LUNCHTIME LIFT: THE THREAD LIFT TREND

Cables are used to support bridges and buildings, to pull elevators up hundreds of floors in skyscrapers, and to transmit people in cable cars valleys above the ground beneath. So why not use a similar concept to lift the aging face?  Doctors have been trying and testing threads to lift the face for many years—so it’s not a new concept at all.  And now, in less than an hour you can have you brows, face, or neck suspended in order to defy gravity using little filaments that are injected or threaded through the skin. 

STRING SUBSTANCE

Over several decades various materials were used to place in the face to deliver face lift results without invasive surgery.  The idea was to avoid a big operation for people who wanted to look better but didn’t want to undergo traditional facelift surgery, bandages and lengthy downtime.  In the beginning, stitches like nylon were placed in the cheeks to pull back the nasolabial fold, that deep line that runs from the nose to the mouth.  Then a substance called polypropylene or Prolene was used.  Prolene is used every day in almost every kind of modern surgery, from abdominal surgery to vascular and heart surgery.  It’s a strong substance that doesn’t dissolve inside the body:  it sits there permanently.  You might think that’s a good thing, but remember, a permanent type of material doesn’t mean a permanent result!  Nothing is permanent, even a full facelift.  To avoid complications after years of inserting permanent threads, doctors designed new threads made of dissolvable substances. One is PDO or polydioxanone.  PDO threads are thin, short filaments injected into various parts of the face to support the skin, stimulate the collagen and provide a subtle but attractive brow lift, midface lift, lower face lift or neck lift [1].  

Poly L-lactic acid or PLLA is another non-permanent type of thread lift material, used in threads such as Silhouette InstaLift®.  PLLA has been used also for many years as a collagen stimulating agent, even in types of fillers like Sculptra®, a product used to plump the face after volume loss.

TECHNIQUE

Almost all thread lifts are carried out under local anaesthesia, the type of numbing a dentist provides.  One of the most important parts of the thread lift treatment is marking.  The doctor has to “map out” exactly where the threads will go, and in what direction or vector [2].  The tail of the brow is lifted toward the forehead hairline; the plumpness of the cheeks upwards and backwards to soften the nose-to-mouth groove and highlight the cheeks; the jowls are suspended upwards.  The neck can be pulled to improve the angle below the chin.  Typically, these little threads are carefully positioned just below the dermis—the bottom skin layer. 

Threads with barbs or ‘hooks’ tend to be positioned such that the hooks grab the layers below the skin to provide a lift.  Depending on which way the barbs are facing on the suture itself, they can lift the skin or project it or push it out to make the area look fuller.  Only small marks reafter the treatment where the skin has been punctured and there are no stitches required.  The threads stimulate the collagen in the skin and then slowly dissolve over time.  Threads like these may take 10-12 months to dissolve.  That’s not to say the results won’t last longer—they might.  However, with such a minimally invasive procedure you simply cannot expect facelift-type results [3].  Facelifts last longer and deliver more dramatic results because the deeper layers of the face are completely dissected and lifted through larger incisions. 

Some threads are anchored to the bones or strong layers of tissue that envelope the muscles.  To do this, an incision is usually required, exposing the layers in the temple to tie the threads down, securing them so they don’t come loose.  Anchored threads may lift the face using cogs, cones, or simply loop around the fat or connective tissue structures of the cheeks or lower face.  When the tissues are grasped and lifted up, some amount of puckering or pleating of skin is inevitable, unless a little skin is trimmed away at the same time.  One method, a so-called One Stitch Facelift, suspends the drooping jowls or cheeks in this way.  When incisions are made, stitched need to be removed after about a week. 

A drooping neck is the bane of many who reach their 40s, 50s and beyond.  The sagging and loss of definition occur due to weakening of the skin itself, accumulation of fat, relaxation of the muscles under the skin and even falling of the salivary glands below the jawline bone.  If a full “open” necklift is not on the cards, there’s always a thread lift to try to get some improvement without the downtime, drains and trauma associated with conventional surgery.  Bear in mind, you’ll never get a surgical result with a few threads, but they can help.  One innovative thread lift technique suspends the neck using threads literally passed from one ear to the other [4].  The threads pass just under the skin and recreate the angle of youth with traction. 

THREADS IN A TOOLBOX

Threads are just one tool aesthetic physicians, dermatologists and plastic surgeons use to refresh and rejuvenate when a minimally invasive option is preferred. It’s one of many tools in the aesthetic medicine toolbox that helps fight against gravity.  The power of thread lifts lies, though, in the synergy they provide to all of the other popular cosmetic procedures such as Botox®, fillers like Restylane® and Juvederm® and Belotero®, lasers and skin treatments.  Most experienced Providers are well versed in the physiology of aging and what happens when men and women reach their 30s, 40s 50s and beyond.  Threads provide a little lift, but they don’t address photoaging—the ravages caused to the skin by sun; they don’t add facial volume, one of the key features that leads to facial aging; threads don’t relax hyperdynamic muscles like botulinum toxins do. Don’t be misled—the transformative result achieved using threads is usually not just threads, but  a skillful combination of threads with other non-surgical cosmetic procedures.  Threads plus fillers, threads with laser resurfacing peels, threads with botulinum toxins and fillers and heating devices all combined to deliver maximum effect. Some plastic surgeons even use threads during facelift surgery as an extra support for certain tissues, like the cheeks or midface.  

However, there are believers and non-believers, and some aesthetic Providers are not advocates of thread lifts.  So there are two sides to every story.

STRINGS ATTACHED

Thread lift popularity comes in waves.  Right now, they’re pretty hot, with doctors using them all over the world [5]. Brands like Aptos®, Happy Lift®, Silhouette®, and a myriad PDO sutures garnish websites, YouTube videos and brochures in every continent.  So with so much out there, what’s the thing to look out for if you’re thinking of a thread lift?  The cost? The type of thread?  The surgeon performing your lift?  Of course—all those things.  But importantly, consider your expectations.  Look in the mirror as you discuss what will make you happy with your doctor.  Make sure you tell him or her what you would expect to see from such a lift. Frequently people think they are going to get a dramatic lift with a thread.  Threads themselves can indeed deliver results, but they are typically subtle or moderate at best.  

That’s appealing to many people, but if you want a facelift and think a thread lift will give you similar results, you’re setting yourself up for disappointment.  Having said that, experts in aesthetics can transform faces by using combination therapies such as fillers, botulinum toxins, peels and of course threads too.  Don’t be surprised if your surgeon recommends volume, skin treatments or energy-based devices as a combination approach. They’re not necessarily upselling—combination is key in facial rejuvenation. 

A THREAD OF EVIDENCE

So what’s the science behind threads, and where’s the evidence that they do anything at all?  There aren’t that many scientific studies assessing thread lifts and how effective they are, so their value if often based purely on anecdotal evidence [6]. However, a recent study analysed the benefits of different threads and revealed they did provide significant aesthetic improvement at two years follow up in some instances [7]. 

Also, as described above, these authors remind us that combining threads with other treatments gives overall more impressive results.  It’s also widely acknowledged by experienced aesthetic surgeons and physicians that thread lifts do not replace traditional facelifts.  Complications from thread lifts can include infection, pain, threads irritating or sticking through the skin, irregularities and short-lived results.  It’s pretty rare that they require removal though, although it’s not uncommon for facial plastic surgeons to fish out old threads during subsequent open facelift surgeries!

References

1. Comparison of Antiaging Effects on Rat Skin of Cog Thread and Poly-L-Lactic Acid Thread.  Kapicioğlu Y, Gül M, Saraç G, Yiğitcan B, Gözükara H.Dermatol Surg. 2019 Mar; 45(3):438-445
2. Thread-Lift Sutures: Anatomy, Technique, and Review of Current Literature. Halepas S, Chen XJ, Ferneini EM.J Oral Maxillofac Surg. 2020 May; 78(5):813-820.
3. Facial thread lifting with suture suspension.  Tavares JP, Oliveira CACP, Torres RP, Bahmad F Jr.Braz J Otorhinolaryngol. 2017 Nov-Dec; 83(6):712-719
4. Micro-Shuttle Lifting of the Neck: A Percutaneous Loop Suspension Method Using a Novel Double-Ended Needle. Tiryaki KT, Aksungur E, Grotting JC.Aesthet Surg J. 2016 Jun;36(6):629-38
5. Thread-Lifts: A Double-Edged Suture? A Comprehensive Review of the Literature.  Tong LX, Rieder EA.Dermatol Surg. 2019 Jul;45(7):931-940
6. Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature.  Gülbitti HA, Colebunders B, Pirayesh A, Bertossi D, van der Lei B.Plast Reconstr Surg. 2018 Mar; 141(3):341e-347e
7. Thread Lifts: A Critical Analysis of Treatment Modalities. Adam A, Karypidis D, Ghanem A.J Drugs Dermatol. 2020 Apr 1; 19(4):413-417