Patent Abstract:
In accordance with a first aspect of the present invention, there is provided A surgical instrument docking handset that includes a generally tubular shaped main body portion that has first and second opposite ends and defines a longitudinal axis. The article of manufacture further includes an instrument dock extending from the first end of the main body portion, and a light port extending from the second end of the main body portion. The instrument dock is generally tubular in shape and includes a threaded interior female connector.

Full Description:
FIELD OF THE INVENTION 
       [0001]    The present invention relates generally to methods and devices for plastic surgery and, more particularly, to a necklift procedure that is minimally invasive and to instruments for performing the procedure. 
       BACKGROUND OF THE INVENTION 
       [0002]    Conventional neck rejuvenation surgeons advocate procedures that alter the anatomy of the neck to restore a more youthful neck contour. These involve platysmal manipulation such as muscle advancement and/or division, and frequently sub-platysmal fat excision. Partial resection of submandibular gland tissue may be performed as well. These techniques vary in complexity and may result in significant complications, including post-operative bleeding, nerve injury, permanent visible skin deformities caused by muscle division, or over-resection of fat. 
         [0003]    Plastic and reconstructive surgeons have long sought to develop methods and devices to aid in the support of physical structures that have lost their natural tension and support. The most often treated areas include the face, the chest region, the buttocks and other regions that lose tension and sag. Current devices are not always adequate in providing a natural-looking structure to prevent such loss of tension in these structures. 
         [0004]    The aging process causes gradual and predictable changes in the soft tissue layers of the lower face and neck, the anatomical basis of which has been well documented. Loss of elasticity and fragmentation of collagen results in rhytid formation and skin redundancy. Subcutaneous fat thickens and droops or is ptotic and becomes more noticeable. Stretching of the fascia and musculature results in a loss of the supporting ‘sling’ of the submentum, often resulting in submandibular gland ptosis. Further loss of tone and muscular atrophy results in banding of the medial platysmal borders, blunting of the cervicomental angle and loss of lateral mandibular definition. 
         [0005]    The classical necklift&#39;s failure in adequately addressing the consequences of aging in the neck has prompted the development of a number of modifications and adjunctive procedures. These include skin excisions, various lipoplasty techniques, anterior or posteriorly based platysmal transection, resection, or plication procedures, SMAS-platysma flaps, and even suture suspension techniques. However, these modifications have their limitations. 
         [0006]    Problems with scar contractures and hypertrophic scarring have resulted in the near abandonment of midline skin excision with subsequent Z, W or T-plasty. Liposuction or direct lipocontouring plays an important role in the aging neck. 
       SUMMARY OF THE PREFERRED EMBODIMENTS 
       [0007]    In accordance with a first aspect of the present invention, there is provided an article of manufacture that includes a generally tubular shaped main body portion that has first and second opposite ends and defines a longitudinal axis. The article of manufacture further includes an instrument dock extending from the first end of the main body portion, and a light port extending from the second end of the main body portion. The instrument dock is generally tubular in shape and includes a threaded interior female connector. 
         [0008]    In a preferred embodiment, the main body portion includes a fiberoptic core that extends from the light port to the first end of the main body portion. Preferably, the fiberoptic core, instrument dock and light port are all aligned along the longitudinal axis of the main body portion. In another preferred embodiment, the instrument dock includes an exterior surface that comprises a male connector that includes means for securing an article to the exterior surface thereof. Preferably, the instrument dock includes a plurality of teeth extending from the end thereof. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]    The invention may be more readily understood by referring to the accompanying drawings in which: 
           [0010]      FIG. 1  is a perspective view of a tape template in accordance with a preferred embodiment of the present invention; 
           [0011]      FIG. 2  is a view of the tape template of  FIG. 1  being used to mark puncture locations on a patient&#39;s chin; 
           [0012]      FIG. 3  is a front elevational view of a lancet in accordance with a preferred embodiment of the present invention; 
           [0013]      FIG. 4  is a perspective view of the lancet of  FIG. 3 ; 
           [0014]      FIG. 5  is a view of the lancet of  FIG. 3  being used to make a puncture; 
           [0015]      FIG. 6  is a side elevational view of a handset in accordance with a preferred embodiment of the present invention; 
           [0016]      FIG. 7  is a sectional side elevational view of the handset of  FIG. 5  showing the fiberoptic core; 
           [0017]      FIG. 8  is a cross-sectional view of the handset of  FIG. 5  before docking with a skin port in accordance with a preferred embodiment of the present invention; 
           [0018]      FIG. 9  is a cross-sectional view showing the skin port inserted through a patient&#39;s skin before deployment; 
           [0019]      FIG. 10  is a cross-sectional view showing the skin port inserted through a patient&#39;s skin after deployment; 
           [0020]      FIG. 11  is a perspective view of the skin port; 
           [0021]      FIG. 12  is a cross-sectional view of another embodiment of a skin port; 
           [0022]      FIG. 13  is a side elevational view of a threading device in accordance with a preferred embodiment of the present invention; 
           [0023]      FIG. 14  is a sectional side elevational view of the threading device of  FIG. 13 ; 
           [0024]      FIG. 15  is a view of the threading device of  FIG. 13  being used on a patient; 
           [0025]      FIG. 16  is another view of the threading device of  FIG. 13  being used on a patient; 
           [0026]      FIG. 17  illustrates the threading device of  FIG. 13  passing through the subcutaneous facial ligaments and neurovascular structures. 
           [0027]      FIG. 18  is a side elevational view of a knot positioning implement in accordance with a preferred embodiment of the present invention; 
           [0028]      FIG. 19  is a view of a patient with a threaded skin port placed in the midline sub-mental access site and a suture knot extending therethrough; 
           [0029]      FIG. 20  is a cross-sectional view of the knot positioning implement of  FIG. 15  pushing the knot through the threaded skin port and under a patient&#39;s skin; 
           [0030]      FIG. 21  is a side elevational view of a threaded skin port in accordance with a preferred embodiment of the present invention; 
           [0031]      FIG. 22  is a sectional side elevational view of the threaded skin port of  FIG. 21 ; 
           [0032]      FIG. 23  is a perspective view of the threaded skin port of  FIG. 21 ; 
           [0033]      FIG. 24  is a side elevational view of a fiberoptic suture in accordance with a preferred embodiment of the present invention; and 
           [0034]      FIG. 25  is a view of a patient with the support matrix shown in hidden lines. 
       
    
    
       [0035]    Like numerals refer to like parts throughout the several views of the drawings. 
       DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0036]    Described herein are preferred embodiments of a technique for plastic surgery (e.g., liposuction to a person&#39;s chin or jaw area) that only uses one small incision. The technique involves several steps which each require specific instrumentation. The technique is referred to herein as Percutaneous Trampoline Platysmaplasty. 
         [0037]    The liposuction portion of the procedure is performed without a large incision under the chin. The placement of the suture support matrix is performed through several small access sites in the neck area under the jaw. The advantage is that the entire support system can be placed without the typical large incision under the chin that is necessary for the surgeons to see the operative field. In addition the surgery is less invasive and does not require an extensive dissection of the skin in the area under the chin. 
         [0038]    The accurate placement of the support suture (also referred to herein as the support structure or support matrix  200  and is shown in  FIG. 25 ) will be described herein along with the description of each of the individual instruments or devices that may be used in connection with such procedure. 
         [0039]    As described above, the inventive aspects of the present invention involve the placement of the support matrix  200  and not the actual liposuction technique. Therefore, it will be understood that any references to liposuction techniques herein are only exemplary. 
         [0040]    It will be appreciated that terms such as “front,” “back,” “top,” “bottom,” “side,” “upwardly” and “downwardly” used herein are merely for ease of description and refer to the orientation of the components as shown in the figures. It should be understood that any orientation of the instruments and articles and the components thereof described herein is within the scope of the present invention. 
         [0041]    Referring to  FIGS. 1-2 , template tape (or tape members)  10  will be described. In a preferred embodiment, tape  10  is a clear piece of tape with perforations  12  therethrough that are spaced apart at predetermined locations. Tape  10  includes adhesive thereon so that it can be secured to the patient&#39;s skin. In an exemplary embodiment, tape  10  is a one inch wide clear tape with about 2 mm circular perforations  12  defined therethrough that are spaced about every 5 mm along the center of the tape. The perforations  12  are preferably positioned along the longitudinal center of the tape  10 , however this is not a limitation on the present invention. In another embodiment, tape  10  is not clear. In a preferred embodiment, tape  10  is provided in roll form. However, this is not a limitation on the present invention. 
         [0042]    Tape  10  is used in immediate pre-operative planning to determine the placement of access sites  14 , which will determine the placement of the support matrix  200 . Tape  10  is used as a guide to help provide proper placement of each suture and its corresponding pivot point (as described below). Perforations  12  are used to mark access sites  14  for the surgery. 
         [0043]    In a preferred embodiment, first and second tape members  10  are placed on each side of the skin overlying the undersurface of the mandible, as is shown in  FIG. 2 . Preferably, tape  10  is utilized with the patient sitting upright, which allows the natural neck contours to be visible. This is not a limitation on the present invention, however. The surgeon uses tape  10  and the plurality of perforations  12  to develop a surgical approach that is individually tailored for each patient, depending on the correction desired. As those skilled in the art will appreciate, placement of the support matrix  200  will be different for different patients depending on the patient&#39;s anatomy. 
         [0044]    The exemplary 5 mm span between perforations  12  allows placement of pivot points in close proximity. This results in a dense support matrix allowing elevation of muscle and glandular tissue. For example, pivot points may be placed 1-2 cm apart if minimal support is needed. Those skilled in the art will be able to make determinations as to where the access sites  14  should be located based on the patient&#39;s needs. For example, as is shown in  FIG. 2 , the surgeon has only chosen four access sites  14  on each side. 
         [0045]    As shown in  FIG. 2 , after the tape  10  has been placed and the surgeon has determined the structure of the support matrix  200 , the surgeon marks skin exposed through the desired perforations  12  with a surgical marking pen or the like. These markings  14  indicate the areas that require suture placement to elevate the soft tissue of the neck. In a preferred embodiment, as is shown in  FIGS. 2 and 5 , the markings  14  made using the first tape member  10  are symmetrical to the markings  14  made using the second tape member  10 . 
         [0046]    As will be described below, each of the markings  14  define a location or access site that will be punctured to allow subcutaneous access at that location. For simplicity, because each access site is marked and then punctured, the access sites, markings and punctures will all be labeled  14  herein. 
         [0047]    As will be appreciated by those skilled in the art, in areas where significant platysmal banding or glandular ptosis is evident significant support will be required. To achieve this, multiple suture strands will be required. As each area to be elevated is recognized, a corresponding tape perforation  12  is marked  14  to insure that suture placement is accurate. 
         [0048]    It will be understood that tape  10  is preferably used before performing liposuction. However, this is not a limitation on the present invention. In another embodiment, tape  10  can be used after liposuction is performed. In another embodiment, the tape  10  can be omitted and the surgeon can mark or puncture the skin as desired. 
         [0049]    It will appreciated by those skilled in the art that the tape  10  can be used on areas of the body other than the chin. For example, the tape (and the remainder of the procedure described below) can be used for a cheek lift. 
         [0050]    After the desired markings  14  have been made, the patient is ready for liposuction. The patients head and neck are prepped and draped in a sterile fashion and local anesthetic is injected into the area under the chin. A small opening (referred to herein as the midline sub-mental access site) is made in this area. Tumescent fluid is injected into the entire area under the chin, including the neck region. Liposuction is performed on the entire region. Upon completion, the area is once again infiltrated with the tumescent fluid. This subcutaneous infusion results in the elevation of the skin from the platysma muscle. 
         [0051]    With reference to  FIGS. 3-5 , after completion of liposuction, the patient is ready for placement of the support matrix  200 . A lancet  40  is used to create access sites  14  by puncturing the dermis at the points marked using tape  10 . 
         [0052]    As shown in  FIG. 3 , lancet  40  includes a blade  42  that has two sharp edges  43  that end at a point  44  with two blunt edges  46  therebelow. In a preferred embodiment, blade  42  is about 8 mm in length. Blunt edges  46  of blade  42  extend from a flange or stop member  48  that prevents blade  42  from going deeper into the skin than desired. Flange  48  ensures consistent depth of blade penetration. Also, blade  42  is sized to allow placement of skin ports  80  as described below. 
         [0053]    Stop member  48  has an upper surface  48   a  and a lower surface  48   b . The blade  42  extends upwardly from the upper surface  48   a  of the stop member  48 . As is shown in  FIG. 3 , the two sharp edges  43  each have first and second ends  43   a  and  43   b , respectively and the two blunt edges  46  each have first and second ends  46   a  and  46   b , respectively. 
         [0054]    In a preferred embodiment, the first ends  43   a  of the sharp edges  43  meet at point  44  and extend downwardly from point  44  at an angle of 90° or less. The first ends  46   a  of the two blunt edges  46  extend downwardly from the second ends  43   b  of the two sharp edges  43 . The sharp edges  43  and blunt edges  46  meet at an obtuse angle. The second ends  46   b  of the two blunt edges  46  are connected to the stop member  48 , which, in a preferred embodiment, is disc-shaped. However, this is not a limitation on the present invention. In an alternative embodiment, the blade  42  can extend from the stop member  48  at a non-right angle (e.g., an acute angle). 
         [0055]    In a preferred embodiment, lancet  40  includes an attachment member  50  that extends downwardly from the lower surface  48   b  of the stop member  48  and allows the lancet  40  to be secured on a standard scalpel handle  52 . In another embodiment, lancet  40  can be provided with a unitary handle. 
         [0056]    The subcutaneous infusion described above results in the elevation of the skin from the platysma muscle. Once infiltrated, the access sites  14  are developed by puncturing of the skin with the percutaneous lancet  40  at the markings developed using tape  10 , as shown in  FIG. 5 . Lancet  40  allows puncturing of the skin in order to gain access to the neck region and preferably ensures that each access site is as small as possible, allowing the placement of the support system  200 . 
         [0057]    It will be understood that in a preferred embodiment, lancet  40  creates punctures instead of incisions, which minimalizes trauma and the risk of scarring. However, incisions can be used in another embodiment. 
         [0058]    Referring to  FIGS. 6-7 , the next instrument used in the procedure is a handset or handle  60 . Handset  60  is embodied in a reusable insertion device with an instrument dock  64  at an end thereof. In a preferred embodiment, handset  60  also includes a fiber-optic light port  62 . In a preferred embodiment, the handset is ergonomically designed to fit into the surgeon&#39;s hand when gripped. However, this is not a limitation on the present invention. Preferably, handset  60  is made of a metal, such as stainless steel or titanium. However, it can be made of other materials, such as a plastic or the like. As is described below, instrument port  64  is compatible with a number of the instruments that are used in the inventive surgical procedure. The design structure and form allows right to left hand interchangability with ease and precision. 
         [0059]    In a preferred embodiment, instrument dock  64  includes an inner threaded surface or threaded female connector  66  and a larger male connector  68  that interlocks with the skin ports  80  (described below) allowing deployment and illumination. The instrument dock  64  is adapted to dock with certain instruments, as will be described more fully below. Handset  60  will be described more fully below in conjunction with the instruments with which it is intended to be used. 
         [0060]    The fiberoptic light port  62  allows docking with a fiberoptic light cord (not shown). The transmission of fiberoptic light through the handset  60  illuminates each device when it is attached to the working end or instrument dock  64 . 
         [0061]    In a preferred embodiment, the handset  60  includes a fiberoptic core  70 , which is made up of at least one, and preferably a plurality, of fiberoptic strands. When a fiberoptic light cord is connected to light port  62 , the light is transmitted through the fibers and out through an opening  72  that is coaxial with female connector  66 . 
         [0062]    In another embodiment other types of lighting can be used. For example, LED, incandescent, fluorescent and other light sources can be used. However, it will be understood that the light transmission is not a limitation on the invention. The handset  60  (and associated instruments) can be provided without a fiberoptic core. 
         [0063]      FIGS. 8-11  show a skin port  80 . In a typical procedure, a plurality of skin ports  80  are used. In a preferred embodiment, skin ports  80  are disposable clear plastic sleeves that are each inserted into one of the access sites  14  created by lancet  40 . 
         [0064]    Generally, skin port  80  includes a flange or cuff  82  that has a tube  84  that extends from it. One end of the tube or sleeve  84  is inserted into the puncture  14  in the skin until the flange  82  rests against the outer surface of the skin. The flange  82  and tube  84  cooperate to define a tunnel  86  that will provide access to the area under the skin. Preferably, the port  80  is comprised of colored clear plastic. However, the port  80  can also be made of other materials, does not have to be clear and does not have to be colored. 
         [0065]    In a preferred embodiment, the handset  60  is used to deploy each port  80  through the individual access sites  14 . Preferably, the skin ports  80  come in a kit, however this is not a limitation on the present invention. The handset  60  design allows quick interlocking with the skin port  80  to remove it from the kit. It will be understood that any design that allows the handset  60  to interlock with or engage the skin port  80  so that it can be deployed into the access site  14  is within the scope of the present invention. 
         [0066]    In a preferred embodiment, the port  80  is snap fit onto the male connector  68 . For example, as shown in  FIG. 8 , the male connector  68  can include a ridge  68   a  extending circumferentially therearound that cooperates with an indented ring  82   a  in the flange  82 . The ridge  68   a  and indented ring  82   a  provide a snap fit so that the port  80  is engaged with the male connector  68  of the handset  60 . Other snap fit arrangements are contemplated. 
         [0067]    The tube  84  is then inserted through the access site  14 . As shown in  FIGS. 8-11 , in a preferred embodiment, the skin port  80  includes an anchor system that comprises threads  88  on the outer surface of the tube  84  and a folding mechanism  90 . The folding mechanism  90  preferably includes a pair of folding members  90   a  that are attached to an internally threaded ring  90   b  that moves up and down the tube  84  on threads  88 . 
         [0068]    As is shown in  FIG. 8 , the male connector  68  includes a plurality of teeth  68   b  on an end thereof that are adapted to interlock with teeth  82   b  on the port  80 . When the port  80  is engaged with the instrument dock  64 , teeth  68   b  engage or mesh with teeth  82   b . After the tube  84  has been inserted through the access site  14 , to deploy the folding mechanism  90 , the handset  60  is turned in a clockwise direction (port  80  can be designed to deploy in a counter-clockwise direction as well). Because teeth  68   b  and  82   b  are engaged, the tube  84  turns with handset  60  and within flange  82 , thereby causing the internally threaded ring  90   b  to move upwardly along threads  88 . As can be seen in  FIG. 11 , folding members  90   a  include a fold crease  90   c . As threaded ring  90   b  moves upwardly, the folding members  90   a  fold, as shown in  FIG. 10 , thereby providing an anchor and preventing port  80  from pulling out of access site  14 . The folding members  90   a  can be disposed in an unfolded position ( FIG. 9 ) and a folded position ( FIG. 10 ). 
         [0069]    In a preferred embodiment, flange  82  includes a plurality of spikes  94  extending downwardly therefrom that burrow into the skin and help anchor the port  80  in place. 
         [0070]    During placement of the port  80 , because the handset  60  includes the fiber optic core  70  and the skin port  80  is clear, upon insertion, transcutaneous visualization of the lighted probe tip will allow safe deployment of skin port  80 . Because of the anchoring system, as the handset is withdrawn, the ridge  68   a  pulls out of the indented ring  82   a  and the skin port  80  is secured in place. In another embodiment, the surgeon can use his/her thumb to aid in separating the port  80  from the instrument dock  64 . 
         [0071]    Preferably, the ports  80  are disposable and are only used for a single surgery. It will be understood that the ports are simply used to gain access to the surgical field. Therefore, the type of port used is not a limitation on the present invention. Any type of port that provides access through the skin is within the scope of the present invention. The transillumination of light gives three dimensional feedback to the surgeon. 
         [0072]    As shown in  FIG. 12 , in an alternative embodiment, port  96  can have a tube  84  that is oriented at a non-right angle with respect to the flange  82 . For example, tube  84  can be oriented at a 45 degree angle with respect to the flange. 
         [0073]      FIGS. 13-17  show a threading device  100 . In a preferred embodiment, threading device  100  is a stainless steel malleable rod or tube that includes an eyelet  102  defined therein and a rounded, blunt tip  104 . Preferably, threading device  100  also includes a fiberoptic core  106  allowing illumination of tip  104 . In this embodiment, the tip  104  is preferably made of a translucent material, such as a plastic that is affixed to the main body of the threading device  100 . Threading device  100  includes an end  108  that is designed to dock with instrument dock  64  of handset  60 . In a preferred embodiment, end  108  is threaded for engagement with female connector  66 , however, it will be appreciated that end  108  can dock with instrument dock  64  in a number of different ways. For example, instrument dock  64  can include a set screw that holds threading device  100  in place or some type of snap or press fit can be provided. In another embodiment, a clamp or chuck, similar to that on a drill can be used. Also, end  108  can be internally threaded and can dock with an externally threaded instrument dock. Instrument dock  64  allows quick connection and disconnection with threading device  100 . 
         [0074]    In an embodiment where handset  60  includes a fiber-optic light port  62 , docking of end  108  (which includes an opening  108   a  therein) with instrument dock  64  allows the transmission of light to tip  104  of threading device  100 . In another embodiment other types of lighting can be used. For example, LED, incandescent, fluorescent and other light sources can be used. 
         [0075]    It will be understood that, eyelet  102  is used to secure the suture  150 . Eyelet  102  can be located anywhere along threading device  100 . 
         [0076]    In use, threading device  100  (and suture  150 ) are inserted through the various skin ports  80  and the support matrix  200  is weaved and created. 
         [0077]    An exemplary construction of a support matrix  200  will now be described. For example, as shown in  FIG. 15 , after first end  150   a  of the suture  150  is connected to eyelet  102 , the handset  60  is grasped by the surgeon and the threading device is inserted through a first skin port  80   a . The lighted tip  104  of threading device  100  illuminates the work area and transilluminates through the skin allowing the surgeon to determine the proper placement of the support matrix  200  and the location of the tip  104 . As described above, in a preferred embodiment, port  80  is clear for aiding in the passage of the threading device  100 . In other words, when the tip  104  of threading device  100  gets close to port  80  it will transilluminate. 
         [0078]    The threading device  100  is preferably long enough that it can be threaded from one side of the jaw line to the other such that the tip  104  is brought out through a second skin port  80   b  on the opposite side of the jaw from which it was inserted. At this point, the tip  104  is grasped by the surgeon and the suture  150  is pulled through the area under the neck. Then the threading device  100  is disconnected from the handset  60  allowing the threading device  100  and the suture  150  to be pulled through the second skin port  80   b , as is shown in  FIG. 16 . 
         [0079]    The threading device  100  is then turned and reconnected to the handset  60  and is then reinserted through second skin port  80   b  and is passed subcutaneously to the contralateral side exiting through third skin port  80   c . The threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through third skin port  80   c.    
         [0080]    Next, the threading device  100  is turned and reconnected to the handset  60  and is then reinserted through third skin port  80   c  and is passed subcutaneously to the contralateral side exiting through fourth skin port  80   d . At this point, the threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through fourth skin port  80   d.    
         [0081]    The threading device  100  is then turned and reconnected to the handset  60  and is then reinserted through fourth skin port  80   d  and is passed subcutaneously to the contralateral side exiting through fifth skin port  80   e . At this point, the threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through fifth skin port  80   e.    
         [0082]    Next, the threading device  100  is turned and reconnected to the handset  60  and is then reinserted through fifth skin port  80   e  and is passed subcutaneously to the midline sub-mental access site which preferably includes a threaded skin port  120  (described more fully hereinbelow). The threading device  100  and first end  150   a  of suture  150  are pulled through the threaded skin port  122  and the threading device is disconnected from the handset  60 . The first end  150   a  of suture  150  is then cut from and/or untied from the threading device  100 . 
         [0083]    Now, the second end (or distal end)  150   b  of suture  150  which is extending from first skin port  80   a  is secured to the eyelet  102  of the threading device  100  and the threading device  100  is connected to the handset  60 . The handset  60  is grasped by the surgeon and the threading device is inserted through the first skin port  80   a  and is passed subcutaneously to the contralateral side exiting through sixth skin port  80   f . At this point, the threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through sixth skin port  80   f.    
         [0084]    Next, the threading device  100  is turned and reconnected to the handset  60  and is then reinserted through sixth skin port  80   f  and is passed subcutaneously to the contralateral side exiting through seventh skin port  80   g . At this point, the threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through seventh skin port  809 . 
         [0085]    The threading device  100  is then turned and reconnected to the handset  60  and is then reinserted through seventh skin port  80   f  and is passed subcutaneously to the contralateral side exiting through eighth skin port  80   h . At this point, the threading device  100  is once again disconnected from the handset  60  and is reconnected after the threading device and suture  150  are pulled through eighth skin port  80   h.    
         [0086]    Next, the threading device  100  is turned and reconnected to the handset  60  and is then reinserted through eighth skin port  80   h  and is passed subcutaneously to the threaded skin port  120  at the midline sub-mental access site. The threading device  100  and second end  150   b  of suture  150  are pulled through the threaded skin port  120  and the threading device is disconnected from the handset  60 . 
         [0087]    As will be understood by those skilled in the art, the tube  84  on the skin ports  80  is long enough that when the threading device  100  is inserted therethrough the suture  150  will anchor itself by encircling the facial retaining ligaments during the procedure described above. Preferably, each time the threading device  100  and suture  150  are passed through a port  80 , the suture is secured on the facial retaining ligaments, thereby creating an anchor or pivot point. 
         [0088]    It will be understood that the number of access sites  14 , ports  80  and/or passes, etc. described above are merely exemplary and any number can be used in the presently described procedure, as required by the particular surgery. 
         [0089]    Transcutaneous light transmission from the tip  104  of the threading device  100  gives feedback allowing the surgeon to determine the location of the tip  104  as the support matrix  200  is weaved and created. This feedback allows the placement of each individual strand relative to areas of needed support. This allows placement of the suture strands  150  adjacent to the muscle, deep to the skin and fat layers. 
         [0090]    Preferably, in each port  80 , the end of the tube  84  that is associated with the flange  82  has a beveled or tapered edge  84   a , which helps prevent the tip  104  of the threading device  100  from catching inside the tunnel  86 , during insertion. 
         [0091]    In another embodiment, two threading devices  100  that are each connected to an opposite end of the suture  150  can be used. In this embodiment the first threading device  100  does not have to be disconnected from the end of the suture  150  before the second end of the suture  150  is threaded through the skin. In yet another embodiment, the suture  150  can come in a kit with two disposable threading devices  100  attached to the opposite ends  150   a  and  150   b . After forming the matrix  200 , the threading devices  100  can be cut from the suture  150  and then the suture can be tied. 
         [0092]      FIGS. 19-23  show the threaded skin port  120  used for the midline sub-mental access site. The threaded skin port  120  is inserted at the same time as the skin ports  80  described above. However, this is not a limitation on the present invention. The port  120  includes a flange  122  having a tube  124  extending therefrom. The tube  124  is preferably threaded  126 . As is shown in  FIG. 22 , the tube  124  and flange  122  cooperate to define a tunnel  128  therethrough. In a preferred embodiment, the portion of the tunnel  128  in the flange  122  includes a beveled or tapered edge  128   a.    
         [0093]    In a preferred embodiment, the port  120  includes a pair of handle portions  130  extending upwardly from the flange  122  that aid the surgeon in threading the port  120  into the midline sub-mental access site. However, the handle portions  130  are not a limitation on the present invention and can be omitted. It will be understood that any skin port that allows access through the skin is within the scope of the present invention. For example, skin port  80  or something similar can be used at the midline sub-mental access site. In another embodiment, port  120  can be used at access site  14 . In a preferred embodiment, port  120  is clear for aiding in the passage of the threading device  100 . In other words, when the tip  104  of threading device  100  gets close to the port  120  it will transilluminate. 
         [0094]    In use, the tube  124  is inserted into the midline sub-mental access site. The handle portions  130  are grasped and the port  120  is turned so that the threads  126  are threaded into the skin until the bottom surface of the flange  122  rests against the outer surface of the skin. 
         [0095]    In another embodiment, a port similar to skin port  80  described above, but somewhat modified can be used for mid-line access. In this embodiment, the flange includes a threaded interior that engages the threads on the exterior of the tube. The distal ends of the folding members are connected to a ring that is not internally threaded. This ring allows the tube to rotate therein, but (because it is not internally threaded) does not cause the ring to ride up the threads of the tube. The opposite ends of the folding members are connected to the flange. 
         [0096]    With this configuration, when the tube is rotated (preferably by engagement with the handset or with a surgeon&#39;s fingers), the threaded engagement of the exterior of the tube with the interior of the flange causes the tube to move outwardly (with respect to the interior of a patient&#39;s body). This action causes the folding members to fold at the crease. In use with a patient, in the folded position, the proximal end of the tube is located outside of the patient&#39;s body, and the distal end has moved closer to the flange than it was in the unfolded position. 
         [0097]    With reference to  FIGS. 18-20 , a knot positioning implement  140  is shown and described. After both ends  150   a  and  150   b  of the suture  150  are threaded and the support matrix  200  has been created, the two suture ends  150   a  and  150   b  are brought out through the midline sub-mental access site (through port  120 ), as is shown in  FIG. 19 . A single throw knot  150   c  is placed (it will be understood that the type of knot is not a limitation on the present invention) and the knot positioning implement  140  is utilized to set the knot  150   c.    
         [0098]    One end  142  of the knot positioning implement  140  (which is preferably threaded) docks with the handset  60  and the other end  144  is forked. The forked end  144  is used to push the knot  150   c  through the tunnel  128  of threaded skin port  120  and under the skin. In a preferred embodiment, the knot positioning implement  140  includes a fiber optic core  152  and an opening  152   a  through which light is transmitted to illuminate the work area when placing the knot  150   c.    
         [0099]    After the knot  150   c  has been pushed through the threaded port  120 , threaded port  120  is twisted out of the access site and the other skin ports  80  are removed using the handset  60 . To do this, the male connector  68  is inserted into the port  80  so that the ridge  68   a  snaps into the indented ring  82   a  and the teeth  68   b  and  82   b  engage one another. The handset  60  is then twisted, thereby turning tube  84  and causing the internally threaded ring  90   b  to travel back down threads  88  and unfolding folding the folding members  90   a . In another embodiment, the ports  80  can be removed by hand. 
         [0100]    After atraumatic removal of the ports  80  and  120 , steristrips are then placed as desired and a neck compression garment is fitted onto the patient. See  FIG. 25  for the final configuration of the exemplary support matrix  200 . 
         [0101]    In a preferred embodiment, the suture that is used in the procedure is a 4.0 braided polyester suture. In a more preferred embodiment, as shown in  FIG. 24 , the suture design contains at least one fiberoptic strand  150   d  intertwined with the non-fiberoptic strands. The suture  150  is braided as is known in the art with one, two or three fiberoptic strands and one or two non-fiberoptic strands, as is desired. This aids in the transillumination of the suture  150  to check subcutaneous placement after the suture  150  has been placed. The fiberoptic strand  150   d  will illuminate when the handset  60  fiberoptic light coupled with the knot placement implement  140  is approximated to the suture during tying. Light transmitted to the suture allows the surgeon to visualize placement of the support matrix  200  as it is secured. The non-fiberoptic strands can be made of any material known in the art, such as nylon, polypropylene, or other non-absorbable material. 
         [0102]    At any point during the creation of the support matrix  200 , suture placement can be confirmed by placing the handset  60  (or any light source) at one of the ends  150   a  or  150   b  of the suture  150 , thereby transmitting light down the fiberoptic strand  150   d  to check placement of the suture  150 . 
         [0103]    The illumination of the suture pathway allows the surgeon to determine the location of the suture. Overall, suture illumination gives the surgeon feedback relating to the anatomical movement of each pivot point. 
         [0104]    It will be appreciated by those skilled in the art that the fiberoptic suture can be utilized in all areas of surgery or other materials where a lit binding material is needed, and not just in the technique described herein. In another embodiment, the threading device may be a straight or curved needle. Application of light energy during a surgical procedure will confirm suture placement and accuracy. Application of light post-operatively could allow surgeons to understand the evolution of suture placement related to time and aging. 
         [0105]    In an alternative embodiment, the neck skin can be elevated from the platysma muscle via an incision similar to that used in the standard procedure discussed above to allow the surgeon to visualize the operative field and then the suture matrix can be placed through the ports  80  and access sites  14 . 
         [0106]    It is contemplated that the above described instruments can be sold in kits. For example, a kit with all or any combination of the instruments, including the tape  10 , a marking pen, lancet  40 , handset  60 , skin ports  80 , threading device  100 , threaded skin port  120 , knot positioning implement  140  and suture  150  can be sold. 
         [0107]    The embodiments described above are exemplary embodiments of the present invention. Those skilled in the art may now make numerous uses of, and departures from, the above-described embodiments without departing from the inventive concepts disclosed herein. Accordingly, the present invention is to be defined solely by the scope of the following claims.

Technology Classification (CPC): 0