Acta Scientific Otolaryngology

Volume 3 Issue 7 July 2021

Review Article

Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

Nikolay P Serdev*
Received: February 06, 2020
Honorary Professor, Director of the International Program in Aesthetic/Cosmetic
Published: June 29, 2021
Surgery at the New Bulgarian University and Head, Medical Centre “Aesthetic
© All rights are reserved by Nikolay P Serdev.
Surgery, Aesthetic Medicine and President the Bulgarian Society for Aesthetic
Surgery and Aesthetic Medicine, Sofia, Bulgaria
*Corresponding Author: Nikolay P Serdev, Honorary Professor, Director of the
International Program in Aesthetic/Cosmetic Surgery at the New Bulgarian
University and Head, Medical Centre “Aesthetic Surgery, Aesthetic Medicine and
President the Bulgarian Society for Aesthetic Surgery and Aesthetic Medicine, Sofia,
Bulgaria.

Abstract
Scarless closed approach suture liftings present skeletal fixation with skin punctures without incisions as a first alternative to
classic excision lifts. We started the anatomy study, instrument creation and thread selection in 1990 and the whole topographic
anatomy, instrumentarium and technique understanding of this new method was ready in 1993 [1-4]. Needle preparation and selec-
tion of threads was experimental. For threads we have performed stretch, elasticity and cut through tests. Thread long term absorp-
tion is crucial in our method. In the year 1993 - 1994 [2] we have operated 54 patients to correct early ptosis and flabbiness in areas
of face and body and published our results. Our contribution is that our closed approach suture techniques lift SMAS and fascias
without traditional incisions. Operations are ambulatory with excellent results, reported by the patients. The trauma is minimal and
the follow-up period is no longer than hours to 3 days with fast, sometimes immediate return to work and social life. There are no
visible scars, the needle perforations on the skin are not visible after days.
Keywords: Serdev Suture®; Augmentation; Face and Body

Technique and anatomical fixations • Cheekbone SMAS lift and volume creation, 
Operations are ambulatory without hospital stay. The tech- • Lower SMAS face and neck lift, 
niques consist of passing closed sutures, by needle perforations
• Chin enhancement, form and position correction by su-
only, to lift movable fascias and fix them to non-movable skeletal
ture; 
structures in several facial and body areas [1-23].
• Nasal tip refinement; nasal tip rotation; nasal alar base
We perform the following scarless closed approach suture lifts: narrowing;
• Scarless Serdev suture® method in prominent ears, 
I. In face areas: 
• Dimple formation in chin and smiling point etc. 
• Ambulatory temporal and supra-temporal SMAS Lift; 
II. In body areas: 
• Brow lift, 
• Scarless buttock lift by suture, 
• Lateral canthus lifting,
• Scarless breast lift by suture, 
• Glabella muscle ligation, 
• Scarless Serdev suture to reposition breast implants in
• Mid face SMAS suture lift, 
symmastia and false position

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.
Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

85

• Abdominal flaccidity tightening, 

• Inner thigh lift.

Results

Figure 7 and 8: Mid-face suture lifts (SMAS zygomatic

extension to upper temporal line periosteum or to
temporo-parietal tendon).

Figure 1-3: Temporal (upper SMAS to upper temporal line

and temporal fascia.

Figure 9 and 10: Cheekbone lifts (Bichat fat pad fascial tube
Figure 4-6: Scarless brow suture lifts (orbito-cutaneous brow to zygoma periosteum) and volumising using own patient
fascia discovered by the author to upper temporal line tissue without implants.
periosteum at 1,5 cm or at hair line).

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.
Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

86

Figure 17: Sutures in rhinoplasty: for tip rotation (medial

crura of greater alar cartilages to nasal bone periosteum), tip
refinement (suturing together all 4 crura of both greater alar
cartilages at the dom), allar base narrowing (suturing the alar
base incl. accessory alar cartilages).

Figure 11-13: Lower SMAS-platysma face and neck lifts

(platysma fixation to mastoid).

Figure 18-20: Otoplasties in prominent ears (closed approach

perichondrium suture to obtain the antihelix fold) etc.

In body areas
Results in all our patients are more than satisfactory. Patients
are mostly amazed by the immediate beautification, rejuvenation
and the great difference before and after without scars and with
nearly immediate return to work and social meetings.

The cosmetic results were evaluated with preoperative and

Figure 14-16: Chin enhancements, form and position
postoperative photographs and by patient satisfaction. Patient
corrections with or without fixation to the menton.
were satisfied with the results and all of them considered their re-
sults as excellent or good.

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.
Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

87

Figure 25: Abdominal flaccidity tightening (linea alba

shortening, superficial fascia to costal line, spina iliaca superior
anterior).

Figure 21: Scarless breast lifts (fixation of breast fascia to

clavicle and/or pectoralis major tendon).

Figure 26: Inner thigh lift.

We have observed no other complications, except some local

infections in one of the perforation points in the early postop pe-
riod, treated in a day or two. No nerve damage by the suture was
observed. Cheekbone sutures were removed in one Asian patient
due to patient’s aesthetic considerations.

Discussion
Nowadays these methods are preferable in the modern society
where business does not allow long time of absence. Closed ap-
proach suture methods have shown priority over classic excision
liftings requiring hours of operation, marked trauma, long postop-
Figure 22-24: Buttock lifts (fixation of the fibrous tissue to the
erative swelling and downtime.
sacro-cutaneus fascia, found by the author).

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.
Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

88

Serdev suture liftings require about 15 min of operating time

®
Contributions
per side, no blood loss or transfusions, no stay at the clinic, no nurs- Serdev Suture® Techniques are the first lifting method to replace
ing care and not more than a day or two off work. Results are imme- scarring classic excision liftings as a complete method for scarless
diate with no downtime. Most of the patients work next day after closed approach liftings on total face and body where movable fas-
operation that is most appreciated by the patients. cias (holding skin by trabecular system) can be lifted and fixed to
non-movable periosteum, tendons and fascias.
Conclusion
We can recommend the closed suture methods for young and Bibliography
mid age patients with congenital problems in aesthetic appearance
1. Serdev NP. “Forehead Subperiosteal Masklift in Combination
and in cases of initial or moderate flabbiness and tissue sagging.
with McIndoe Facelift Technique and Profile Correction”. The
7th IPRAS Congress European Section, Berlin, Germany (1993).
Author’s Suture Techniques Contributions:
• A new method for closed approach face and body liftings - a 2. Serdev NP. “Year 1994, suture suspensions for lifting or volume
new alternative to classic excision lifts. augmentation in face and body”. (English version), presented
• Scarless, skin punctures only - no incisions and excisions. at the 2nd Annual Meeting of the National Bulgarian Society
for Aesthetic Surgery and Aesthetic Medicine, Sofia, 18 March
• Mini-invasive, no downtime.
1994”. International Journal of Surgical 1.1 (2001): 2561-2568.
• Beautification and rejuvenation.
• When needed tissue augmentation is performed using pa- 3. Serdev N. “Accessories to Face Lifting. II International Sympo-
tient’s tissue - a new alternative without implants. sium of Updating on Skin Aesthetic, Sao Paolo, Brazil (1994).

• Can be used in cosmetic, aesthetic and plastic-reconstructive

4. Serdev NP. “Temporal SMAS lift without skin excision”. AAARS
surgery.
Annual Meeting, New Orleans, USA, (1994).
• Downtime is shortened from weeks into some days. No
bruising, no danger of hematoma formation, no nerve dam- 5. Serdev NP. “Temporal SMAS Lifting of the Face. Life Surgery
age, no scars. Workshop”. Unidad Medica Clinica Del Country, Bogota D.C.,

• The suture methods became possible after creating special Colombia, (1999).

curved semi-elastic, semi-blunt needles.

6. Serdev NP. “SMAS Lifting of the Face by Minimal Incisions – the

Serdev needles were specially designed and developed for best Serdev Technique. 42 Life Surgery Workshop sponsored by In-

use and have the following qualities: ternational Academy of Cosmetic surgery and the Balkan Acad-
emy of Cosmetic Surgery, held at the Krilig Clinic in Caracas,
• Elastic curve (the curve can not be changed when using
Venezuela (1999): 12-18.
pressure).
• Smooth surface (does not cut periosteum). 7. Serdev NP. “Principles of Face Beautification, Ier Congresso

• Cone semi-blunt tip (trauma is minimized). Internacional de Cirurgia Cosmetica, Buenos Ares Argentina
(1999).
• Length and thickness depending on application from 50
to 250 mm. 8. Serdev NP. “Temporal SMAS lift, Lecture and Life Demonstra-
tion, 1st World Congress of Cosmetic Surgery with Life Dem-
Surgical threads were selected and best results were obtained
onstrations, Edsa Shangri-La Manila and Quezon City Medical
with the Bulgarian policaproamide sutures Polycon, which are en-
Center (2000).
suring semi-elastic fixation of movable to non-movable tissue, they
do not cut through the tissue like other available non elastic surgi- 9. Serdev N. “Live Surgery Workshop, SMAS Lifting of the face by
cal treads, we have tried on experiment. Preferred thread qualities minimal incision – Brow, Temporal, Medial, Lower - the Serdev
were - short elasticity, absorbable within two years - after final fi- Technique”. The International Academy of Aesthetic Surgery
brosis formation, anti-microbial action. Our test have shown that and Aesthetic Medicine, The Krulig Clinic, Caracas, Venezuela
only Polycon ensures that qualities. Polycon offers thread thickness (1999).
depending on application - 3/0, 0, 2, 4, 6, 8.

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.
Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body

89

10. Serdev NP. “Temporal SMAS Lifting of the Face, Combined with 22. Serdev NP. “Brow lifting to the upper temporal line 1.5 cm”. In-
Liposuction and Chin Augmentation Using Suture”. Life Surgery ternational Journal of Esthetic Dentistry 12.1 (2012): 1-62.
Workshop, Tel Aviv, Israel (2000).
23. Serdev NP. “Brow lifting with fixation to the upper temporal
11. Serdev NP. “Principles of face beautification, The 3-rd World line at the hairline”. International Journal of Esthetic Dentistry
Congress of ISAS, Tokyo (2000): 9W58. 1 (2012): 3-6.

12. Serdev NP. “Lifting del SMAS con Una Pequenna Incision Tem-
poral, VIIIas Journadas Mediterraneas de Confrontaciones Ter-
apeuticasen Medicina y Cirurgia Cosmetica, Sitges, Barcelona
Volume 3 Issue 7 July 2021
(2000).
© All rights are reserved by Nikolay P Serdev.
13. Serdev N. “Scarless Brow Lift Using A Special Suture”. Presenta-
tions - 3rd World.

14. Serdev N. “Auriculoplasty for beautification - a post-congress

workshop, Asia Pacific Craniofacial Association. Third Confer-
ence, Shanghai, P.R. China (2000).

15. Serdev N. “Principles of Face Beautification, XIas Jornadas

Mediterraneas De Confrontaciones Terapeuticas En Medicina y
Cirugia Cosmetica, 21-25. 03. 2001, Congress of Cosmetic Sur-
gery with Live Surgical Demonstrations”. International Journal
of Cosmetic Surgery 2.4 (2001).

16. Serdev NP. “Tratamento De Flacides Cutanea Abdominal Com

Filos Elasticos Serdev /Scarless Serdev Suture Methods For
Abdominal Skin Flaccidity, 12 Congresso Brasiliero Medicina
Estetica - 15 - 18 June 2005, Salvador”. International Journal of
Cosmetic Surgery (2006).

17. Serdev NP. “Scarless Serdev Suture Method In Prominent Ears

(Bulgarian), Original Papers”. International Journal of Surgical
9.4 (2009): 1-9.

18. Serdev NP. “Breast Lift: My Methods Presentations from the

Congress “VI Sharing with the Experts” - San Salvador”. Interna-
tional Journal of Cosmetic Surgery 9.2 (2009): 1-39.

19. Serdev NP. “Serdev Suture Techniques Breast Lift Original Pa-
pers”. International Journal of Cosmetic Surgery (2009): 1-3.

20. Serdev NP. “Minimally Invasive Author Technique for Breast Lift
Without Scars Using Sutures Abstracts - The First World Multi-
disciplinary Congress on Cosmetic Surgery and Medicine”. In-
ternational Journal of Cosmetic Surgery (2010): 1.

21. Serdev NP. “Eyebrow lifting by suture (from “Serdev Sutures.

Scarless face and body liftings”)”. International Journal of Es-
thetic Dentistry 11.3 (2011): 1-2.

Citation: Nikolay P Serdev. “Transcutaneous Serdev Suture® Suspensions for Lifting or Volume Augmentation in Face and Body". Acta Scientific
Otolaryngology 3.7 (2021): 84-89.