Patent Publication Number: US-2019183623-A1

Title: Apparatus and method for lifting or restraining a body part

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation-in-part of U.S. patent application Ser. No. 15/709,754, filed Sep. 20, 2017 (now U.S. Pat. No. ______), which claims the priority benefit of U.S. Provisional Patent Application 62/397,297, filed on Sep. 20, 2016. Each of these documents is incorporated herein by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates generally to organ and tissue lifting devices and procedures, and more specifically to an apparatus and method for lifting or restraining a body part. 
     BACKGROUND 
     In 2015, there were more than 125,000 facelifts and more than 40,000 brow lifts in the U.S. The state of the art has trended towards minimally invasive procedures involving percutaneous or endoscopic interventions. For example, the “thread lift” is achieved by percutaneous insertion of Quill® or Silhouette® sutures with unidirectional anchors that grip tissue when the suture is pulled proximally, thereby suspending the soft tissue of the mid-face by a marionette-like mechanism. 
    
    
     
       DRAWINGS 
       While the appended claims set forth the features of the present techniques with particularity, these techniques may be best understood from the following detailed description taken in conjunction with the accompanying drawings of which: 
         FIG. 1  depicts a curvilinear mesh strip, according to an embodiment. 
         FIG. 2  depicts a rectangular mesh strip, according to an embodiment. 
         FIG. 3  depicts a cord, according to an embodiment. 
         FIG. 4  is a detailed view of a knit mesh strip, according to an embodiment. 
         FIG. 5  is a detailed view of a woven mesh strip, according to an embodiment. 
         FIG. 6  is a detailed view of a braided cord, according to an embodiment. 
         FIG. 7  is a detailed view of knitted fibers with anchors, according to an embodiment. 
         FIG. 8  is a detailed view of woven fibers with anchors, according to an embodiment. 
         FIG. 9  is a detailed view of cord filaments with anchors, according to an embodiment. 
         FIG. 10  is a detailed view of a fiber with barbs, according to an embodiment. 
         FIG. 11  is a detailed view of a fiber with hooks, according to an embodiment. 
         FIG. 12  is a detailed view of a fiber with cones, according to an embodiment. 
         FIG. 13  is a detailed view of a mesh strip introduced through skin and subcutaneous tissue with a straight needle at a first end, according to an embodiment. 
         FIG. 14A  depicts an introducer, according to an embodiment. 
         FIG. 14B  depicts an introducer with a mesh strip and an obturator disposed inside the introducer, according to an embodiment. 
         FIG. 14C  depicts an introducer with a secondary introducer disposed inside the introducer and a mesh strip disposed inside the secondary introducer, according to an embodiment. 
         FIG. 15  is a detailed view of an introducer with a mesh strip having a straight needle and an end fastened to the distal end of the mesh strip, according to an embodiment. 
         FIG. 16  shows a raised portion of skin and subcutaneous tissue under which mesh configured according to an embodiment will be introduced. 
         FIG. 17  shows an introducer (configured according to an embodiment—a trocar in this case) inserted in raised tissue with a straight needle projecting from the introducer. 
         FIG. 18  shows the introducer of  FIG. 17  inserted in the raised tissue with the straight needle attached to the mesh strip with a suture (which extends from the mesh strip). 
         FIG. 19  shows a mesh (configured according to an embodiment) being held by the suture attachment while the introducer of  FIG. 17  being withdrawn. 
         FIG. 20  shows the mesh of  FIG. 19  (from which the introducer of  FIG. 17  has been removed) remaining as a mesh layer, with its barbs or hooks holding the skin and subcutaneous layer. 
         FIG. 21  depicts a mesh implant configured according to an embodiment. 
         FIG. 22A  is a diagrammatic view of an introducer according to an embodiment. 
         FIG. 22B  is a close-up view of area  22 B from  FIG. 22A . 
         FIG. 22C  is a close-up view of area  22 C from  FIG. 22A . 
         FIG. 22D  is a perspective view of the introducer. 
         FIG. 22E  is a close-up view of area E of  FIG. 22D , with the implant loaded into the introducer. 
         FIG. 22F  depicts part of  FIG. 22E  with the rod exposed (without the implant loaded). 
         FIG. 22G  is a perspective view of the introducer along with the mesh implant. 
         FIG. 22H  is a close-up view of area  22 H of  FIG. 22G . 
     
    
    
     DETAILED DESCRIPTION 
     The disclosure is generally directed to assemblies and methods that include (1) strips or cords of material configured to lift, restrain, or hold whole body organs (e.g., of a human patient) or parts of body organs in desired positions via tissue anchors (e.g., barbs, hooks, or cones), (2) an introducer device that facilitates the introduction of such strips or cords into a patient, and (3) the process of inserting such strips or cords of material into a patient (e.g., using an introducer device). 
     As used herein, the terms “fiber” and “filament” (and their plural forms) are used interchangeably. In places where only one of these terms appears, it is to be understood that it encompasses the other term as well. 
     According to various embodiments, each strip or cord is made of fibers or filaments. At least some of the fibers or filaments have anchors (e.g., barbs, hooks, or cones) along their lengths at fixed or variable intervals. The fibers or filaments may be knitted or woven together (e.g., into a mesh) or braided together (e.g., into a cord). The anchors are disposed on the outer surfaces of individual fibers or filaments and are configured to engage organs (e.g., one or more layers of tissue, such as skin and underlying muscle) along the face of the strip or cord. The mesh of the strip (or the cord) and its anchors are made of an absorbable or a non-absorbable material (permanent or dissolvable within a body). The anchors are configured to engage and anchor the fibers or filaments in living tissue (e.g., tissue of a human patient). 
     In an embodiment, each strip or cord is inserting into tissue via an introducer. Examples of introducers include hollow guides; blunt introducers; trocars; and obturators of metal or plastic with sharpened or non-bladed tips, cannulas, and seals. In an embodiment, a distal tip of a mesh strip or cord is pulled and secured concurrently with the withdrawal of the introducer. 
     The assemblies described herein can be used in various procedures for elevation of muscle, subcutaneous tissue, fascia, or periosteum for facial reanimation, rejuvenation, or lifting; urogynecologic suspension; breast lifting; neck lifting; and other restraining or shaping procedures in other living tissues. 
     According to an embodiment, a mesh implant for lifting or restraining a body part includes filament strands (e.g., monofilaments) braided together into a tubular configuration that is hollow along a longitudinal axis and anchors (e.g., barbs) extending from the filament strands along their length, wherein the anchors are configured to anchor onto tissue of the body part. In one implementation, a first end of the mesh implant is closed and a second end has a needle attached thereto (e.g., via a monofilament strand, which may or may not have anchors along it). 
     In an embodiment, an assembly for lifting or restraining a body part includes an introducer having a cannula and a mesh implant at least partially disposed within the cannula. The mesh implant includes filament strands braided together into a tubular configuration that is hollow along a longitudinal axis and anchors (e.g., barbs) extending from the filament strands along their length. The anchors are configured to anchor onto tissue of the body part and the introducer is configured to introduce the mesh implant into tissue near the body part. According to various implementations, introducer further includes a rod disposed within the cannula, wherein one end of the mesh implant has an opening that is sized to fit over the rod. Additionally, the introducer may further include a sheath disposed within the cannula, wherein the rod is disposed within the sheath. One or more of the rod and the sheath may have a blunted tip. 
     According to an embodiment, a method for lifting one or more layers of tissue in a body, includes introducing an introducer (possible embodiments of which are described above) under the one or more layers, wherein the introducer holds a mesh implant (possible embodiments of which are described above) therein; exposing the mesh implant under the one or more layers; and withdrawing the introducer from the body. The method may further include one or more of : loading the introducer with mesh implant, inserting the rod into an open end of the mesh implant, and retracting part of a sheath to expose the mesh implant. 
     In an embodiment, a restraint or shaper, for example, a 2×9 cm strip of polydioxanone mesh with 0.5 mm hooks on one surface may be placed percutaneously, hook-side-down over the superficial muscular aponeurotic system (SMAS) through a scalp incision, and pulled proximally to suspend the subcutaneous fat of the mid-face through traction created between the hook-laden interface of the mesh and the superficial surface of the SMAS. The mesh strips and cords may be coated with collagen, cytokines or antimicrobials. 
     According to an embodiment, the mesh strip is spring loaded when in the introducer and is adapted for self-expanding when removed from the introducer. 
     In an embodiment, a system and method includes assemblies of introducers and meshes or cords and their use to achieve the objectives of distributing tension. Distributed tension leads to less “cheese wiring” across each point of tissue anchoring, and greater longevity of lift. Furthermore, distributed tension leads to less puckering or irregularity at points of tissue anchoring. 
     In various embodiments, barbed mesh is provided for tissue and organ lifting and for facial surgical applications. The strips of mesh, with, for example, dozens to hundreds of hooks or barbs, allow for elevation of soft tissue of the face or of other locations by traction at the interface of the mesh with the soft tissue. 
     Surgical applications for one or more of the embodiments described herein include breast lifting, hernia support, orthopedic anchoring, urogynecologic suspensions, neck lifting, loose tissue forming and shaping, abdominal support, rhytidectomy, rhytidoplasty (face lift), and forehead/brow lift. 
     In some embodiments, the anchors are configured on opposite faces of the mesh or cord for engaging all of the surrounding tissue. Example implementations of the anchors include barbs, hooks, and opposite facing hooks. 
     Turning to  FIG. 1 , a mesh strip configured according to an embodiment is shown. The mesh strip, generally labeled  12 , is made up of individual fibers that have anchors and are knitted or woven together. Filaments may be used instead of fibers. 
     The periphery of the mesh strip  12  is curvilinear (e.g., narrower at both ends than in the middle). The curvature of the periphery of the mesh strip  12  depicted in  FIG. 1  is only meant to be exemplary, and other curvatures are possible (e.g., a curvature fitting the desired locations and functions within the body of a patient). Non-curvilinear geometries for the mesh strip are also possible. For example,  FIG. 2  depicts a mesh strip  14  that is rectangular, with a width that is between 0.1 and 6 centimeters and length that is between 2 and 20 centimeters. The mesh strip  14  can accommodate similar or different attachments along both ends. Other dimensions are possible for the mesh strip  14 . Additionally, these (and other) dimensions may also apply to the embodiments shown in  FIG. 1  and  FIG. 3 . 
     Turning to  FIG. 3 , a cord configured according to an embodiment is shown. The cord, generally labeled  16 , is made up of individual filaments that are twisted, braided, wound, and/or bound together. Fibers may also be used instead of filaments. 
     Turning to  FIG. 4 , a magnified view of a section of mesh of the mesh strip  12  (of  FIG. 1 ) configured according to an embodiment is shown. In this embodiment, individual fibers  22  of the mesh are knitted together. 
     Turning to  FIG. 5 , a magnified view of a section of mesh of the mesh strip  14  (of  FIG. 1 ) configured according to an embodiment is shown. In this embodiment, individual fibers  24  of the mesh are woven together. 
     Turning to  FIG. 6 , a magnified view of an end of the cord  16  (of  FIG. 1 ) configured according to an embodiment is shown. In this embodiment, individual filaments  29  are braided together. 
     Turning to  FIG. 7 , a magnified view of the fibers of  FIG. 4  configured according to an embodiment is shown. In this embodiment, each of the individual fibers  22  has anchors  32  attached to its surface. 
     Turning to  FIG. 8 , a magnified view of the fibers of  FIG. 5  configured according to an embodiment is shown. In this embodiment, each of the individual fibers or filaments  24  has barbs  34  attached to its surface. 
     Turning to  FIG. 9 , a magnified view of the filaments of  FIG. 6  configured according to an embodiment is shown. In this embodiment, each of the individual filaments  24  has hooks  36  attached to its surface. 
     According to an embodiment, the mesh (e.g., surgical mesh) or cord described herein is created by weaving, knitting, braiding or otherwise joining together fibers or filaments (which may be made of synthetic material) with anchors. 
     In an embodiment, the mesh or cord described herein is created by adding anchors to pre-constructed mesh or cord. 
     According to an embodiment, the fibers or filaments (e.g., of any of the embodiments depicted herein) are formed with extending anchors before they are knit, woven, wound, or braided together. 
     In an embodiment, the mesh or cord is formed into strips at the time of weaving, knitting, or braiding. In another embodiment, the mesh or cord is cut into strips after being woven, knit, or braided. 
       FIG. 10  depicts a fiber or filament configured according to an embodiment. The fiber or filament, generally labelled  41 , is from 0.05 to 1.00 millimeters thick and has anchors, each of which is a barb  42 . Each barb  42  has a base that is from 0.001 millimeters to 2 centimeters wide.  FIG. 11  depicts a fiber or filament configured according to another embodiment. The fiber or filament, generally labelled  43 , has anchors, each of which is a hook  44 .  FIG. 12  depicts a fiber or filament configured according to still another embodiment. The fiber or filament, generally labelled  45 , has anchors, each of which is a cone  46 . 
     In each of the embodiments depicted in  FIG. 10  through  FIG. 12 , the anchors extend from the fiber or filament along the length of the fiber or filament. 
     In an embodiment, each anchor extends from the fiber or filament at an angle so as to purchase tissue and pull it along the axis of the mesh strip or cord when it is pulled. For example, in the embodiments depicted in  FIG. 10 ,  FIG. 11 , and  FIG. 12 , the axis X of the fiber or filament intersects with the axis Y of the anchor at an angle A of no more than 60 degrees. 
     According to an embodiment, a straight or a curved needle is attached to one or both ends of a mesh strip or a cord (e.g., to one of the mesh strips or one of the cords described herein) in any combination (e.g., a straight needle at each end, a curved needle at each end, a straight needle and one end and a curved needle at the other end). The needle (one or both) may be directly attached (e.g., cinched to the mesh strip or to the cord) or indirectly attached (e.g., attached via suture) to the mesh strip or to the cord. Furthermore, in the case of a mesh strip, there may be one or more needles attached to parts of the mesh strip other than the ends (e.g., one or more needles may be attached to the lateral edges of the strip). 
     In an embodiment, a sterile introducer (e.g., a trocar or a cannula) houses the strip or cord as it is introduced within the tissues of a patient. The introducers depicted in the figures are generally tubular and hollow but may, for example, be more flattened (e.g., planar) in order to accommodate a mesh strip having needles attached to the lateral edges of the mesh strip. 
     Turning to  FIG. 13 , an embodiment of a mesh strip (e.g., as previously described) having a curved needle, a suture, and a straight needle attached thereto, as well as how such an assembly is used (according to an embodiment) will now be described. The mesh strip, generally labeled  50 , is introduced through skin  80  and subcutaneous tissue with a straight needle  56 , which is attached to a leading distal end  54  of the mesh strip  50 . Attached to the proximal end  52  of the mesh strip  50  (via a suture  62 ) is a curved needle  58 . The curved needle  58  is used to suture (with the suture  62 ) the proximal end  52  of the mesh strip  50  in the skin  80  or to surrounding tissue (e.g., internal body tissue, subcutaneous tissue). The suture  62  has a first end attached to proximal end  52  of the mesh strip  50  and a second end attached to the curved needle  58 . Although not depicted in  FIG. 13 , a cord as previously described may be used in place of the mesh strip  50 . 
     In an embodiment, a mesh strip or cord (such as any of the mesh strips and cords described herein) is introduced into tissue via an introducer.  FIGS. 14 through 20  depict an embodiment of the introducer being inserted into the tissue of a patient and a mesh strip being inserted into the patient through the use of the introducer. 
     Turning to  FIG. 14A , an introducer configured according to an embodiment is shown. The introducer, generally labeled  70 , is implemented as a trocar having a leading or distal end  72  and a trailing or proximal end  74 . The distal end  72  may be sharpened for penetrating skin. During use, the proximal end  74  of the introducer  70  may be left outside the penetrated skin or may be moved within the skin. Accordingly, the mesh strip  50  is intially packed within the introducer  70 . For example, the mesh strip may be folded or rolled and compressed into the introducer. 
     According to an embodiment, the assembly described herein also includes a blunt obturator, as shown in  FIG. 14B . The obturator  102  that is pushed out through the distal end of the introducer  70  ahead of the mesh strip  50  (or ahead of a cord, if a cord is used) so as to facilitate raising the patient&#39;s tissue in order to create a space for the subsequent implantation of the mesh strip  50 . In an embodiment, the obturator  102  contains the mesh strip  50  (e.g., in an internal chamber). 
     According to an embodiment, a variation on the obturator implementation depicted in  FIG. 14B  operates as follows: The obturator is inserted into the introducer before the mesh strip (or cord). The obturator facilitates raising the patient&#39;s tissue (e.g., as it is pushed forward). The obturator is then removed. Then the mesh strip (or cord) is inserted in through the introducer (e.g., via needle and/or rod or via a secondary introducer, discussed below, or by itself). 
     In an embodiment, the obturator  102  opens up at its tip in order to release the mesh strip  50  (or cord if a cord is used). 
     According to an embodiment, the assembly described herein also includes a secondary introducer, as shown in  FIG. 14C . The secondary introducer  104 , which itself is cannulated, is slideably disposed within the center bore of the primary introducer (i.e., the introducer  70 ) and contains the mesh strip  50  (or cord if a cord is used). Although not shown in  FIG. 14C , the secondary introducer  104  includes a rod that drives a straight needle out of the distal end of the secondary introducer. 
     In  FIG. 15 , the distal end  54  of the mesh strip  50  (most of which is inside within the introducer  70 ) is fastened to the straight needle  56 . The distal end  54  of the mesh strip  50  is shown extending out of the distal end  72  of the introducer  70 . 
     To introduce a mesh strip or cord according to an embodiment, tissue of a patient is raised and the introducer is inserted into the space underneath the tissue. For example,  FIG. 16  shows a raised portion  81  of the skin  80 , subcutaneous tissue  82  and muscle tissue  84  under which the mesh will be introduced (e.g., between the muscle tissue  84  and internal body tissue  90 ). As shown in  FIG. 17 , the introducer  70  is inserted under the raised tissue with the straight needle  56  (which is shown as projecting from the introducer  70 ). The straight needle  56  is attached to a distal end of the mesh strip (which is, at this point, still held within the introducer  70 ). 
     According to an embodiment, the tissue may be elevated with the assistance of the introducer  70  (containing either a blunt obturator or the mesh strip  50 ). For example, in  FIG. 16  the unlabeled space under the elevated tissue may, in fact, be occupied by the introducer  70  being used to elevate the tissue. 
     Continuing the example of  FIG. 16  and  FIG. 17 ,  FIG. 18  shows an introducer  70  inserted under the raised tissue (raised portion  81 ) with the straight needle  56 . The straight needle  56  is attached to a suture  63 . The suture  63  is connected to the needle  56  and to a first end of the mesh strip (or cord, if a cord is used) and is adapted to hold the first end of the mesh strip (or cord) within the body while the inserter  70  is being withdrawn for the purpose of releasing the mesh strip or cord in situ within the body. The suture  63  is used to secure the distal end of the mesh strip or cord (e.g., under the skin of the patient at the distal extent if the dissection). Put another way, the suture  63  is meant to hold tension while removing the introducer  70 , but it is actually the anchors that hold the mesh strip  50  in place distally, such that the suture  63  may be cut or otherwise removed distally after the introducer has been remove proximally. 
     Turning to  FIG. 19 , after the distal end of the mesh strip  50  is secured (with the suture  63 ), the introducer  70  is withdrawn. As the introducer  70  is withdrawn, the mesh strip  50  remains in place.  FIG. 20  shows how, after the introducer  70  has been withdrawn, the mesh strip  50  forms a mesh layer. The mesh strip  50  and its anchors (barbs, hooks, or cones) holds the skin and subcutaneous layer, which can be pulled cranially, for example. 
     A method carried out according to an embodiment will now be described with reference to  FIG. 1  through  FIG. 20 . The method includes one or more of the following actions: (a) providing an introducer (e.g., introducer trocar  70 ), providing a mesh (e.g., mesh strip  50 ) in the introducer, (b) providing anchoring protrusions (e.g., barbs, hooks, or cones as shown in  FIG. 7  through  FIG. 12 ) on the mesh, introducing the introducer between tissues in a body (e.g., between the muscle tissue  84  and internal body tissue  90 ), holding a first end of the mesh (the proximal end  52 ) within the body (e.g., using the curved needle  58 ), withdrawing the introducer from the body while holding the first end of the mesh within the body, and fastening a second end of the mesh (e.g., the leading distal end  54 ) within the body after the introducer is fully withdrawn from the body. 
     The method includes automatically expanding the mesh within the body, engaging tissue on at least one side of the mesh with the anchoring protrusions (e.g., barbs, hooks, or cones) on the mesh and moving the tissue on the at least one side of the mesh (e.g., as in the elevated portion  81 ) by moving the mesh before fastening the first end of the mesh within the body. 
     In an embodiment, the actions of elevating and securing the first end in the body and concurrently elevating the mesh and elevating surrounding tissue with the mesh holds the tissues in desired new positions and restraints, and lifts organs and other parts of a body for promoting tissue growth through and around the mesh or cords. 
     In the embodiments described herein, the mesh strips or cords may be used for facelifts. In other parts of the body, the mesh strips or cords may be used to hold or urge any tissue or organ to a different desired position or to restrain tissues or organs from moving to undesired positions. 
     In the embodiments described herein, the mesh strip may be laterally folded or otherwise compressed into the introducer and when released may return to its normal outspread condition. Surgical instruments may be used to spread or to assist spreading of the mesh strips laterally to desired positions. 
     As shown in the examples of  FIG. 16  through  FIG. 20 , space may be provided and retained for lateral expansion of the mesh strip into its desired position before releasing the outward tissue to close the space. 
     In an embodiment, the mesh of the mesh strip includes a plurality of synthetic fibers or filaments formed into a curvilinear strip, rectangular strip or cord. The mesh has small hooks, cones or barb anchors at fixed or variable intervals along some or all of the fibers or filaments. The mesh and its anchors are made of an absorbable or a non-absorbable material. 
     According to an embodiment, a method of introducing one or more strips or cords (as previously described) into living tissue involves housing each strip or cord within a sterile introducer (e.g., a trocar or cannula) and introducing each strip or cord into the tissue (e.g., subcutaneously) via an introducer. An introducer may be, for example, a hollow guide, a blunt piece, a trocar, or an obturator. The introducer may be made, for example, of metal or plastic and may have one or more of a tip (sharpened or non-bladed), a cannula, and seal. 
     In an embodiment, a method of introducing one or more strips or cords involves pulling and securing the distal tips of the mesh and, concurrently, withdrawing the one or more introducers. 
     According to an embodiment, barbed mesh is provided for tissue and organ lifting and for facial surgical applications. The strips of mesh, with, for example, dozens to hundreds of hooks or barbs, allow for elevation of soft tissue of a patient&#39;s face or of other locations on the patient by traction at the interface of the mesh with the soft tissue. 
     An embodiment of the disclosure includes structures that lift or restrain whole body organs or parts of body organs. Such structures include an introducer, mesh or cord held with an introducer configured to introduce a mesh or cord into and between body parts. The mesh or cord is configured to hold body parts in desired positions. Outer surface anchors on the mesh or cord is configured to engage body parts along a face of the mesh or cord. 
     In an embodiment, a mesh implant may be created by braiding eight strands of barbed monofilament. The result of this braiding is a stent-like implant that is hollow along its longitudinal axis and circumferentially covered with barbs along its length. Securely attached to the proximal end of the implant is an un-barbed or barbed monofilament with a swaged curved needle or other means of fixation at the proximal end of the monofilament. The distal end of the implant is closed, such that the hollow cavity begins at the proximal end of the implant and runs along its longitudinal axis, terminating before the distal tip. 
     According to an embodiment, the barbed braid is hollow along its length, which allows for collagen deposition and a “filler” effect. It is also has macroporous walls, allowing tissue integration by the native tissues that lie circumferentially in apposition to those walls. This is achieved by using a pore size for the braid that is small enough to allow for good mechanical support (e.g., greater than 4 Newtons of pullout force), but large enough to facilitate tissue ingrowth through the pores and into the hollow interior of the braid, requiring a passage of approximately 800 microns in diameter or greater. Thus, the tissue can adhere to its newly-lifted position, potentially increasing the longevity of the result beyond that of an non-porous absorbable implant. 
     In an embodiment, the mesh implant may be used with a previously-mentioned, cannulated, mechanically-driven introducer. The first step in using this introducer device is to load the implant into the introducer. The implant is loaded into the hollow introducer so that implant is encased by the introducer. In an embodiment the implant is loaded into the introducer from the distal tip by slipping it over a thin rod that runs the length of the introducer. This rod serves to keep the implant stationary inside the introducer and prevent proximal slippage. 
     According to an embodiment, the introducer is used to tunnel within tissue in a way that causes minimal damage/trauma to surrounding tissue. This is achieved by employing an introducer with a blunted tip and narrow profile. The barbs/anchors of the barbed braid are revealed from the introducer, with the most distal barbs revealed first and the most proximal barbs released last, after insertion into the body. The implant may be initially exposed to the surrounding tissue by a push-button mechanism which retracts part of the distal sheath of the introducer to reveal the barbed braid. The introducer is then completely withdrawn from the body, leaving behind the fully-exposed implant. The layers of tissue that are superficial to the implant may be massaged to further engage with barbs/anchors. The proximal end of the implant may be pulled prior to securing it, to further lift or elevate tissue. The proximal end of the implant may be secured within the body by a ratcheting mechanism that allows continuously increasing tension and therefore elevation of the distal tissue even after the proximal end is initially secured. 
     To use this implant for a minimally-invasive facelift procedure, a small incision is made at the anterior hairline, or other subtle area depending upon target region. The implant is driven through this incision into the subcutaneous tissue of the face near the ptotic region to be lifted, for example the nasolabial fold or jowl. The barbs on the implant hold onto the surrounding tissue allowing the implant to be pulled at the proximal end until the desired level of tissue lifting is achieved. Once the desired lift is achieved the proximal monofilament of the implant can be anchored and the skin incision can be closed over it. Multiple implants can be deployed to target different anatomical regions of both sides of the face, brow, or neck. 
     Turning to  FIG. 21  a mesh implant according to an embodiment will now be described. The mesh implant, generally labeled  2100 , includes a tubular mesh  2102  that is hollow along its length. The mesh  2102  has a first end  2104  that is open and has an opening that is sides to fit over a rod (described below in conjunction with  FIGS. 22A through 22F ) and a second end  2106  that is closed to form a blunt tip. The mesh  2102  is made of multiple strands  2108  (e.g., eight strands) of filament (e.g., monofilament). Each strand has anchors (e.g., barbs)  2110  extending outwardly from the strand along its length, but for the sake of clarity only a portion of a few strands are depicted in  FIG. 21  as having anchors. As in the previously-described embodiments, the anchors are configured to anchor onto tissue of a body part. The mesh implant  2100  includes a monofilament strand  2112  having one end attached to the first end  2104  of the mesh  2102  and the other end attached to a needle  2114 . 
     Turning to  FIGS. 22A through 22F , an introducer according to an embodiment will now be described. The introducer, generally labelled  2200 , includes a handle portion  2202  and a cannula  2204  extending from an opening  2206  ( FIG. 22B ) in the handle portion  2202 . Disposed within a hollow portion of the cannula  2204  is a sheath  2208  ( FIG. 22F ). Disposed within a hollow portion of the sheath  2208  is a rod  2210 . Along the length of the cannula  2204  and the sheath  2208  is a groove  2212  that provides space for the monofilament  2112  and needle  2114  (from  FIG. 21 ). 
     In order to insert the mesh implant  2100  according to an embodiment, the mesh implant  2100  ( FIG. 22E ) is slid onto the rod  2210  through the opening on the first end  2104  of the mesh  2102  and the rod  2210  is retracted into the sheath  2208  (with the monofilament  2112  and needle  2114  using the groove  2212 ). The cannula  2204  is then inserted under one or more layers of tissue. The sheath  2208  is then retracted, thereby exposing the mesh  2102 . The anchors  2110  attach to the surrounding tissue, and the introducer  2200  is then retracted. 
     It should be understood that the embodiments described herein should be considered in a descriptive sense only and not for purposes of limitation. Descriptions of features or aspects within each embodiment should typically be considered as available for other similar features or aspects in other embodiments. It will be understood by those of ordinary skill in the art that various changes in form and details may be made therein without departing from their spirit and scope.