At our busy ophthalmology center, we're always looking for procedures we can add to expand services and boost the bottom line. Fast, minimally invasive cosmetic procedures are often a good fit. For example, many ophthalmology practices have added Botox injections. Oculoplastic procedures such as brow lifts and eyelid revisions can also be good additions.

One of our oculoplastic docs, John LiVecchi, MD, has been doing research on suspended sutures, and using them in several different types of surgeries. They're marketed as the minimally invasive alternative to facelift, but it's really amazing what they can be used for: full face lifts and eyelid correction and even breast lifts. These thread lifts are growing in popularity for three reasons:

• People hesitate when it comes to major surgery, which a facelift is;
• thread lifts are cheaper than a facelift; and
• thread lifts can be removed if the patient so desires, making the procedure reversible.

Your options
There are several different kinds of thread-lift techniques and sutures. Here's a rundown.

• Contour Threads. The newest barbed suture on the market, the company claims Contour Threads are the only non-absorbable barbed suture product cleared by the FDA for the elevation and fixation of mid-face, brow and neck areas. Made of clear polypropylene, the sutures are self-anchoring.
• FeatherLift/Russian threads/Aptos threads. The first barbed sutures, considered to have started the revolution in minimally invasive facelifts, Aptos threads are made from non-absorbable prolene and are said to have a bi-directional cog-like design that let them anchor, support and lift the skin and underlying tissue. They are monofilament.
• Curl Lift/Soft Lift. This technique involves placing nylon threads in a loop fashion and then pulling them upward.
• Cosmo Lift. This procedure is "very close to the Curl Lift with a little twist," says Sam Assassa, MD, a cosmetic surgeon with Beverly Hills Aesthetics in California who developed the technique. It uses regular prolene suture and two-point anchoring to help prevent migration of thread, he says.
• Isse Endo Progressive Face Lift Suture. Developed by Nicanor Isse, MD, this is a monodirectional, distally-converging thread with spirally or helicoidally aligned barbs on the distal caudal end. The suture is barbed for 10cm and smooth for 15cm; the barbs grab and reposition soft tissue, while the smooth end glides through proximal fascia and fixes to deeper non-mobile planes via knots. The idea is that multiple barbs will spread tension over a broader area so surgeons can reposition blocks of tissue.

Nuts and bolts
Your target market is people who want to get facelift-like results in a minimally invasive way. We're using it for fixing saggy tissue around the eyes, brows/forehead and face/cheek, as well as for some procedures involving functional eyelid revision.

We purchase the threads for $1,490 per box (two to a box), and charges for private-pay patients start at about $1,600, depending on the number of threads used and what the procedure is.

But you don't have to limit yourself to private-pay patients. If you're performing these procedures out of medical necessity (reconstructive rather than cosmetic surgery) to correct conditions such as brow ptosis, blepharoptosis and dermatochalasis, Medicare will reimburse you.

You can make suture suspension profitable because they're generally extremely quick. Performed under local anesthesia - a big benefit compared to the general anesthesia required for a facelift - the procedures last 10 minutes (small eyelid revision) to an hour (the works), depending on how much the patient is having done.

The surgeon threads the barbed sutures under the skin through a thin needle. Once the surgeon has positioned the threads under the skin, he applies tension in an upward motion that makes the evenly spaced barbs pull the skin up from underneath; the skin stays in place because the barbs embed in the tissue. The surgeon can tighten or loosen the threads to achieve the desired look.

Patients are out of PACU in less than an hour, and recovery is amazing because there is minimal swelling and bruising.

Little downside
The risk of complications - threads coming out, infection, malpositioning - is low.

How long the threads will last is a big question. Sometimes patients have to come back for tightening after a few months, once the sutures and tissue have had a chance to settle. A lot depends on the patient's age. When used for cosmetic purposes, these procedures are targeted at patients in the 40-years-old to 50-years-old age range, and there's a fairly good chance patients this young might need additional threads later.

Enhance surgical lighting with Xenon fiber optic illumination
If you're looking for ways to enhance lighting at the surgical site, PerkinElmer's XL3000, a fiber optic illumination system, might be able to help. The device can be customized for attachment to endoscopy equipment, surgical headlights or any device that is used for illumination. The XL3000 features the latest in the company's patented Cermax Xenon technology, which is said to be the premiere fiber optic illumination technology for integration into endoscopy equipment and other demanding medical applications. The illuminator's 300-watt Cermax Xenon light source offers consistent 6000K color temperature that yields true white light throughout lamp life, according to PerkinElmer. You can tune the broadband Xenon spectrum for narrow-band illumination applications such as bio-fluorescence. The XL3000 complies with the latest international regulatory standards to ensure safety and electromagnetic compatibility, the company says. The company refused to provide a price. For more information, call (800) 775-OPTO, visit www.perkinelmer.com or circle number 166 on your Reader Service Card.

A Very Loud Reminder of Wrong-site Surgery
A St. Louis ear surgeon is hoping the same security tags and doorway sentries that sound an alarm when shop-lifters attempt to sneak through will help to prevent wrong-site surgery. Richard Chole, MD, PhD, head of the department of otolaryngology at the Washington University School of Medicine, has invented a wristband embedded with a chip that will trigger a retail-style security detector installed between pre-op and the OR if a member of the surgical team hasn't marked the surgical site with a pen, peeled off a specialized sticker and placed it on the wristband, which neutralizes the chip and lets the patient pass through the sentry without activating the reminder signal. The product is called the CheckSite System.

Dr. Chole had the idea while shopping for home improvements. "I spend a lot of time at Home Depot," says Dr. Chole. "I watched employees deactivate the little security tags, then researched how those worked." The detectors cost $7,000 to $8,000 and each wristband and pen set costs $2.50. For more information, call (314) 667-5720, visit www.checksitemedical.com or circle number 167 on your Reader Service Card.

Intranasal splint can improve patient comfort
You may be able to make sinus drainage surgery more comfortable for patients by implanting Breeze Nasal Airway Splints. The splints feature a tapered airway, beveled ends and two suture holes. Micromedics, the manufacturer, says the tapered airway creates a pressure gradient force, providing superior airflow to the patient, and that it resists clogging of the splint. The beveled ends are said to allow easier entry for suctioning, as well as more direct access to the two suture holes, which make suture placement easier. Fifty pairs per package, bulk non-sterile costs $552; two per package, one package per box, sterile for $23. For more information, call (800) 624-5662, visit www.micromedics.com or circle number 168 on your Reader Service Card.

Get your BI results faster
You now have a faster option for biological indicators for the Steris System 1 sterilizer: the SporView PA Culture Set, which has an incubation time of just 24 hours - the fastest on the market, according to SPSMedical, the manufacturer. The company says other BIs take up to seven days to give you results. You can store the SporView at room temperature instead of refrigerating it, and it fits existing incubators. Each SporView box contains 25 tests; a record notebook is available to store results. Incubation time savings is significant when failures are detected and the sterilizer needs servicing, says the company. Pricing is about $52.50 for a box of 25, varying slightly based on GPO affiliations. For more information, call (800) 722-1529, visit www.spsmedical.com or circle number 169 on your Reader Service Card.

Old favorite back on the market
For surgical nurses missing the discontinued Sof-Kling product, DeRoyal has responded with Apex, a conforming gauze bandage. The one-ply polyester and rayon blend conforms to the body, stretches and clings to itself. Highly absorbent, it maintains its conformability when wet and stays in place even when saturated with drainage, says DeRoyal. Because it is soft, low-linting and doesn't ravel, it's said to be a good primary post-op dressing that is gentle and non-contaminating to fragile skin. Apex is easy to apply, can be cut and stretches to require minimal securement, the company says. When used as a secondary dressing, it reduces primary dressing displacement. The gauze is available in sterile and non-sterile rolls in five sizes: 1" x 60"; 2" x 65"; 3" x 75"; 4" x 75"; and 6" x 85". The company declined to give pricing. For more information, call (800) DEROYAL, visit www.deroyal.com or circle number 170 on your Reader Service Card.

Protection from contact dermatitis that may help alleviate it
Dry, cracked skin is a fact of life in a surgical facility because of frequent hand-washing and contact with chemical irritants on top of environmental factors. But you may be able to help alleviate the problem by using Gloves In A Bottle, a protective lotion that works to keep moisture-robbing irritants out while retaining the skin's natural moisture, according to Gloves In A Bottle, Inc., the manufacturer. Instead of attempting to replace natural oils as artificial moisturizers do, Gloves In A Bottle forms a bond with dead skin cells, working like an invisible pair of gloves to reduce natural oil and moisture loss, and allows the skin to heal itself, according to the company. The lotion also helps protect against reactions to latex, latex powders and other irritating substances found in disposable gloves. Gloves In A Bottle is said to be virtually undetectable once dry, lasts four hours or more, and comes off naturally with exfoliated skin cells. Twelve 8-oz. bottles or one one-gallon bottle cost $140; a case of four one-gallon bottles costs $448. For more information, call (800) 600-1881, visit www.dry-skin.net or circle number 171 on your Reader Service Card.

Integrate voice recognition, transcription and record distribution
A new software platform may help automate the conversion of recorded dictation into electronic transcripts, which can significantly reduce the time and cost associated with manual transcription, says ScanSoft, the manufacturer. Dragon MT Workflow System integrates several programs. The Dragon MT Speech Server manages front- and back-end speech recognition, including automatic identification of physicians who are good candidates for speech recognition; using Dragon NaturallySpeaking technology, a physician can dictate operative notes via telephone or microphone, or enter them via handheld device or keyboard. The Dragon MT Transcription Server then manages the capture of physician dictation through transcription, quality assurance, e-signature and document distribution, including network fax or printer, e-mail clients, and HL7 interface to any HIS system. All modules are accessible through the Web and are HIPAA-compliant. Pricing depends on the number of licenses and combination of products purchased. For more information, call (800) 443-7077, visit www.scansoft.com/workflow or circle number 172 on your Reader Service Card.