Comparison of results of wire subcision performed alone, with fills, and/or with adjacent surgical procedures.

Background: Because of the fixed attachments (or muscle-superficial musculoaponeurotic system [SMAS] insertions) to the undersurface of wrinkles, folds, and retracted scars, the use of fills alone has resulted in unpredictable and unsatisfactory improvements.

Objective: To demonstrate that use of a wire dissector to completely release these attachments, accompanied by an immediate fill and/or an adjacent aesthetic surgical procedure, may optimize final results, improving deep wrinkles, folds, and scars.

Methods: The subcision wire was positioned under various wrinkles, folds, and scars in a triangulated outline and then zigzagged to uniformly release any subdermal attachments. Patients were divided into 4 categories based on the treatment received: group 1, wire subcision only; group 2, wire subcision plus immediate fill with a strip of autogenous filler or xenograft material; group 3, wire subcision without fill but with an adjacent aesthetic surgical procedure; and group 4, wire subcision, fill, and an adjacent surgical procedure. Results were rated with a photographic wrinkle/fold assessment scale (mean +/- standard deviation) by 2 blinded evaluators after at least 6 months. Assessment was based on a quartile grading scale that indicated improvement (0= <25% improvement; 1=25-50% improvement; 2=51-75% improvement; and 3= >75% improvement).

Results: Eighty-five patients experienced 338 wire subcisions at 8 facial, 1 posterior neck, and 4 thigh (cellulite) sites. The longest follow-up was 1.5 years (mean, 6.3 mos). The cumulative quartile grading scale was recorded as follows: group 1 (1+/-1.5 SD); group 2 (3.1+/-0.1 SD); group 3 (2.5 +/- 0.2 SD); and group 4 (3.6+/-0.2 SD). When fills were employed as spacers under the release tracts in group 2 and 4 sites, strips of SMAS, dermis, and microfat droplets were the favored fills in the areas of nasolabial and marionette folds because of the capacity of the graft's volume and tissue acceptance. For shallower depressions, such as the glabellar frown lines and crow's feet, strips of deep temporal fascia or muscle were more effective. Complications after wire subcision with or without fill were few and transient.

Conclusions: The use of wire subcision for resistant wrinkles, folds, or scars can result in a satisfactory outcome with minimal complications when used as a solitary procedure. Results may be further optimized with the immediate addition of fill into the released tract. An adjacent aesthetic surgical procedure that impacts at the subcised site may provide additional benefit to the site, but not as much as observed with the usage of an immediate fill. Autogenous fills that are substantitive provide longer lasting effects because of volume and tissue acceptance.