Thread Lifts: The Subtle, Non-Surgical Face Lift
Non-invasive facial treatments have radically transformed aesthetic medicine, offering more tolerable and cost-effective treatments with rapid recovery times. Patients are eager to undergo ‘lunchtime procedures’ which can improve the appearance of mild to moderate signs of aging, with neuromodulator toxins, dermal fillers and facial resurfacing procedures all extremely popular.
However, when injectable compounds or skin resurfacing no longer provide the same results due to advancing skin laxity, thread lifts can provide a powerful, minimally-invasive alternative to the facelift. Thread lifts improve the appearance of mild sagging in the soft tissue, reducing the appearance of a ptotic brow, jowl formation, nasolabial fold prominence or flattening of the malar area. When used in conjunction with other non-invasive treatments such as dermal fillers, Botox or radiofrequency, patients can enjoy more holistic facial rejuvenation.
Advances in thread lift technology
The first thread lift introduced in the late nineties, the Aptos thread lift, was celebrated as a gentler form of facelift. A thread was subcutaneously inserted into the skin to provide subtle lift and suspension of the ptotic facial tissue. Earlier thread lifts used barbed, non-absorbable filaments that were inserted via a cannula through a small incision.
The thread was hooked to the skin to gently tighten and lift lax skin. The suture was cut at the insertion point, and permanent knots were tied. Unfortunately, patients who underwent the earlier thread lifts were regularly plagued with unpleasant side effects such as visible bumps and nodules, granulomas, prominent scar tissue, and infection, leading to a downturn in popularity of the thread lift, and scathing reviews online.
Today, the thread lift has been completely overhauled and revitalized for a new generation of patients looking to achieve gentle tightening of lax skin. The risks and likelihood of side effects are dramatically reduced compared to earlier thread lifts. The newest FDA cleared thread lifts, NovaThreads and Silhouette Instalift, are targeted at lifting the neck, jowls, and lower face, and use threads that come in various sizes, lengths and diameters. Biocompatible sutures, such as polydioxanone which does not require anchoring and is safely absorbed by the body within six months, are used. The threads offer a mechanical lift which is maintained by the formation of collagen once the threads have dissolved.
NovaThreads are available in both barbed sutures and smooth sutures made from polydioxanone. Barbed sutures effectively gather more skin and produce more lifting action, and are commonly placed near the hairline to lift the cheeks and jowls. Smooth sutures produce less lift but stimulate more collagen, and are usually placed in problem areas around the face where the signs of aging are particularly evident, such as the corners of the mouth. The sutures stay in place between four to six months, and then slowly dissolve. The results of treatment will remain for a year or more due to the improvement in skin condition that arises from neocollagenesis.
Silhouette Instalift is more focused on lifting the skin than promoting neocollagenesis (although it achieves both objectives). The threads are neither smooth nor barbed, but contain sutures interspersed with cone shapes that can easily grip to temporal fascia. The thread gathers more skin, producing a noticeable lift to problem areas such as the cheeks and jowls. Results last between one and three years.
Delivering the best thread lift results for patients
- The thread lift is most suitable for patients in their late 30s to early 60s who have passed the ‘finger test’. The finger test can be used to determine the degree of laxity of a patient’s skin. Two marks are placed on the cheek which is then lifted towards the top of the ear. The movement of the markers should be less than 1.5cm to ensure the patient derives an excellent outcome from the procedure. Candidates with very saggy, loose skin are better candidates for a traditional facelift.
- Patients in a robust state of health are more likely to enjoy optimal outcomes. Thread lifts provide maximum lift when a response from the immune system is induced, resulting in new collagen production. The immune system degrades with age resulting in diminished collagen production in older patients, and a poorer aesthetic outcome of short duration.
- Women generally enjoy better outcomes than men, as men require more threads and have a higher rate of relapse.
- Thread lifts are commonly performed as 5-point, 8-point or 10-point procedures. However, the number of points used should not be rigid, but customized to the patient’s needs, taking into consideration facial asymmetry.
Enhancing thread lift results with other treatments
A common complaint among patients who have undergone the thread lift is that although the procedure provided good initial results, the results deteriorated relatively quickly. One major study has shown that when a thread lift is combined with other non-invasive aesthetic treatments patient satisfaction is increased, providing enhanced results and even improving longevity. Depending on the patient’s needs and skin condition, the following complementary procedures can be considered:
- Dermal fillers or autonomous fat grafts: Provides volumetric enhancement in strategic locations to supplement the thread lift results.
- Botulinum toxins: While thread lifts generally lift the midface and jowls, Botox, Dysport and Xeomin can soften and reduce the appearance of fine lines and rhytids in the crows’ feet, glabella and forehead in the upper third of the face, contributing to a more refreshed appearance.
- PRP therapy: PRP is commonly combined with a thread lift to provide the patient with a plumped facial appearance and youthful, rosy glow.
- Radiofrequency: Can help to tighten lax skin to a limited degree, and reduce the appearance of superficial rhytids.
- Microneedling: Can help to soften the appearance of fine rhytids and further promote collagen production.
- Facial resurfacing procedures such as CO2 laser: Removes sun-damaged skin and uneven pigmentation.
- Hyaluronic acid tissue modulators using patented heat technology: High and low hyaluronic particles contribute to increased collagen production. They are synergistic when combined with thread lifts as they can also smooth the epidermis, and any skin folds or ripples.
Thermogenic procedures such as laser or radiofrequency must be used with care as thread lift sutures can sometimes denature with heat. These treatments should not be performed prior to the thread lift.
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