at the end of the anchor spring  1750 . The anchor  1755  is, in some embodiments, deployed up one side of the breast through the bottom anchor hole  1783 , such that the two suture ends are protruding, one of the ends being a suture connected to one end of the sling  1785 . A second anchor  1755  is then fed up to the opposing side of the breast and secured into place. For this anchor, there are also two strings protruding, one of which is the opposite of end of the sling. Now both anchors will be in place and there should be a sling and two suture ends coming out of the exit hole  1783 . By pulling the two suture ends, the sling will retract into the breast through the exit hole  1783  ( FIG. 63B ). The breast will lift and once at optimal location, the suture ends may be tied together ( FIG. 63C ) to secure the sling  1785  in place, as shown in  FIGS. 63B-63C . 
       FIG. 63D  depicts embodiments of a sling weave anchor spring device  1800 . Similar to the sling loop anchor spring device, depicted in  FIGS. 63A-63C , the two suture ends would be oriented to the exit hole at the bottom of the breast. However, with the sling weave  1800 , the two suture ends would be weaved within the sling  1805  to its center and then down to the exit hole. This would allow a knot to be tied at the center of the sling. Two main advantages include there being no cheese wiring of the suture and the inability for the sling to rotate. Once the anchors are deployed and at the desired location, the sling may then be pushed up into the breast, by pulling on the suture ends. Once the lift is obtained, a knot may be tied to secure the device. 
     The material of the anchor  1750  of the device  1800  may include an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device will be between about 0.0625″ and about 0.75″ wide. The diameter of the suture hole can approximate the diameter of the suture used. The spring will preferably be made of an implantable grade flexible polymer including but not limited to silicone. The length of the spring extension will be between about 0.25″ and about 6″. 
     The length of the device  1800  is preferably long enough to simultaneously insert both anchors  1750  and still have maneuverable access to the sling  1805 . This length could vary dependent on the site of application. In addition, the diameter (or cross-sectional measurement) of the access port (that can be used in connection with this and other embodiments) should, in some embodiments, be wide enough to encompass two springs  1770  at the same time and also the sling  1805  doubled over with two suture stands. The diameter of the port could accommodate the larger of the two. The spring may be implantable non-resorbable grade flexible polymer including but not limited to silicone. 
     Double Anchor Spring 
       FIG. 64  depicts embodiments of a double anchor spring  1850 . The non-resorbable double anchor spring  1850  is a spring  1770  with two anchors  1750  on opposite ends facing in opposing directions. Each anchor  1750  has a hole that is connected to a suture  1760 , so as to allow for controllability of the anchor  1750 . Once one anchor  1750  is in place, the second anchor  1750  may be placed to allow tissue to be drawn together. This can be used for supraareolar lift, as well as for other lifts. 
     In some embodiments, the anchor material and dimensions are dependent on the anchor used. The length of the connecting suture, depending on the location of implantation, may be between about 0.025″ and about 6″ long. The suture material may be resorbable or non-resorbable monofilament or multifilament polymer material. The spring may be implantable non-resorbable grade flexible polymer including but not limited to silicone. 
     Barbed Anchor Release Device 
       FIGS. 65A-65E  depict embodiments of a barbed anchor release device  1900 . Starting from a side breast exit point  1903 , a needle  1905 , or elongate member, is inserted up to an anchor point in the tissue, without puncturing skin at the anchor point. Once at the correct location, a sheath tube  1910  is slid over the needle  1905  up to the anchor point. The needle  1905  is removed, and, a hooked rod  1915  is used to advance a barbed plate  1920 , connected or coupled to a suture  1925 , through the sheath  1910 . Once the barbed plate  1920  is at a desired anchor point, the sheath  1910  is withdrawn, and the hooked rod  1915  releases the barbed plate  1920 , leaving suture  1925  with barbed plate  1920  at the anchor point. The same process can be repeated on the opposite side of the breast or tissue. In some embodiments, multiple device  1900  can be inserted through each exit point  1903 . Following advancement of the barbed plate  1920  to the desired anchor point, a sling can be inserted into the tissue, and a knot can be tied with the suture  1925  on each side of the sling connecting to anchoring suture  1925 . In  FIG. 65A , a needle  1905  is inserted at sling exit hole  1903 . A dilator with a sheath  1910  is inserted over the needle, as shown in  FIG. 65B . In  FIG. 65C , the needle  1905  and dilator are then removed, leaving the sheath  1910  and the anchor. A hooked rod  1915  slides through the sheath  1910 , advancing the barbed plate  1920 , attached to suture  1925 , as shown in  FIG. 65D . In  FIG. 65E , the sheath  1910  is removed, and the barbed plate  1920  is left in place. 
     The delivery system is preferably wide enough to encompass the anchor, and in some embodiments, is between about 0.0625″ and about 0.75″. The length of the delivery system is preferably long enough to obtain desired delivery location, and in some embodiments, is equal to or greater than about 0.25″ 
     Key Hole Anchor 
       FIGS. 66A-66B  depict embodiments of a key hole anchor  1950 . The non-resorbable key-hole anchor  1950  is one with a key-hole shaped hole  1955  (with a key-shaped slot) at the bottom  1960  with small holes  1965  throughout for tissue ingrowth. Once the anchor  1950  has been placed properly within the tissue, the suture may be pulled through the larger portion  1970  of the hole  1955 , and once sufficient lift is obtained by pulling on the suture, the suture may be pulled into the smaller portion  1975  of the key-hole  1955 , locking it into place. 
     The material of the anchor  1950  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor  1950  is preferably between about 0.125″ and about 2″ with a thickness of between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. The larger portion  1970  of the hole  1955  will be, in some embodiments, equal to the diameter of the suture used. The smaller portion  1975  of the hole will be the diameter of the suture at maximum compression. 
     “V” Anchor 
       FIGS. 67A-67B  depict embodiments of a “V”-shaped anchor  2000 . The non-resorbable anchor  2000  is shaped like a “V” with small holes throughout for tissue ingrowth. The device will be deployed and the “V” shape will allow more area of tissue to be grabbed. Each leg  2005  of the “V” includes smaller barbs  2010  attached allowing for further securing. Each leg  2005  of the “V” will be able to be rotated inward, into a compressed configuration, in order to deliver to the anchoring site. The anchor  2000  preferably includes a bottom portion  2015  that includes one or more holes  2020  for securing to a suture. 
     The material of the anchor  2000  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor  2000  is preferably between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device  2000  will be between about 0.0625″ and about 0.75″ wide. The hole will be equal to the diameter of the suture used. An angle  2025  of separation between the two legs  2005  can be between about 10° and about 160°, and in some embodiments, the angle between the two legs can be between about 10° and about 45°. 
     Tongue Depressor Anchor 
       FIGS. 68A-68B  depict embodiments of a tongue depressor anchor  2050 . This non-resorbable anchor  2050  is one that is shaped like a tongue depressor, but is bent slightly with small holes throughout for tissue ingrowth. Each side preferably contains small barbs  2055 . The device will preferably be deployed to a desired anchor location within the tissue, and once at the anchor location, the device may be moved back and forth slightly in order to secure into the tissue. This device  2050  may be used for supraareolar lift, as well as for other lifts. 
     The material of the port is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 4″ with a thickness between about 1/32″ and about 0.1875″. The device  2050  will preferably be between about 0.0625″ and about 0.75″ wide. The angle of bend in the device  2050  is preferably less than about 180°. The plate barbs  2055  will be bent, in some embodiments, in an direction substantially different (or opposite in some embodiments) than the bending of the device  2050 . 
     Wall Anchor 
       FIGS. 69A-69F  depict embodiments of a wall anchor  2100  used in connection with the systems and methods described herein. This non-resorbable anchor  2100  is diamond shaped when relaxed or unrestrained ( FIGS. 69A-69B ), and has a pointed head  2105  for driving or advancing the anchor  2100  through tissue. At a bottom  2110  of the anchor  2100 , there is preferably a hole  2115  for attaching a suture. The suture is then fed up to a hole  2120  at the top head  2105  and then back down through the bottom hole  2115 . When directing the device into place, it straightens out to be long and thin ( FIGS. 69C-69D ). Once at a desired location, the suture coming from the bottom  2110  of the anchor  2100  can be pulled, pulling the top head  2105  and bottom  2110  of the device  2100  together, changing the shape to increase a cross-sectional dimension of the anchor  2100 . The device  2100  will change from the long and thin shape to the diamond shape, and further pulling will allow the device  2100  to change from a vertical-oriented shape to a horizontal oriented shape, further engaging tissue substantially perpendicular to direction that the suture is pulled ( FIGS. 69E-69F ). 
     The material of the anchor  2100  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The device  2100  will preferably be between about 0.0625″ and about 0.75″ wide and long at deployment. An angle  2125  between two legs  2130  extending toward the bottom  2110  from the top head  2105  will preferably be less than about 90° in relation to each other at deployment. The thickness of the device  2100  will preferably be between about 1/32″ and about 0.1875″. 
     Suture In-Weave Anchor 
       FIG. 70  depicts embodiments of a suture in-weave anchor  2150 . This non-resorbable anchor  2150  is one with a suture hole  2155  at the bottom. Passing through the suture hole  2155  is preferably a suture loop  2158  of braid that is about 0.25″. One suture tail  2160  is attached to the sling, and the other suture tail  2165  is used for securing. The anchor  2150  may be directed into a desired location, and once at the locations, the securing suture  2165  end is pulled until desired lift is obtained. The suture may then be secured. 
     The material of the anchor  2150  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device  2150  will be between about 0.0625″ and about 0.75″ wide. The diameter of the suture hole approximates, in some embodiments, the diameter of the suture used. The length of the suture extension will preferably be between about 0.25″ and about 6″, depending on the location of implantation and sufficient to loop within itself in a portion greater or equal to the diameter of the suture itself. The suture material may be resorbable or non-resorbable multifilament polymer material. 
     Hybrid Anchor 
       FIG. 71  depicts embodiments of a hybrid anchor  2200 . The non-resorbable hybrid anchor  2200  is a plate  2205  with barbs, (for example, for adipose and fascia securing) with small holes throughout the anchor  2200  for tissue ingrowth. In some embodiments, adipose barbs  2215  are directed outwardly in a plane that is substantially parallel to the plate  2205 , and in certain embodiments, fascia barbs  2220  extend in a plane that is transverse to the plane of the plate. Some embodiments include both barbs  2220 ,  2215 , allowing for securing in both tissues. 
     The material of the anchor  2200  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor  2200  will, in some embodiments, be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. 
     Trap Anchor 
       FIGS. 72A-72B  depict embodiments of a trap anchor  2250 . The non-resorbable trap anchor  2250  is one with two plates, a first plate  2255  on top of a second plate  2260  in a substantially parallel orientation, with small holes throughout for tissue ingrowth. Each plate  2255 ,  2260  with have a pointed head  2265  for separating tissue while the plate is being advanced through tissue, and each plate is attached at a base  2370 , that has a hole  2375  for securing to a suture. As the parallel plates are driven into the tissue, the tissue becomes trapped within the two plates by small divots, which allow the tissue to enter but not exit. 
     The material of the anchor  2250  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device will be between about 0.0625″ and about 0.75″ wide. The jaw width is preferably between about 0.15″ and about 0.5″ depending on the location of insertion. 
     Bent Barbed Anchor 
       FIGS. 73A-73B  depict embodiments of a bent barbed anchor  2300 . The non-resorbable anchor is derived from a plate  2305 , which has a series of barbs  2310  cut out either side with small holes throughout for tissue ingrowth. Each barb  2310  is curled outward in some embodiments. The anchor barbs  2310  may be pushed back toward the plate  2305  while the anchor  2300  is being advanced through tissue to a desired location. Once at the desired location, the barbs  2310  are released allowing them to secure into the tissue. In some embodiments, this design may be advantageous for adipose tissue securing. Also, an alternative version would be every other prong bent down, out of plane with the plate  2305 , as shown in  FIG. 73B , in order to obtain resistance in both the fat and fascia planes. In some embodiments, the anchor  2300  includes one or more holes  2315  at one end for securing to one or more sutures. In some embodiments, the plate  2305  includes a pointed head  2320  for separating tissue when the anchor  2300  is advanced through tissue. 
     The material of the anchor  2300  is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor  2300  will be between about 0.125″ and about 2″ with a thickness of between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. The diameter of the suture hole  2315  approximates the diameter of the suture used. 
     Barbed Plate 
       FIGS. 74A-74B and 75A-75B  depict embodiments of a barbed plate anchor  2350 . The non-resorbable barbed plate anchor  2350  consists of a plate  2355  with barbs  2360  stamped out of it with small holes throughout for tissue ingrowth. The barbs  2360  are then bent out of plane with the plate  2355  in order to grab fascia once installed in the tissue. This bending motion also allows the barbs  2360  to be substantially flat during delivery of the anchor. Embodiments depicted in  FIGS. 74A-74B  contain one or more holes  2365  at the bottom to create a friction fit with looped suture. Embodiments depicted in  FIGS. 75A-75B  contain reverse directing barbs  2370  in order to prevent movement upward. Once the anchor  2350  is at the desired location, it may be shifted up and down slightly to properly secure the fascia in both directions. 
     The material of the anchor is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. The diameter of the suture hole approximates, in some embodiments, the diameter of the suture used. 
     Staple Anchor 
       FIGS. 76A-76B and 77A-77B  depict embodiments of a staple anchor  2400 . The non-resorbable anchor  2400  is derived from a partial (e.g., half) tube  2405  with a series of teeth  2410  cut out on the sides allowing for securing into the fascia. Due to the curvature of the partial tube  2405 , the direction of the teeth  2410  will facilitate penetration into the fascia. The back end of the anchor will preferably contain a hole  2415  for suture securing and device deployment.  FIGS. 76A-76B  contain two holes at back end to allow the suture to loop secure anchor and feed into the center of the device.  FIGS. 77A-77B  show a series of holes  2420  to optimize ingrowth. In some embodiments, there is a divot created along the top of the anchor  2400  for the suture to lay flush on top. This can aid in condensing the delivery sheath diameter. In addition, the teeth  2410  may be bent outward in order to grab the fascia more easily. For some of these embodiments, every other tooth  2410  would be bent out slightly and twisted out to create a paddle effect against the tissue. 
     The material of the anchor is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The overall length of the anchor will preferably be between about 0.125″ and about 2″ with a thickness between about 1/32″ and about 0.1875″. The device will preferably be between about 0.0625″ and about 0.75″ wide. The arc of the anchor used from the tube will preferably be between about 5° and about 320°. The diameter of the suture hole approximates, in some embodiments, the diameter of the suture used. 
     Staple Anchor Deployment Device 
       FIGS. 78A-78E  depict embodiments of a staple anchor deployment device  2500 . The anchor  2505  can be cut from a half tube  2510 . The other half  2515  of the tube can be used to in deployment to secure the anchor  2505  while be directed to an anchor site. The tube can allow for a breast needle  2520  to fit inside. The needle  2520  can then create a path to the anchor site. There is preferably a tapered sheath  2525  over the device to cover the anchor  2505  until at desired location. Once at the desired location, the outer sheath  2525  will be pulled slightly, allowing the anchor  2505  to be exposed enough to grab into the tissue. The outer sheath  2525  and needle  2520  may then be removed leaving the anchoring device and remaining tube. The suture  2530  may then be pulled at the exit hole  2535  to disconnect the lower portion of the tube from the anchor itself. Once the anchor  2505  is disconnected from the tube, the tube may be removed. The anchor is then secured by pulling slightly to secure into the fascia. 
     The delivery system is preferably wide enough, in some embodiments, to encompass the anchor, and, in some instances, is between about 0.0625″ and about 0.75″. The length of the delivery system is preferably enough to obtain desired delivery location, which, in some embodiments, is equal to or greater than about 0.25″. 
     Supraareolar Device 
       FIG. 79  depicts embodiments of a supraareolar device  2550 . The device  2550  can include four anchor springs  2555 . The breast needle will preferably be driven up into the breast from the bottom exit hole  2560 . The needle will be directed up around and supraareolar. Then the needle will come around the other side of the breast, exiting out the entrance hole as if to create a circular path around the nipple. Each of the four anchors  2550  will be deployed through the circular path. In some embodiments, the top two anchors  2550  will carry supraareolar support, and in certain embodiments, the second two will support the sling  2565 . 
     The length of the device  2550  is greater, in some embodiments, than the circumference of the areola and, in certain embodiments, is less than that of the breast. 
     Sling Positioning Procedure 
       FIG. 80  depicts embodiments of a sling positioning procedure. This procedure will allow the sling  2600  to be repositioned without having to run a suture through the anchor loop. In some embodiments, control of the lateral part of the breast tissue is obtained through a lateral anchor hole  2605  and control of the medial part of the breast tissue through a medial anchor hole  2610 . For modification, the 3-exit hole procedure will have the addition of a longer suture loop to the anchor needle. Instead of pulling the suture through the anchor, the anchor will leave an access suture that will run the anchor loop after positioning is deemed suitable. 
     Belt Buckle 
       FIG. 81  depicts embodiments of a belt buckle securing device  2650 . The belt buckle suture securing device  2650  is one that will allow movement of the implant within the breast tissue. One end  2655  of a suture  2660  is connected to two loops  2665 ,  2670 . The end of a second suture  2675  is then wound though the two loops  2665 ,  2670 . Once the device is in the appropriate location, the second suture  2675  can be pulled tight to obtain a friction fit connection. This can be done remotely from an exit point. 
     The material of the ring, or loop, is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The ring or loop may have an ID of about 0.015″ up to about 0.25″ and a diameter from about 1/32″ to about 0.0625″. 
     Variable Durometer Spring 
     Incorporating a spring of variable durometers can allow a more secure range of movement. The lower durometers spring would allow for every day movement. Incorporating the higher durometers would ensure that there would be a buffer if high impact occurs. This would give relief to the anchor point and would allow that the suture not create a shock load. The durometers variations could include parallel variations or step variation, having one durometers next to another rather than along side. 
     The materials can include an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. In some embodiments, the two components may be any combination of the above said materials or the same material. In some embodiments, the durometers of the two components are dissimilar. The varying durometers may run, in some embodiments, concentric to each other, or on top of each other. 
     Recapturing Device 
     The recapturing device would allow the anchor to be relocated during a procedure if the anchor position was too superior. The recapturing device would be one that can be fed up through the exit point along the bottom of the anchor or where the anchor meets fascia. By being planar, parallel, and larger in diameter than the anchor, the component is able to be slid under the anchor and lifted to release the anchor from the fascia for repositioning. 
     The material of the recapturing device is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The width and length of the device should be, at minimum, about 0.005″ greater than the width and length of the anchor extracted, and greater than or equal to about 0.75″, depending on the area of extraction and the size of implant. The thickness of the device should be, in some embodiments, between about 0.015″ and about 0.25″. 
     Angled Anchor Deployment 
       FIG. 82  depicts embodiments of an angled anchor deployment. While deploying the anchor within the fascia, orientation of the anchor  2600  becomes critical. The anchor  2600  may be deployed superiorly parallel to the fascia plane. This will allow the anchor  2600  to grasp the fascia or, depending on the anchor type, sit within the adipose flush to the fascia. It is also possible to orient the anchor  2600  so that it is not linear with the suture  2605 , but rather angled to the suture  2605 . While deploying the anchor  2600  into the anchor site, the anchor  2600  may then be turned approximately 90° or parallel or perpendicular to the muscle fibers depending on the anchor design. Depicted in  FIG. 82 , and designated as A is a perpendicular deployment of anchors. Designated as B is a parallel deployment of anchors, and designated as C is a posterior directed deployment of anchors. 
     In some embodiments, deployment of the anchors are dependent, in some embodiments, on the anchor used, and in certain embodiments, the angle will be any angle perpendicular and parallel to the angle of the chest wall up and down, or left to right. 
     Profiled Spring 
       FIGS. 83A-83B, 84A-84B, and 85A-85B  depict embodiments of profiled springs. The profiled spring  2650  is one that is extruded and inserted into the braid for the suspension of the device. By profiling the spring it allows for less outer surface area in which the component may contract more allowing for greater extension. There are straight and helical extrusions allowing for varying deformation. 
     In some embodiments, the diameter (or cross-sectional dimension) of the spring will be between about 0.015″ and about 0.325″. The length of the spring will preferably be between about 1/16″ and about 6″. The helical component will preferably have between about 1 and about 60 revolutions per inch. 
     Progressive Knot Pusher 
     The progressive knot pusher would allow the device to be installed and properly fixed by deploying a series of previously tied knots at a specified distance within the breast. This would allow for securing of the sling on either side of the breast at the anchor points. This would ensure that the sling does not rotate, in addition, to the suture not cutting through the tissue. The knot pusher would be a polymer tube with interval slits for the knots. Once the device is as the desired location, the suture that is fed within the tube may be pulled, releasing the series of knots to secure the device. 
     The material of the pusher is preferably made of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the pusher will preferably be sufficient to reach the final knot location from the outside of the body. 
     Interrupted Lumen 
       FIGS. 86A-86C  depict embodiments of an interrupted lumen  2700 . The interrupted lumen  2700  would allow for an anchor delivery system to run alongside the breast needle. A polymer lumen  2705  would be manufactured to slide over the breast needle  2710  and would contain the anchor at the tip  2715 . Approximately halfway down the needle  2710  the lumen  2705  would be interrupted and the breast needle would exit, however, the lumen  2705  would continue alongside the breast needle  2710 . At this point the anchor holding device  2720  would run down the middle of the lumen  2705 . The top portion  2725  of the anchor holding device  2720  would sit on the outside of the lumen  2705  that is over the breast needle  2710  at the tip covering the anchor. The breast needle  2710  and device  2720  would be inserted into a desired location. Once there, the anchor covering device  2720  could be slid down, advancing or revealing the anchor to the tissue. Then the breast needle  2710  may be removed leaving the anchor in position. 
     The material of the sheath, slide, and other components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the sheath should, in some embodiments, be sufficient to allow the tip to reach the desired anchor location but still have the interrupted portion of the lumen outside the body. This should be between about 0.5″ and about 30″. The Sheath length should preferably be long enough to cover at least a portion of, and preferably, the entirety of, the anchor, but preferably not to exceed it by more than about 2″. The ID of the sheath should preferably be greater than the outer diameter of the needle used but not more than about 0.125″ larger. The length of the lumen connection should be between about 0.125″ and about 5″. 
     Attached Lumen 
       FIGS. 87A-87C  depict embodiments of an attached lumen delivery system  2750 . The attached lumen delivery system  2750  is one that has added rigidity due to the addition of polymer loops  2755  at the distal end of the device. The loops  2755  are wrapped around the lumen and the breast needle to keep them together during deployment. The lumen contains the anchor at the tip. The anchor cover is controlled from the exit point. The breast needle is inserted into the breast up to the desired anchor position. Once at the right location, the anchor cover is pulled off using the controller that exits out of the breast. The breast needle is then pulled out, leaving the anchor in place. The lumen is attached to the breast needle using a series of loops  27555 . 
     The material of the sheath, slide, and other components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the sheath should preferably be sufficient to allow the tip to reach the desired anchor location but still have the interrupted portion of the lumen outside the body. This should preferably be between about 0.5″ and about 30″. 
     The Sheath length should preferably be long enough to cover then entirety of the anchor but, in some embodiments, not to exceed it more than about 2″. The ID of the sheath should be greater than the OD of the needle used, but, in some embodiments, not more than about 0.125″ larger. The length of the lumen connection should be between about 0.125″ and about 5″. The diameter of the loops should preferably be approximate to the diameter of the needle used. The length of the loop should preferably be between about 0.015″ and about 1″, depending on the scale of device used. 
     Tubular Spring 
       FIG. 88  depicts embodiments of a tubular spring  2800 . Rather than having a profiled spring, the tubular spring  2800  would be inserted into the suture  2805 . The spring  2800  would be a tube that is hollow inside. Therefore when the spring  2800  is extended it will collapse into the center. 
     In some embodiments, the material of the suture components is preferably made from an implantable grade monofilament or multifilament resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The spring component is preferably made from an implantable non-resorbable polymer including but not limited to a flexible silicone. 
     The outer diameter of the spring should preferably be able to fit within the spring center when fully expanded, but larger than the inner diameter of the suture when relaxed. The OD of the spring may be between about 0.002″ and about 1″ and the wall thickness between about 0.0001″ and about 0.075″. The length of the spring should be between about 0.01″ and about 6″. 
     Slide Sheath Deployment System 
       FIGS. 89A-89C  depict embodiments of a slide sheath deployment system  2850 . The slide sheath deployment system  2850  would be one that has a syringe-like base. The outer sheath  2855  of the syringe would be attached to a long lumen  2860 . This lumen  2860  would have a slit  2865  at the end in which the suture  2870  that is attached to an anchor can slide. The inner sheath  2875  of the syringe like component would also be attached to an inner lumen  2878 . This inner lumen would slide through the outer lumen and contain an anchor  2880  at the end. The anchor  2880  at the end would be connected to a piece of suture  2870  at the tip. This suture would be free to move due to the slit in the outer lumen. For deployment, the inner lumen would slide over the breast needle  2885 . Once at a desired location within the tissue, the inner lumen would be pushed forward, therefore allowing the outer lumen to release the anchor  2880  and allow for the suture to easily slide through. Once the anchor  2880  is in place, the deployment portion of the device may be removed. 
     The material of the sheath, slide, and other components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The slit for the suture is preferably greater or equal to the diameter of the suture  2870 , and is, in some embodiments, equal to or less than about 0.0125″. The length of the slit will preferably be between about 0.015″ and about 3″. The overall length of the device will preferably be such that the syringe component is operative outside the body when the tip of the device is at the desired anchor location. 
     Corkscrew Deployment Device 
       FIGS. 90A-90B  depict embodiments of a corkscrew deployment device  2900 . The corkscrew deployment device  2900  is one in which the anchor  2905  is set at the  2910  tip of a corkscrew  2915 . The corkscrew  2915  is set inside a deployment lumen  2920 . The anchor  2905  at the tip would be one that is ring-like with an umbrella of barbs  2925 . The anchor  2905  would also have a suture attachment  2930 . The lumen  2920  would have an opening slit  2935  at the end exposing the corkscrew once at the desired location within the tissue. At that location, the corkscrew  2915  would be turned into the fascia. This turning motion would allow the suture  2940  to be sewed into the fascia for several throws. Once the corkscrew  2915  is fully deployed, turning of the corkscrew in the opposite direction would release the device. The barbs  2925  on the anchor  2905  would bite into the tissue and secure it place, leaving the suture loops in the fascia. 
     The material of the sheath, slide, and other components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The suture may be of the above materials in a monofilament or multifilament. The outer diameter of the corkscrew is preferably between about 0.015″ and about 3″, dependent on the location of deployment. The diameter of the corkscrew rod is less than one-third of the overall diameter. The corkscrew preferably has sufficient revolution, so as to thread the suture at a width of the suture diameter from each other. The anchor preferably has an inner diameter, so as to securely fit on the tip of the corkscrew rod. The length of the sheath cut is preferably sufficient to expose the tip of the anchor and deploy it. The overall length of the sheath is preferably sufficient to reach to the anchor site while maintaining control from out of the exit point. The inner diameter of the sheath is preferably greater than the diameter of the overall corkscrew, but is preferably small enough to maintain control of the corkscrew. 
     Corkscrew Plate 
       FIG. 90C  depicts embodiments of a corkscrew plate  2950 . The corkscrew plate  2950  is one that the corkscrew device  2900  sutures around. This plate  2950  would have a path for the corkscrew  2915  to cycle, leaving the suture  2940  behind and would allow a more solidified anchor to be placed in the body. The plate  2950  would be deployed above the fascia, allowing the suture loops to penetrate the fascia. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The width of the plate  2950  is preferably greater than the outer diameter of the corkscrew  2915 . The length of the plate  2950  is preferably between about 0.015″ and about 3″ dependent on the location on implantation. The top and bottom portion of the plate may or may not be flat. 
     Barbed Multifilament Suture 
       FIG. 91  depicts embodiments of a barbed multifilament suture  3000 . The barbed multifilament suture  3000  is one that has an insertion of barbs  3005  down the center of the braid and is capped by an anchor tip  3010 . This allows the barbs  3005  to puncture through the side of the braid and catch the skin. This suture  3000  could be fed down the center of a deployment device, allowing the tip of the suture to direct the device and be deployed. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. 
     Umbrella Suture 
       FIG. 92  depicts embodiments of an umbrella suture  3050 . The umbrella suture  3050  is a suture that has a polymer tip  3055 . The suture  3050  is bound to the polymer center. The polymer tip is pointed at the end  3060  for directing through tissue and separating tissue as it is advanced. At the base  3065  of the polymer tip  3055 , there are barbs  3070  that extend out into the shape of an umbrella. The barbs  3070  are directed as to easily be inserted if suture is directed with the tip advancing first, however, if pulled in the opposite direction, the barbs catch the flesh and secure into the tissue. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. 
     Umbrella Deployment Device 
     Some embodiments provide for an umbrella deployment device. The deployment device would utilize the umbrella suture. The suture preferably includes a sheath over the barbs. A sheath may be placed over the barbs and sit against the lip of the tip, allowing the suture to be pushed inside the breast. Once at the desired location within the tissue, the sheath may be removed, exposing the barbs so that they may be secured in the tissue. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The inner diameter of the deployment device preferably is larger than the largest diameter of the anchor but preferably equal to or less than about 0.5″ than the largest diameter of the anchor. The suture and tip are preferably bonded by, but not limited to, material additive, heat set, friction or shrink fit, and plasma bonding. 
     Advancing Corkscrew 
       FIG. 93  depicts embodiments of an advancing corkscrew  3100 . The advancing corkscrew  3100  would be one with two distinct varying pitch and angles springs that are either concentric or non-concentric in order to create an offset during installation. In some embodiments, for example, the corkscrew includes a larger diameter spring  3105  and a smaller diameter spring  3110 . The larger diameter spring  3105  would preferably enter the tissue first in order to create a larger bite for tracking into the smaller diameter spring. This would allow for better feed into position. 
     Hanger 
       FIGS. 94A-94B  depict embodiments of a hanger anchor  3150 . The hanger  3150  is a resorbable or non-resorbable rod-like anchor that is attached perpendicularly to suture in the center  3155  of one side  3160  of a rod  3165 . One end  3170  of the shaft is pointed to act as a guide in feeding up through the breast. Separated from the point, and shown approximately one-third down from the point, the cross-sectional shape of the shaft changes and is representative of a “D” encompassing less than, or half, the diameter of the original cross-section. Then, halfway down the shaft, the “D” shape has a ring  3175  attached to it for suture attachment. 
     The remaining portion of the shaft then resumes the “D”-shape. This “D” shape has multiple advantages. First, it allows the suture to lie alongside the anchoring device during insertion inside the breast, without increasing the overlying sheath diameter in order to accommodate the suture. Second, the flat portion of the “D” will lie perpendicularly to the force of pull within the fascia plane allowing for heightened support. 
     A second version ( FIG. 94B ) of the hanger  3150  does not contain an additional ring  3175 . Rather, the “D” shape is still maintained for two-thirds of the device; however, less than half of the cross-sectional area is removed allowing for more mass to be maintained. Instead of having the ring  3175 , there is a hole  3180  in the center of the hanger that runs parallel with the suture and perpendicular to the overall shape of the device. The hole  3180  is dual diameter with a larger diameter at the top of the device and a smaller one at the bottom. To secure the suture to the second version, a knot is tied in the suture. The larger diameter of the knot is to rest in the larger diameter portion of the hole, and the remainder of the suture is fed through the smaller hole. The suture can then be bonded in the larger diameter hole. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the device is preferably greater than the width. The width is preferably greater than the diameter of the suture. For version 1 ( FIG. 94A ), the inner diameter of the hole preferably is greater or equal to the diameter of the suture. For version 2 ( FIG. 94B ), the smaller hole preferably is approximate to the diameter of the suture. The larger diameter hole preferably is great enough to hold the width of the suture tied in chosen knot. 
     Braid Overlay Corkscrew 
     The Braid Overlay corkscrew  3200  is a corkscrew-shaped device that may be inserted into the fascia to apply the suture in a stitched fashion. The suture  3205  is applied to the corkscrew  3210  prior to insertion. This is done by feeding the corkscrew  3210  down the center of the suture  3205 . At the end of the suture  3205 , the anchor  3215  will preferably be attached to the suture  3205 , and the anchor  3215  will sit on the end of the corkscrew  3210 . The anchor  3215  may or may not be used to drive into the tissue and fascia. Once the corkscrew  3210  is stitched into the tissue, the corkscrew  3210  is then removed by driving or rotating it in the opposite direction. By reversing the direction, the corkscrew  3210  will back out leaving the suture in place. This is aided by the fact that the anchor  3215  has a prong  3220  flange on the end that will secure into the tissue and allow the suture to stay in place and not back out with the corkscrew  3210 . 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The inner diameter of the suture is preferably large enough to easily slide over the corkscrew. 
     Leaf Anchor 
       FIG. 96  depicts embodiments of a leaf anchor  3250 . The leaf anchor  3250  is one that has one or more spear-shaped prongs  3255  around the tip  3260  of the anchor  3250 . During deployment, leaves of the tip  3260  are wrapped around the suture that is attached to the anchor  3250 . Once deployed, these spear-like prongs  3255  spring out and secure into the fascia perpendicularly to the pull. One or more of these may be applied around the anchor tip  3260 . The prongs  3255  are attached via a slender attachment point that will allow deflection and perpendicular placement to the head of the anchoring system. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The inner diameter of a ring  3270 , through which the suture may pass, on one end of the leaf anchor preferably is greater than that of the suture under radial compression. 
     Umbrella Anchor 
       FIG. 97  depicts embodiments of an umbrella anchor  3300 . The umbrella anchor  3300  is one that is shaped like an umbrella with prongs  3305  pointing in the a direction opposite than that of insertion. A tip  3310  of the anchor  3300  is used to drive and separate the tissue as the anchor  3300  is advanced therethrough. In some embodiments, a sheath is applied over the anchor tip. Once at a desired location within the tissue, the sheath is removed exposing the anchor. The anchor can then be pulled in the opposite direction of insertion. Once pulled, the prongs  3305  on the umbrella anchor  3300  then deploy outward grabbing onto the tissue. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. 
     Washer Anchor 
       FIGS. 98A-98B  depict embodiments of a washer anchor  3350 . The washer anchor  3350  is an anchor created to adapt to the end of the corkscrew deployment system. The washer anchor  3350  is attached to the suture  3355 . The anchor is a circular disk  3360  that is contractible, to have a first cross-sectional dimension in a compressed state ( FIG. 98A ), and is expandable, to have a second cross-sectional dimension ( FIG. 98B ), greater than the first cross-sectional dimension, in an expanded state. The washer is created to be deployed under the fascia. When pulled perpendicularly to the plane, the washer  3350  is expanded created a large surface area for pull through resistance. Prior to deployment, the washer wraps around the suture  3355  until it is deployed at the desired location. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The diameter of the disk is preferably greater than the diameter of the needle that is used to puncture the fascia. In some embodiments, the thickness is between about 0.00001″ and about 0.3″ 
     T-Bar Anchor Support 
       FIG. 99  depicts embodiments of a T-bar anchor support  3400 . The T-Bar Anchor support  3400  is a rod-like component that runs perpendicular to the suture at varying distance from the anchor tip. The anchor support  3400  will have a suture attachment point  3405  (which, in  FIG. 99 , is depicted as a hole) at the center  3410 . During deployment, the anchor support  3400  is turned parallel alongside the anchor. Once the distal anchor is deployed, the suture is pulled back in the opposite direction to engage the anchor support rods. The anchor supports  3400  then turn perpendicular to the suture and allow for additional support within the tissue. In some embodiments, the attachment point  3405  comprises a hole, and in certain embodiments, the hole can have a plurality of internal diameters. For example, as depicted in  FIG. 99 , the hole can include a smaller hole  3415 , having a smaller diameter, and a larger hole  3420 , having a larger diameter. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the device is preferably greater than the width. The width is preferably greater than the diameter of the suture. The smaller hole is preferably approximate to the diameter of the suture. The larger diameter hole is preferably great enough to hold the width of the suture tied in chosen knot. 
     Fascia Puncture Deployment System 
       FIG. 100  depicts embodiments of a fascia puncture deployment system  3450 . This deployment system  3450  is created specifically to locate and penetrate the fascia plane. The deployment system  3450  is inserted in the exit-hole consisting of a blunt needle with a sheath. The needle is slid up to the desired fascia plane location. The blunt needle is similar to a tipped hypotube in which a blunt tip shaped sheath is placed at the end. Therefore, once at the fascia plane, the blunt tip will not puncture through. Once the fascia plane is located, another sharper needle  3455  can be pushed through the hypotube  3460 , out the blunt end  3465 , and into the fascia. The sharp needle  3455  would have curvature as to allow angled deployment. Once punctured through the fascia, the sheath may then be slid through the fascia layer acting as a port. The needle  3455  may then be removed and the anchor may then be inserted under the fascia layer, leaving the suture exit through the fascia and into the tissue. 
     The material of the components is preferably made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the device is preferably greater than the width. The length of the device should preferably be sufficient to allow the inner needle to reach through the desired location on the fascia plane while allowing control out of the exit point. 
     Tree Branch 
       FIG. 101  depicts schematic representations of embodiments of a device  3500  that can be used alone or in combination with other embodiments described herein. The material of the components can be made from a combination of an implantable grade resorbable or non-resorbable polymer and/or metal material, including but not limited to, Polypropylene, Polyester, Nylon, PEEK, Polyurethane, Polycarbonate, Titanium, and Stainless Steel. The length of the device may be greater than the width. This shape will allow for the device  3500  to be inserted into the center of a braided suture and when pulled back, the branches  3505  will spread out away from a central portion  3510  and pierce the suture to form a barbed suture. This device  3500  can be made long and cut down to any appropriate size. The amount of barbs, or branches  3505 , shown will dictate the amount of grip the device will have. The diameter of the main branch is preferably less than the inner diameter of the suture at full expansion. 
     Materials &amp; Construction 
     Elements of the support system can comprise a number of materials including, without limitation, biocompatible polymers (e.g., ePTFE), intestinal sub-mucosal mesh, tendon, Gore-Tex®, and polypropylene. Materials can be monofilament, or multifilament, and can be braided, woven, or knitted. In some embodiments materials are absorbable (i.e., biodegradable). In some embodiments, the materials comprise coatings or other agents that promote healing, reduce inflammation, or improve biocompatibility. 
     In some embodiments, the use of biological materials can improve tissue interaction with the device. Where a lack of tissue ingrowth or vascularization is a concern, the materials can be further modified by perforation, or by other treatments such as fixation with radiation, glutaraldehyde, heat or 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC), to improve porosity. 
     In some embodiments, the mesh material of the support member, for example a sling or hammock, comprises a flexible, polypropylene monofilament that resists weakening or degradation when implanted within a patient. One such material is Marlex. Other mesh and non-mesh materials, can comprise, but are not limited to, synthetic biomaterials, allografts, homografts, heterografts, autologous tissues, materials disclosed in U.S. provisional application Nos. 60/263,472; 60/281,350; and 60/295,068; the contents of all of which are herein incorporated by reference in their entireties, synthetic materials (such as metallics, polymerics, and plastics) and any combinations thereof. 
     In some embodiments, the support member material will result in minimal or no reaction with body tissues and fluids and indefinitely retain its particular material characteristics and mechanical properties. Further, portions or all of the support member can be configured or fabricated from a material to either promote or prevent tissue in-growth, or are resorbable. 
     In some embodiments, the support member, support member assembly or portions thereof, can have one or more substances associated therewith through processes such as coating, impregnation, or combinations of these processes. Examples of appropriate substances include, without limitation, drugs, hormones, antibiotics, antimicrobial substances, dyes, silicone elastomers, polyurethanes, radiopaque markers, filaments or substances, anti-bacterial substances, chemicals or agents, and any combinations thereof. 
     The substances can be used to enhance treatment effects, reduce potential rejection by the body, enhance visualization, indicate proper orientation, resist infection or other effects. For example, a substance such as a dye may be coated on one surface of a component of the support system. The dye can provide the practitioner/surgeon with a visual indicator to aid in orienting the support member or suspension members at the target site within the patient and to avoid undesirable twists along the length of the system. In some embodiments, one or more components can be configured to be visualized transcutaneously. As another example, the system may be coated by the process described in U.S. Pat. Nos. 5,624,704; 5,756,145; 5,853,745; 5,902,283 and 6,162,487; the entire contents of which are hereby incorporated by reference. 
     It will be apparent to those skilled in the art that varying geometries for the components of the device will be useful. For example, certain dimensions of thickness, width, or length will be recognized as being of particular advantage. In addition, components that are woven, braided, wide or narrow can also provide particular support functions. 
     For example, as described above, in some embodiments the support member comprises a “hammock” or “sling” shaped element. A sling or hammock can be especially useful for supporting glandular tissues, such as breast tissue. In some embodiments, a hammock with dimensions of about 7 cm to about 15 cm in length, and about 2 cm to about 5 cm in width, with a pocket of about 0.5 to about 3 cm, provides effective tissue support. In some embodiments, a hammock can have a length of about 10 cm, a width of 2.5 cm and a pocket depth of about 1 cm. In manufacturing a hammock, the particular shape can be formed by wrapping the material about a spherical or elliptical shaped mandrel, followed by heating and cooling the mandrel to induce the material to conform to the shape of the mandrel. 
     A sling (or hammock) can comprise first and second major surfaces, a pair of end portions, and a support portion for placement in a therapeutically effective position relative to a physiological environment intended to be supported (e.g. the glandular tissue of the breast). In some embodiments, the sling has a tension adjustment or control member associated with the sling, for transferring sling adjustment forces from one portion of the sling to other portions of the sling such as the ends of a support portion of the sling. The member affords effective repositioning of the sling while avoiding undesirable permanent deformation of the sling. 
     The support member can be substantially surrounded by a protective sheath. The support member, tension control element, and sheath can be made of biocompatible materials with sufficient strength and structural integrity to withstand the various forces exerted upon these components during an implant procedure, and/or following implantation within a patient. In some embodiments, the protective sheath is constructed of a material that affords visual examination of the implantable support member material and that affords convenient passage of the assembly through tissue of the patient. 
     In some embodiments, a woven mesh with a predetermined pore or opening size to permit tissue ingrowth can be used. The shape of the openings is not considered limiting to the scope of the present disclosure, and square, rectangular, and/or round openings are useful. In some embodiments the size of the openings can vary, for example and without limitation, from an area of at least about 0.1 mm2 to no more than about 30 mm2. The arrangement of pores can vary throughout the device in order to provide some areas with added porosity, or to provide more support. Some areas can comprise pores, while in other areas pores can be absent. The device can be produced from elastic materials, or alternatively can be fashioned from relatively rigid materials. 
     In some embodiments, the mesh-like support member is woven from a monofilament line. Some monofilament lines are finished with a smooth surface, while others are roughened during the manufacturing process. Roughening the surface increases surface area and thus increases opportunities for tissue ingrowth throughout the surface interstices. 
     Roughening can be accomplished during the extrusion process where the material is flowing through the extrusion die hot thus creating a dimpled surface. Other roughening methods include, without limitation, sanding, grinding, roll forming, laser etching, chemically etching, and spirally or radially scoring to a predefined depth with a cutting blade, laser, or other means. Examples of sanding may use a 5-100 grit sand paper pulled across the material. This drags portions of the material along the longitudinal axis and leaves behind whiskers or microscopic barbs that can also be effective to engage the tissue. A similar process could be used with a grinding wheel. Grinding can be performed in a radial pattern, a helical pattern, or a combination of patterns. Roll forming allows for a predetermined shape or pattern to be pressed into the monofilament, and can be performed either with a heated roll or at ambient temperatures. 
     Laser etching allows for an inline process to be added to the formation of the monofilament. The laser can be angled or focused directly perpendicular to the material. Chemical etching removes material at a predictable random pattern and a predefined depth based on chemical strength and length of contact with the material being etched. Other materials can be plasma etched to create a desired surface finish where a chamber is pumped to a preset base pressure and gas is introduced and a radio frequency field is applied to the electrodes of the chamber producing a glow-discharge plasma. 
     Knife scoring allows a partial cut to the material to a predetermined depth leaving behind a ribbed monofilament material that will be more flexible and allow tissue ingrowth to the cut sections. These cuts can also be in a spiral patterning to allow a continuous cut throughout the material length. This also allows for tissue ingrowth. 
     In some embodiments, partially or completely absorbable materials are used, such that a component(s) can be absorbed over a period ranging from about 6 weeks to about 2 years. This allows the skin and other tissues to retighten and remodel, while otherwise being supported in a desired position. Other methods are also useful in remodeling or tightening the skin around the breast including, without limitation, forced scarring, use of laser, heat, and the like. 
     In some embodiments, the overall dimensions of the support member assembly, including individual sheath, mesh element and tension control member, are effective to extend from the upper most connection point down partially encircling the lower portion of the breast and back up to the upper most portion of the connection point, with additional length to account for the imprecision associated with the range of human anatomy sizes. In some embodiments, the support member has a length, width, and thickness of within the ranges of length: 8 cm to 16 cm, width: 1.0 cm to 6.0 cm and thickness: 0.10 mm to 1.0 mm. In addition, the length of the tension control element can be approximately equivalent to or slightly longer than the length of the support member to tighten or loosen the sling after it is placed in the body. Alternative lengths, widths and thicknesses can also be used, depending on the particular anatomical features of the individual patient, and the tissue(s) being supported. 
     In addition, the size of the resultant openings or pores, in support members configured as a mesh, can be adapted to allow tissue in-growth and fixation within surrounding tissue. The quantity and type of fiber junctions, fiber weave, pattern, and material type influence various sling properties or characteristics. Non-mesh sling configurations are also included within the scope of the invention. 
     As an example, and not intended to be limiting, the mesh can be woven polypropylene monofilament, knitted with a warp tricot. The stitch count can be 10±1 courses per cm, and 5±1 wales per cm. In an exemplary mesh, the mesh thickness can be 0.6 mm. 
     The support system of the present disclosure is not limited by the need for additional sutures or other anchoring devices, although such sutures and devices can be used if desired. The frictional forces created between the system and patient tissue are effective to prevent movement and loss of tension once the system is properly located at the target site. As a result, the system remains securely in place, even when subjected to various forces imparted on the tissue as will in the patient during various activities. 
     The system is designed to remain within the body of a patient as an implant for a predetermined therapeutically effective amount of time. Implantation can be temporary or permanent. The system can be non-absorbable, absorbable or resorbable, including any combinations of these material properties, depending on the desired treatment. For example, portions of the system may be constructed of a bioabsorbable material designed to last for a predetermined period of time within the patient. The general characteristics of the materials and design used in the system will withstand the various forces exerted upon it during implantation (for example, frictional forces associated with tissue resistance) and after implantation (for example, normal activities, including walking, running, coughing, sneezing, and other “normal” activities). 
     The system as disclosed can be anchored to a variety of locations in the body, including, but not limited to fascia, muscle, bone, ligament, and the like. In addition, an anchor can further comprise an adjustment device that permits the surgeon to adjust the tension on the suspension members either at the time of implantation, or post-implantation. The adjustment device can be a simple screw-like mechanism, around which an end of the suspension line is wrapped. Turning the screw in one direction increases the tension on the line, while turning in the opposite direction decreases tension. In some embodiments, the tensioner is adjusted through a small incision using an endoscope or other like instrument, in combination with a tool designed to turn the tensioner. 
     In some embodiments the suspension members can be anchored to a single attachment point. In some embodiments multiple attachment points are used. The elements of the devices can be elastic, or non-elastic as desired. In some embodiments, a braided portion overlying an elastomeric portion is used. In some embodiments, the braided portion is also elastomeric. 
     Although preferred embodiments of the disclosure have been described in detail, certain variations and modifications will be apparent to those skilled in the art, including embodiments that do not provide all the features and benefits described herein. It will be understood by those skilled in the art that the present disclosure extends beyond the specifically disclosed embodiments to other alternative or additional embodiments and/or uses and obvious modifications and equivalents thereof. In addition, while a number of variations have been shown and described in varying detail, other modifications, which are within the scope of the present disclosure, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the present disclosure. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the present disclosure. Thus, it is intended that the scope of the present disclosure herein disclosed should not be limited by the particular disclosed embodiments described above.