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Hanging by a Thread: Choosing the Right Thread for the Right Patient



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wrinkles due to the facial scaffoldingnot being able to provide as
much support. Thread lifts or suture lifts involve the use of threads or
sutures made from materials used in surgery to close wounds. When
threads are placed under the skin they can tighten and lift loose or
sagging areas in various parts of the face and body to help reduce the
effects of gravity and ageing, or they can be used to rejuvenate the
There are three main types of threads currently available;
polydioxanone (PDO), polylactic acid (PLA) and polycaprolactone
(PCA). PDO threads have been around the longest and are made of
a synthetic biodegradable polymer that has been used in surgery for
many years. PDO threads are absorbed into the body over 6 months
by hydrolysis and work by triggering broblasts to produce more
collagen in a targeted area. There are three main types of PDO threads
used; mono, cog and screw threads. Mono threads are smooth without
barbs and are anchored to a point on the face or the scalp. They mainly
tighten the skin and provide a small amount of lift.2 Cog threads have
barbs which hook onto the skin to provide support and lift the sagging
tissue. Screw threads have one or two intertwined threads around the
needle and provide good volume restoration to sunken areas of the
skin. The production of collagen around the threads and their barbs
helps to restore volume and improves the skin texture and elasticity
resulting in a natural aesthetics outcome.
After PDO threads, PLA threads were developed. They are made
from a biocompatible polymer derived from lactic acid that has been
used in many applications such as orthopaedic pins and sutures. PLA
threads are resorbable and regenerate collagen over a longer time than
PDO threads. PLA threads use cones to hook to the tissue and increase
the volume of saggy areas therefore helping to restore shape to the
facial area as well as providing a lift.
PCA threads are the newest threads and are bio-absorbable,
monolament suspension threads of synthetic origin (caprolactone).3
They work by regenerating collagen over a longer time than PDO
and PLA threads. They leave behind a collagen structure that provides
support for the skin, tightens the skin and prevents it from sagging.
Due to the brotic reaction caused by the threads, the lifting and
stretching action will continue even after the threads have been
resorbed. The process of thread breakdown produces molecules of
small molecular weight which subsequently induce the production of
collagen and Hyaluronic acid by the skin. The resulting skin is more
moisturized, revitalized and rm with a long lasting result.
Before deciding what type of thread to use we must consider
the treatment indications and what we are trying to achieve; facial
lift or facial rejuvenation.4 If a patient wanted tissue lifting PDO
monolament threads would be unsuitable as they are placed
supercially, are completely smooth and without barbs. While they
produce a regenerative and rming effect that visibly improves skin
quality they do not provide an effective amount of tissue lifting.5
To achieve a powerful lift with improvement in facial tightening
and rejuvenation, barbed threads must be used. The barbs along the
threads act as cogs to clasp the skin creating tension in the thread
which lifts and suspends the facial area. Collagen is formed around
the threads and their barbs resulting in an increased effect.6,7 Consider
now a patient, who requires a facial lift, there are further factors which
ensure efcacy and longevity of the results (barb length, angle, spatial
distribution and direction of barbs or cones, resorption time and the
collagen-stimulating ability of the thread).
The barbs must have a length that enables them to hook onto the
skin tissue and maintain the lift required. If they are too long then they
become too exible and incapable of lifting the facial tissue. On the
other hand, if the barbs are too short they will not be able to hook onto
the facial tissue in the rst instance. Furthermore, we need to consider
how densely the barbs are placed along the thread length. Threads
with a low barb density will not be able to lift the same amount of
tissue as threads with a high barb density and therefore will not result
in the desired facial lift. In addition, low barb density threads will be
less effective at lifting larger volumes of tissue or heavier tissue and
restrict the practitioner to working only with small amounts of soft
tissue. Of course, a thread must have smooth areas that are barb-free
to ensure there is adequate anchoring and to avoid any puckering of
the skin.
The angles of the barbs also have a place in how much hold is
achieved. If the angle is too small then the lift will be weak, conversely,
if the angle is too big the barb may dig into the thread causing it to
break. The manufacturing process for some threads can result in the
barbs actually digging into the thread, reducing its thickness or gauge
in areas. Ideally, the length of the base of the barb should be equal
to the thickness of the thread. The spatial distribution of the barbs
J Dermat Cosmetol. 2017;1(4):8688. 86
© 2017 Wong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Hanging by a thread: choosing the right thread for
the right patient
Volume 1 Issue 4 - 2017
Vincent Wong, Raq N, Kalyan R, Hsenriksen
A, Funner R
Derma Clinic, London
Correspondence: Vincent Wong, Derma Clinic, London, Tel
0207 299 0380, Email
Received: May 15, 2017 | Published: December 05, 2017
Journal of Dermatology & Cosmetology
Mini Review Open Access
Keywords: surgery, polydioxanone, polylactic acid, orthopaedic,
polycaprolactone, hyaluronic acid
Abbreviations: PDO, polydioxanone; PLA, polylactic acid;
PCA, polycaprolactone
Mini review
Ageing causes loss of facial fat, especially around the cheeks, the
eye area, the jowls and the neck. Accompanying this is skin ageing
where the elastic bers in the skin become thinner resulting in loss of
facial elasticity? The two processes result in a longer face an
Hanging by a thread: choosing the right thread for the right patient 87
©2017 Wong et al.
Citation: Wong V, Raq N, Kalyan R, et al. Hanging by a thread: choosing the right thread for the right patient. J Dermat Cosmetol. 2017;1(4):8688.
DOI: 10.15406/jdc.2017.01.00021
along the thread will also vary and the more contact there is between
the barbs and the facial tissue, the better the hold. Some threads have
barbs at different angles in order to achieve a 3600 lift; some have
cones to maximize tissue contact, while others have all the barbs lined
up in one line only.
Threads can come as either mono-directional or bi-directional. To
achieve effective lifting of facial tissue the bi-directional threads are
preferred as they provide immediate anchoring to the tissue and the
thread cannot move either way due to the two-way direction of the
barbs. Some mono-directional threads are anchored on both ends at
xed points to enhance stability.8 The nal consideration to make is
how long the thread will last in the tissue. PDO threads will stay in the
tissue for around 6 months, PLA threads around 12 months, and PCA
threads will stay in the tissue for 12-15 months. The longer the thread
lasts the more collagen is stimulated and therefore the result is much
better and longer lasting. PDO and PLA threads cause brosis in the
surrounding area and create type 1 collagen. PCA threads stimulate
the production of type 1 and 3 collagen which helps to improve the
condition of the skin giving a youthful appearance.
How do we decide which thread to use for which patient? Ultimately
we have to look at the age of the patient, the treatment area and what
we are trying to achieve. PDO threads are better at repositioning and
revitalizing tissue but not for providing lift so would be suited more to
younger patients. PLA threads provide some lifting, but again would
be suitable for patients who only require a small amount of tissue lift.
PCA threads provide more lift and are more suitable for patients who
require a small to moderate amount of lift. Other factors that have an
effect on the desired results are the technique used to insert the threads
and the positioning of the threads (Figure 1).9
Figure 1 Decision tree to select the right thread for the right patient.
In summary, each thread type has a place and selecting the right
thread for the right patient is vital to achieve the desired outcome as
well as managing the patients expectations. Good skin is essential
as response to the treatment relies on the threads to tighten over the
lifted area. Patients with thin skin may have more chances of sutures
showing, rippling effect and bruising.10 Threads lifts are not suitable
for patients with excessively saggy skin. Threads may not be suitable
if the skin is very aged, thick or damaged, but still it is important
to remember that thread lift, especially PCA, represents an option
for those who cannot tolerate surgical lifting or narcosis. Patients
with good soft tissue volume, less facial fat and a small amount of
skin to be lifted will benet the most from thread lifts. For patients
who desire a lifting and/or revitalization effect, thread lifting is a
minimally invasive technique which is well-tolerated. The procedure
is quick and mostly pain free, although the outcome and nal results
are dependent on the qualications discussed above. There will be
patients for whom surgical lifting will be a more suitable option and
most importantly, we must remember that thread lifts are not designed
to replace surgical lifting (Table 1).
Table 1 Summarizing the different threads
type Rejuvenation Mild
Mild to
lift Longevity
PDO X 6 months
PDO X X 6 months
PLA X X 12 months
PCA X X 12-15
Conict of interest
The author declares no conict of interest.
1. Khazanchi R, Aggarwal A, Johar M. Anatomy of ageing face. Indian J
Plast Surg. 2007;40(2):223–229.
2. Shimizu Y, Terase K. Thread lift with absorbable monolament threads. J
Japan Soc Aesthetic Plast Surg. 2013;35(2):1–12.
3. Savoia A, Accardo C, Vannini F, et al. Outcomes in thread lift for facial
rejuvenation: a study performed with happy liftTM revitalizing. Dermatology
and Therapy. 2014;4(1):103–114.
4. Tonks S. Understanding thread lifting. Aesthetics. 2015.
5. Dancey E. New generation absorbable threads. Aesthetics. 2014.
6. Wu WT. Barbed sutures in facial rejuvenation. Aesthet Surg J.
7. De Lorenzi C. Barbed sutures: Rationale and technique. Aesthet Surg J.
Hanging by a thread: choosing the right thread for the right patient 88
©2017 Wong et al.
Citation: Wong V, Raq N, Kalyan R, et al. Hanging by a thread: choosing the right thread for the right patient. J Dermat Cosmetol. 2017;1(4):8688.
DOI: 10.15406/jdc.2017.01.00021
8. Kalra R. Use of barbed threads in facial rejuvenation. Indian Journal of
Plastic Surgery. 2008;41(Suppl):S93–100.
9. Mian I. PDO Threadlifting. Aesthetics. 2017.
10. Paul MD. Complications of barbed sutures. Aesthet Plast Surg.
... Since surgeons rely on prosthetic materials to treat POP, using approaches currently applied in face lifting may be a solution for POP treatment. Face-shaping supports being lost, especially around the cheeks, the eye area, the jowls and the neck is one of the telltale features of ageing, which are due to progressive soft-tissue laxity [20,21]. Thread lifting is becoming popular among patients despite its less effective lifting result. ...
... Since the thread's barbs firmly anchor into the soft tissue, no additional anchoring points are needed, reducing the material burden, which can cause an inflammatory reaction [27]. Moreover, the procedure could be personalized by the injected threads number, material choice and thread type [21]. ...
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The diagnosis and treatment of pelvic organ prolapse (POP) remain a relevant and scientifically challenging topic. The number of cases of genital prolapse increases each year, one in ten women need at least one surgical procedure and one in four women in midlife have asymptomatic prolapse. Using mesh implants to correct POP presents unsatisfactory clinical outcomes, requiring hospital readmission and further surgery. We hypothesize using an alternative surgical intervention technique, applying injectable biodegradable cog threads, currently used for face lifting procedures, to reinforce and correct vaginal wall defects. The threads used in this investigation are commercially available 360° 4D barb threads (PCL-19G-100), made of polycaprolactone (PCL), supplied in sterile packs (Yastrid, Shanghai, China). Eleven sows’ vaginal walls were used to analyze the immediate reinforcement effect of the threads. Uniaxial tensile testing and scanning electron microscopy (SEM) was performed for the initial characterization of the threads. Threads were inserted into the vaginal wall (control n = 5, cog n = 5) and were characterized by ball burst testing; a pull-out test was performed (n = 6). With SEM images, dimensions, such as thread diameter (≈630 µm), cut angle (≈135°), cut depth (≈200 µm) and cog distance (≈1600 µm) were measured. The mechanical behavior during uniaxial tensile testing was nonlinear. Threads could sustain 17–18 N at 18–22% of deformation. During the ball burst test, vaginal tissue reinforced with threads could support 68 N more load than normal tissue (p < 0.05), indicating its strengthening effect. Comfort and stress zones were significantly stiffer in the tissues reinforced with threads (p < 0.05; p < 0.05). Both groups showed identical deformation (elongation); no significant differences in the comfort zone length were observed, showing that threads do not affect tissue compliance. The pull-out test showed that the threads could sustain 3.827 ± 0.1891 N force when the first cog slip occurs, at 11.93 ± 0.8291 mm. This preliminary research on using PCL cog threads for POP treatment showed promising results in increased vaginal wall resistance to pressure load and, at the same time, not affecting its compliance. Nevertheless, to obtain long term host response in vivo, further investigation will be carried out.
... Absorbable polymers are clinically beneficial as they avoid the need for thread removal or knot creation, thus reducing foreign body reactions and, consequently, tissue scarring. PDO threads reabsorb within 6 months and induce fibroblast production of collagen in a defined region, but mainly around the threads and its barbs, to create volume and improve skin elasticity and texture [34]. PLLA threads require more time to be resorbed than PDO threads and thus also prolong collagenesis. ...
... PLLA threads require more time to be resorbed than PDO threads and thus also prolong collagenesis. PLLA cones facilitate the lifting, shaping, and volumization of sagging facial tissues [34]. ...
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IntroductionAsian patients often seek to address lower facial aging through clinical interventions that increase anterior projection and jawline contouring. The Definisse™ (also known as Happy Lift™) thread lift treatment uses barbed absorbable threads to suspend tissues and induce biostimulation. We evaluated the efficacy and safety of absorbable barbed threads for lower facial reshaping in Thai patients.Methods This prospective, evaluator-blinded study enrolled 27 Thai patients diagnosed with mild to moderate facial laxity. Patients underwent thread implantation along the mandibular angle with one of two double needle thread lengths (12 and 23 cm) to create a “J stitch”. Primary outcome was the clinical improvement in facial laxity as graded by two blinded dermatologists at baseline, immediately after treatment, and at 1 week and 1, 2, 3, 6, and 12 months follow-up. Objective measurements included volume in the jawline, nasolabial folds, and submental area. Patients’ self-assessment scores and adverse reactions were recorded.ResultsOf the 27 patients recruited to the study, 25 (92.6%) attended all follow-up visits. Clinical improvement of facial laxity was observed immediately after thread implantation. There was significant volume improvement in the jawline, nasolabial folds and submental area at almost all follow-up visits (p < 0.007), with most patients (51.9%) reporting excellent lifting effect as early as the 1 week follow-up visit. All adverse reactions were mild and resolved spontaneously without any medical intervention.Conclusion Implantation of absorbable barbed threads is a safe and effective treatment for facial rejuvenation in Thai patients. Long threads (23 cm) showed a slight superiority to short threads (12 cm) in terms of face-lifting efficacy, which suggests the benefit of additional barbs in tissue suspension and biostimulation. The disadvantage of absorbable threads is that their visible lifting effects are not as long-lasting as those of non-absorbable ones, since they are reabsorbed from 6 months onwards.Trial identifier: TCTR20210415001. This clinical trial was retrospectively registered 12 April 2021.
... Complications like bruising, swelling, tenderness, numbness, post-operative pain or infection, any facial asymmetry, any visible suture were also evaluated. 13 Post-operative follow up was done at 1 week, 1 month, 3 months and 6 months. ...
... [4][5][6] threads can be used for the same depending upon the amount of tightening required. [11][12][13] Complications associated with the thread lift are rare. These include bruising, swelling, tenderness, numbness, facial asymmetry, visible sutures, post-operative pain or infection. ...
... Most commonly, 1-3 PDO threads per side are used when using lifting threads. When using tightening threads, several to dozens of threads per area can be used [50]. The effects of using lifting threads can be seen as early as three weeks after the procedure. ...
Full-text available
The subject of the work concerns the dermatological management of patients mainly with aged skin. The purpose of the work was to present the basic techniques and preparations which are performed by dermatologists in the treatment of aged skin. There are dermatological treatments related to the treatment of skin diseases and cosmetic treatments which are mainly related to skin care. In this work, the method of literature research was applied. On the basis of books and journal articles on dermatological and cosmetic procedures for aged skin, an analysis of treatment types was made. Then, the results of this analysis were presented in the paper under discussion. The paper presents information on the skin and its properties. The structure and functions of the skin, aging processes and characteristics of aged skin were discussed. Then, the possibilities of reducing the visible signs of skin aging through the use of invasive and non-invasive dermatological and cosmetological treatments were given, and the most important components of preparations used supportively in combating skin aging processes were discussed.
... Barbed threads can produce an anterior projection effect (especially for nasal tips and dorsal lengthening; Lee and Yang, 2018 ). Implementing barb thread repositioning also solves the sagging of mid-and lower-face fat compartments ( Wong et al., 2017 ). With barbed sutures, skin texture can also be improved ( Palermo et al., 2019 ). ...
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Background: Aging is a natural process that causes skin texture changes, facial volume loss, and altered 3-dimensional topography of the underlying tissues.Objective: The aim of this study is to assess the malar reshaping strategy in Asian patients using bidirectional suspension-barbed threads.Methods: A prospective interventional study was conducted on Asian patients presenting with mild-to-moderate facial aging who were treated with the Definisse double-needle thread in the Hong Kong Special Administrative Region. The primary endpoint was assessed using the Global Aesthetic Improvement Scale and scoring the benefit of anterior projection using a questionnaire. Patient safety was the secondary endpoint measured.Results: Twenty Asian patients (4 men [20%] and 16 women [80%]; age
... PDO threads are absorbed into the body over six months by hydrolysis and better suited to younger patients. 17 While the lesions in this present case were treated with combined therapy of methotrexate, topical steroids, topical tacrolimus ointment and clobetasol propionate, no significant improvement was observed. Nevertheless, no recovery was observed with only tacrolimus ointment therapy. ...
The term plaque morphea describes a variant of morphea (localized scleroderma) in which oval or round circumscribed areas of induration, pigmentary changes, and violaceous or erythematous halo (i.e., lilac ring) are found in the dermis and occasionally to the superficial panniculus. We report a case of 28-year-old male patient with recurrent plaque morphea who was treated with polydioxanone (PDO) mono threads and topical tacrolimus ointment. After the introduction of PDO mono threads, the patient was prescribed topical tacrolimus ointment for six months. After that six-month period, the lesions were softer to palpation and lighter in color. This was observed as a positive therapeutic response. Notably, no future recurrence was seen at one-year follow up.
... 17 Threads made from PCL are slowly absorbed into the body within 1 ~ 1.5 years compared to PDO (6 ~ 8 months) and PLLA (12 months). 18 For functional improvement of the collagen synthesis and wrinkle improvement, the new PCL thread with less residual monomers and a higher molecular weight has been developed expecting prolonged durability and enhanced efficacy. ...
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Background Polydioxanone (PDO) threads, poly‐L‐lactic acid (PLLA) threads, and polycaprolactone (PCL) threads have been used for lifting and antiaging purposes. The new PCL threads that have less residual monomer compared to the previous PCL are developed. Aims The efficacy of threads regarding collagen synthesis and wrinkle improvement was evaluated in vivo model. Methods In this study, threads were inserted into 30 six‐week‐old male SKH‐1 hairless mice. One of four threads was implanted at either side of the spine of each mouse. Biopsy specimens obtained at 1, 4, and 8 weeks were examined using hematoxylin and eosin (H&E) and Herovici's stain. Additionally, immunoblot analysis was performed using primary antibody for collagen type III and transforming growth factor‐β (TGF‐β) and visualized by chemiluminescence and densitometric quantification. Finally, skin replicas were used to calculate total wrinkle area (mm²). Results Neocollagenesis was significantly increased by 50% in the new PCL and pre‐existing PCL groups at 8 weeks (p value < 0.001). Additionally, new‐PCL‐implanted mice showed a significant increase in collagen type III and TGF‐β expressions at 8 weeks (p value < 0.001). The number of inflammatory cells was also increased in the skin of PCL‐implanted mice at 8 weeks. Finally, wrinkles were reduced about 20% in the new PCL group at 8 weeks. Conclusions The new PCL thread exhibited a superior skin rejuvenation effect. This suggests that the material processing technology can be applied not only to the thread but also to various products such as dermal filler and cosmetics.
Background: "Thread lifting" has quickly gained popularity as a minimally invasive treatment for facial rejuvenation. However, the effectiveness is questionable, and the safety and adverse effects are often not discussed. Objective: To identify and discuss the adverse effects associated with various types of threads. Materials and methods: Studies describing the use of thread lifts were identified using a PubMed search. Inclusion criteria included studies in which barbed and nonbarbed threads were used for the face and neck. Results: Fifty-nine articles consisting of 14,222 patients (14,134 barbed, 81 nonbarbed, and 7 combined cases) were included. The most common side effects overall were facial asymmetry (n = 6,143), edema/tumefaction (n = 453), and ecchymosis (n = 407). Serious adverse effects were rare and consisted of paresthesias, alopecia, and injuries to vessels/glands. Most adverse effects were transient and self-resolving, with the exception of contour irregularities, injuries to vessels/glands, infections, and inflammatory reactions. Conclusion: Most side effects associated with threads were self-resolving, whereas more serious cases subsided with treatment. Future studies are critical to further determine whether thread lifting provides long-lasting, safe, and satisfying results.
This study aimed to evaluate satisfaction in terms of facial appearance, quality of life, and adverse effects in patients undergoing the facial thread lifting procedure using the absorbable facial threads anchored on the superficial and deep temporal fascias. The charts of patients for whom facial anchored thread lifting was performed using absorbable threads between February 2017 and September 2019 were reviewed. Demographic data including age and gender as well as data from the Face-Q scales were collected. Descriptive analysis was made for the adverse effects 1 week after the procedure. The mean value of adverse effects scales was compared 1 and 2 weeks after the procedure and also the mean values of facial appearance and quality-of-life scales were compared at baseline, 6 months, and 12 months after the procedure. All recruited subjects were females with a mean age of 43.42 years. There was a statistically significant decrease in the rate of adverse effects following the procedure between the first and second week. The mean difference in patients' perceived age 6 and 12 months after the procedure was statistically significant when compared with baseline. The psychological distress significantly decreased and the psychological function improved 6 and 12 months after the procedure. The overall satisfaction with facial appearance increased significantly after 6 months with a mean of 20.08. This was maintained at 12 months. The satisfaction in skin appearance, cheeks, nasolabial folds, marionettes, lower face, and jawline appearances improved significantly 6 months after the procedure. This was also maintained at 12 months. Face lifting using the polycaprolactone threads anchored on the temporalis fascia showed a significant improvement in the quality of life and facial appearance. The adverse effects are tolerable starting 2 weeks after the procedure.
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Barbed suture lifting is a minimally invasive surgical technique for facial rejuvenation. This study examined the efficacy and associated risks with this procedure, using a new synthetic, monofilament suspension thread named "Happy Lift™ Revitalizing" (Promoitalia International S.r.l, Naples, Italy). All the patients had average aging signs and required a lifting of modest degree. A total of 37 thread lifts were performed over a 24-month period. In the majority of patients (89%), the results obtained were considered satisfactory. The incidence of complications was low. Only 6% of the patients had slight post-operation asymmetry that was easily corrected. Minor complications experienced by patients included small ecchymosis (62%), mild erythema (40%), small hemorrhage (25%), mild transitory esthesia (6%) and mild post-operation tumefaction (40%). Histopathological and ecographic analyses were performed on the treated skin of selected patients, demonstrating that the lifting effect is guaranteed and fortified by the cutaneous reaction that appears along the length of the thread. Thread lift with "Happy Lift™ Revitalizing" is a safe procedure associated with minor complications, when performed on cohorts of patients requiring a facial lifting of modest degree.
Full-text available
Use of barbed threads, available with uni- and bi-directional cogs or barbs, is a semi-invasive method of lifting sagging skin of the face. Areas treated with this method include the eyebrows, the cheeks, the jowls and the neck. Ease of use and a shorter down-time have made their use popular. Specific indications, operative procedures, risks and complications are described and some clinical results of the author shown.
The author provides a comprehensive overview of barbed suture technology, explaining the hypothesized underlying cellular mechanism. He then describes the procedure, including patient selection, materials, and technique.
Self-retaining barbed sutures, innovations for nonsurgical facial and neck rejuvenation, are currently available as short APTOS threads or long WOFFLES threads. The author uses APTOS threads for malar rounding, facial tightening and firming, and uses WOFFLES threads as a sling, suspending ptotic facial tissues to the firm, dense tissues of the temporal scalp.
Thread lift with absorbable monofilament threads
  • Y Shimizu
  • K Terase
Shimizu Y, Terase K. Thread lift with absorbable monofilament threads. J Japan Soc Aesthetic Plast Surg. 2013;35(2):1-12.
Outcomes in Thread Lift for Facial Rejuvenation: A Study Performed with Happy Lift TM Revitalizing
  • A Savoia
  • C Accardo
  • F Vannini
  • P B Di
  • A Baldo
Savoia A, Accardo C, Vannini F, Di P B, Baldo A (2014) Outcomes in Thread Lift for Facial Rejuvenation: A Study Performed with Happy Lift TM Revitalizing. Dermatology and Therapy 4(1): 103-114.
Understanding Thread Lifting. Aesthetics
  • S Tonks
Tonks S (2015) Understanding Thread Lifting. Aesthetics.
New generation absorbable threads. Aesthetics
  • E Dancey
Dancey E. New generation absorbable threads. Aesthetics. 2014.