Article

Outcomes in thread lift for face and neck: A study performed with Silhouette Soft and Promo Happy Lift double needle, innovative and classic techniques: XXXX

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Abstract

Introduction Increased demand for rejuvenation of the aging face has led to the evolution of various plastic surgery techniques. This study was conducted to evaluate the surgical efficacy and outcomes of the absorbable suture suspension system related to eyebrow, midface, mandibular, and neck lifting. Materials and Methods In this prospective review chart clinical study, a total of 193 patients were included in the study from January 2016 to May 2017. All participants underwent thread lifting using the Proma Happy Lift double needle and Silhouette Soft threads. The patients were followed up for first week and first, third, and sixth month after lifting surgery. Outcomes were assessed by two surgeons and patients based on the GAIS score. Results A total of 193 patients (mean age: 52.22 ± 11.74 year, range: 25‐89), 23 (11.9%) men and 170 (88.1%) women, were included in the study. The most common sites for the face lifting surgery were the jawline (46.1%), midface (33.7%), eyebrows (12.4%), and neck (7.8%). The level of satisfaction increased from 94% in the first week after surgery to 99% in the sixth month after surgery for patients, increased from 94% to 99% for surgeon 1, and increased from 83% to 98% for surgeon 2. Conclusion The results showed that the level of satisfaction of patients and surgeons increased over time. These results demonstrated that facial rejuvenation thread lift with Proma Happy Lift double needle and Silhouette Soft threads is a being cosmetically more acceptance, safe, and effective procedure associated with minor complications.

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... The insertion of the thread is mostly through subcutaneous fat and the SMAS, the fibrous layer that covers the muscles in the face and in some cases the muscle deep layer to fortify the stability of the anchored thread [11]. For instance, to lift skins around the midface and mandible areas, the thread is first inserted on the hairline of the forehead or the pre-tragus area, and maneuvered the movement of the thread in the pattern(s) of straight, curved, or zigzag to reach the targeted loosed soft tissues [12,[17][18][19][20][21][22]. Additionally, threads for the neck area are inserted on the mandibular region parallel to the jaw angle to create visible fine lines by pulling loosed soft tissues between the mental protuberance and the laryngeal prominence [19,20,23]. ...
... For instance, to lift skins around the midface and mandible areas, the thread is first inserted on the hairline of the forehead or the pre-tragus area, and maneuvered the movement of the thread in the pattern(s) of straight, curved, or zigzag to reach the targeted loosed soft tissues [12,[17][18][19][20][21][22]. Additionally, threads for the neck area are inserted on the mandibular region parallel to the jaw angle to create visible fine lines by pulling loosed soft tissues between the mental protuberance and the laryngeal prominence [19,20,23]. Although there are various approaches with threads, all are aimed to lift up the loosed facial tissues to give rejuvenating effects (Fig. 1). ...
... A large number of manufacturing companies produce and develop various types and shapes of threads. For instance, Silhouette Install and Silhouette Soft have recently developed a cone-shaped thread directly connected with a needle on both end sides [20]. Therefore, specialists can decide the best fitting threads to fulfill the demands of consumers/ patients [24]. ...
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Thread lift treatment has been advanced significantly over the past decades and gained popularity due to its minimally invasive and non-surgically achievable rejuvenating effects. This treatment uses a specifically designed thread(s) to lift/pull up targeted loosed skin on areas of face such as midface, eyebrow, mandible, and neck. The visible effects of the thread lift are more obvious when used to minimize and improve the nasolabial folds that extend to the side of the nose and tend to become more noticeable with age. In this review, we aimed to demonstrate rejuvenating mechanisms and effects of thread lift and explain various materials and shapes of threads as well as thread inserting tools. In addition, we provided advantages and disadvantages of each approach to establish a potential standard procedure of the thread lift that can maximize its rejuvenating therapeutic efficacy. Level of evidence: Not gradable
... An example of a bidirectional barbed thread is the Definisse threads, which were previously known as Happy Lift revitalizing threads. Definisse is effective in improving the esthetics of aging skin, which has been confirmed by various clinical studies ( Rezaee et al., 2019 ;Savoia et al., 2014 ). This thread can be used in various approaches of facial reshaping as presented in Table 3 ( Kacey, 2019 ). ...
... Global score on esthetic improvement was recorded by both patients and the physician using the Global Aesthetic Improvement Scale (GAIS) during every follow-up visit. The assessment score rating and description of the scale are presented in Table 4 ( Rezaee Khiabanloo et al., 2019 ). To score for anterior projection, patients were asked to score the benefit of the anterior projection and other benefits in terms of esthetic improvement using a seven-point questionnaire ( Fig. 6 ). ...
... The study reported that 33 patients (89%) were satisfied with the esthetic improvement (65% and 24% with excellent and good level of satisfaction, respectively; Savoia et al., 2014 ). A study by Khiabanloo et al. (2018) also reported that thread lifting is a more acceptable, safer, and effective cosmetic technique associated with a high level of satisfaction among patients and surgeons ( Rezaee Khiabanloo et al., 2019 ). The results were in concordance with the present study as all patients experienced marked improvement in their signs of aging. ...
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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
... The safety and effectiveness of PLCL threads have been demonstrated in clinical studies by Rezaee Khiabanloo et al, 24 Savoia et al, 13 and Kalyan et al. 25 In the study by Rezaee Khiabanloo and colleagues, 193 patients were enrolled and underwent thread lifting procedures to the eyebrows, midface, jawline, and neck using PLCL threads in conjunction with Silhouette Soft threads. These patients aged 25 to 89 years old underwent correction of the jawline (46.1%), midface (33.7%), eyebrows (12.4%), and neck (7.8%). ...
... Patient-perceived level of satisfaction increased from 94% in the first week after surgery to 99% in the sixth month after surgery, while surgeon satisfaction increased from 94% to 99%, and from 83% to 98% for surgeons 1 and 2, respectively. 24 The most reported adverse event was ecchymosis (40.9%), followed by complications of dimples (28.5%), tumefaction (18.1%), and pain (5.2%). 24 Overall, the results of this study showed that facial rejuvenation using combination of PLCL threads and Silhouette Soft threads is effective, safe, and is associated with minor complications. ...
... 24 The most reported adverse event was ecchymosis (40.9%), followed by complications of dimples (28.5%), tumefaction (18.1%), and pain (5.2%). 24 Overall, the results of this study showed that facial rejuvenation using combination of PLCL threads and Silhouette Soft threads is effective, safe, and is associated with minor complications. 24 Savoia and colleagues evaluated patient-perceived surgical outcomes associated with PLCL threads in eyebrow lifting, forehead lifting, mid-face lifting (zygomatic malar), upper-mandibular region lifting, and high cervical region lifting. ...
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Article
The use of bioabsorbable threads has become a common minimally invasive technique for the nonsurgical lifting of sagged facial tissues. It entails the passage of barbed threads that form a support structure under the skin of the face and neck to mechanically reposition sagging tissue. Poly(L-lactide-co-ε-caprolactone) has long been used as absorbable sutures and as such has a well-demonstrated efficacy and safety profile. This biomaterial also has a well-defined biocompatibility and degradation profile. All studies reviewed in this paper show that thread lifting with absorbable barbed threads is an effective and well-tolerated procedure for correction of ptosis in facial and neck soft tissue and is associated with minor and reversible adverse effects. Most patients and surgeons consider the procedure satisfactory, with good to excellent results. This publication reviews the literature and clinical data supporting the degradation, absorbability, biocompatibility, safety, and effectiveness of these threads when used for tissue repositioning and facial rejuvenation procedures.
... They have a risk of migration, extruding from the skin, and may be visible under facial skin. 13 Nowadays, the use of lifting threads made from biocompatible and biodegradable materials has received global attention. ...
... 22 Polycaprolactone (PCL) threads are the latest monofilament suspension threads of synthetic origin (caprolactone). 13 They regenerate collagen for a longer period than PDO and PLLA threads. The breakdown process of threads produces small molecular weight molecules which gradually induce the production of collagen and hyaluronic acid by the skin. ...
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Article
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.
... 7 Thus, facial rejuvenation techniques using threads have been frequently performed to lift brow, midface, jowl, and neck, and their treatment outcomes have been well described in the literature. [8][9][10][11] The barbed suture was first used to lift the ptotic facial tissue by Sulamanidze et al. 12 Since then, its efficacy and safety have been reported in published studies, followed by the emergence of variants of the original antiptosis suture (Aptos) threads. But facial rejuvenation techniques using threads share a similarity; cogged threads are inserted in the subcutaneous layer, pulled to achieve the desired skin lift and secured and then trimmed at the entry point. ...
... But facial rejuvenation techniques using threads share a similarity; cogged threads are inserted in the subcutaneous layer, pulled to achieve the desired skin lift and secured and then trimmed at the entry point. 11,[13][14][15] Conventional types of face-lifting procedures are characterized by dissection of facial layers followed by maximal traction of the dissected plane and fixation of it to the desired location. 16 Moreover, previous "long-thread" types of threadlifts share similar procedures to conventional face-lifting procedures in that threads are anchored at the deep temporal fascia and then lift the skin from their end. ...
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Article
Background: Threadlifts are classified as absorbable or nonabsorbable, natural or synthetic, and multifilament or monofilament ones, each of which has its own merits and demerits. We placed a novel absorbable polydioxanone monofilament threadlift (Mint Lift Fine; HansBiomed Co. Ltd., Seoul, Korea) in the subcutaneous fat compartment for facial rejuvenation in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. Here, we describe its short-term treatment outcomes in a retrospective consecutive series of 21 patients. Methods: A total of 21 patients (n = 21) were evaluated; their treatment outcomes were described based on a comparison between preoperative and postoperative findings and Global Aesthetic Improvement Scale (GAIS) scores were assessed at 6 months. This is accompanied by analysis of the incidence of postoperative complications. Results: The patients had a mean GAIS score of 3.62 ± 0.84 points, which corresponds to "Much improved" or "Very much improved." Moreover, there were no significant differences in the GAIS scores between the target sites (midface and lower face: 3.78 ± 1.13; lower face: 3.43 ± 0.50; and midface: 3.60 ± 0.49; P > 0.05). Furthermore, there were a total of 4 cases (19.0%) of postoperative complications, all of which were spontaneously resolved within a maximum period of 4 months. Conclusions: We describe short-term treatment outcomes of facial rejuvenation using the Mint Lift Fine in patients with nasolabial folds, nasojugal groove, marionette lines, or sagging jowl. But further large-scale, prospective, multicenter studies with long periods of follow-up are, therefore, warranted to establish our results.
... Many histopathological studies have indicated, the use of absorbable lifting threads might trigger TGF-b signaling, which induces increases in collagen components and fibrosis formation. Therefore, the suture placement enhances the volume of the subcutaneous tissue over time and helps to permanently alter the surrounding structures biologically, resulting in favorable rejuvenation effects, skin lifting, and generating a longer-lasting smooth, contoured appearance [16,23,24]. ...
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Article
Background Horizontal neck wrinkles develop during the aging process. Aims This study assessed the effectiveness of a comprehensive approach to treating horizontal neck wrinkles using non-cross-linked hyaluronic acid injection and smooth absorbable PPDO (Poly p-dioxanon) thread insertion. Methods Ten patients with horizontal neck wrinkles were treated with hyaluronic acid injection and thread-lifting. The clinical outcomes were evaluated six months after treatment. Results The median global aesthetic improvement scale scores evaluated by plastic surgeons and the patients were 4.3 ± 0.8 (3–5) and 4.1 ± 0.7 (3–5), respectively, at six months post-treatment. Five (50%) patients strongly agreed, and three subjects (30%) agreed that their horizontal neck wrinkles had improved following treatment. No serious adverse events, including infections, lumps, irregularities, or the Tyndall effect, occurred during treatment. Conclusion This study revealed that a comprehensive approach using hyaluronic acid and thread-lifting provided satisfactory and effective clinical outcomes in treating horizontal neck wrinkles. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
... Non-absorbable barbed sutures are a suitable alternative for surgical techniques. However, it persists for a long time and might be easily palpable, or might extrude across the skin [4][5][6][7][8]. ...
... To the best of the authors' knowledge, published reports about the efficacy and longevity of thread lifting are merely based on nonstandardized photographic assessment and self-related questionnaires addressed to patients, even during long follow-up periods of large patient groups and after a statistical evaluation of the results. [3][4][5] The resulting treatment indications and patient selection recommendations are, therefore, quite broad. [6,7] This observational study has been carried out on the basis of the routine assumption that cosmetic procedures are very subjective and, beyond the mere judgment of patients and clinicians, is thus strongly recommended to bridge the gap in facial aging treatment. ...
Article
Introduction: The facial aging process produces changes that are characteristic of the superficial and deep fat framework and skin layers. Subdermal suspension with threads enables the sagging tissues to be lifted by means of a minimally invasive, closed procedure without surgical dissection. This observational study has been carried out on the basis of standardized tridimensional photographic analysis and measurement, aimed at determining objective, repetitive, and reliable evaluation of the soft tissue suspension technique. Materials and methods: Eight participants were enrolled in this pilot study presenting with mild to moderate ptosis of the jawline tissues. Patient photographs were taken before (t0), immediately after threads implantation (t1), and at the following visit (t2). Each image captured before thread insertion was registered by the software and surface linear lengths in between the mentioned points were calculated. Results: The result showed an overall average improvement in the "tragus-to-marionette distance" (C-A) and the "tragus-to-jowl distance" after a mean follow-up time of 8.16 months (t0-t2). All analyzed parameters improved significantly (P < 0.05) at t1 and at t2 with respect to t0. Conclusions: This pilot study suggest that facial tissue suspension by means of poli-lactic/poli-caprolactone threads is safe and effective in treating skin flaws that affect mild-to-moderate ptosis of the jawline up to 8 months.
... 11,12 To the best of the authors' knowledge, published reports about thread lifting efficacy and longevity are merely based on nonstandardized photographic assessment and self-related questionnaires addressed to patients, even during long follow-up periods of large patient groups and after a statistical evaluation of the results. 13,14 This observational study has been carried out to determine, through standardized photographic analysis, the outcome of thread lifting procedures of the midface. ...
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Article
INTRODUCTION Volume restoration then remains the principal target to be addressed when approaching midface rejuvenation, and absorbable sutures can create a suspension system that addresses ptotic skin located primarily in the midface. This observational study has been carried out to determine the outcome of thread lifting procedures of the midface. MATERIALS AND METHODS six participants were enrolled and treated with suspension threads to correct mild to moderate ptosis of the flabby tissues of the midface. Volumetric changes were calculated at t0 (pre‐treatment), t1(120days) and t2 (365 days), with a mean follow‐up time of 349.64 days, (range from 304 to 380.5 days). RESULTS showed an overall average improvement of 5.59 ml at 120 days (t0‐t1) after thread implantation, up to a mean value of 4.16 ml at the end of the 350 days follow up (t0‐t2). A comparison was made in between and statistical analysis was performed with level of significance set at P < 0.05. DISCUSSION The aim of this pilot study was to investigate the effectiveness in lifting sagging tissue of the midface: the results shown suggest that it is possible to achieve volume restoration which lasts up to 12 months as all parameters improved significantly (P < 0.05) at t1 and at t2 with respect to t0. CONCLUSIONS The results suggest that facial tissues suspension by means of threads is safe and effective, as it is possible to achieve tissue repositioning which lasts up to 12 months for the correction of mild to moderate ptosis of the midface. This article is protected by copyright. All rights reserved.
... Sonra ipler gerilerek gerekli askılama ve kaldırma yapılarak iplerin uç kısımları deri altında kalacak şekilde derinden kesilmelidir (Şekil 4). 7,[27][28][29] l TEKNİğİ İlE KAŞ KAlDIRMA L tekniğinde, giriş noktası genellikle kaşın lateral ucu ile yayı arasındandır. İlk iğne kaş yayı boyunca mediale doğru hareket eder ve en az 3 cm geçtikten sonra çıkarılır. ...
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Yüz yaşlanmasına kaşı yapılacak bütün estetik işlemde yüz anatomisini bilmek gerektiği gibi göz çevresi ile ilgili işlemlerde de göz çevresi anatomisini bilmek çok önem arz eder. Göz ve göz çevresi birbiri ile ilişkili karmaşık bir anatomiye sahiptir. Bu bölgede bulunan yüzeyel ve derin yerleşimli sinirler ve damarlar göz ve göz kaslarının damarları ve sinirleri ile bağlantılı olarak yer almaktadır. Ayrıca göz üstten ve alttan damar ve sinirlerin çıktığı supraorbiküler ve infraorbiküler deliklerin ortasında lokalize olmaktadır. İp veya diğer uygulamalarda sinir ve damar yaralanmalarında ciddi komplikasyonlarla karşılaşmak kaçınılmaz olabilir. Ayrıca göz çevresi ve göz kapağı derisi vücudumuzdaki en ince deri yapısına sahip olup yüzeyel yağ dokusu ve kollajen bakımından da zayıftır. İp uygulamalarında ipleri yerleştirdiğimiz subkutan doku içinde yer alan süperfisyal muskulo-aponörotik fasya olan SMAS göz çevresi lateral kısımlarında bulunurken göz altları, burun ve göz medialine doğru azalarak etkinliğini yitirir. Estetik uygulamaların etkinliği açısından göz çevresi yağ yastıkçıklarının, ligamenter yapıların, lakrimal bez ve kanallarının anatomik yerleşimlerinin iyi bilinmesi gerekmektedir. Periorbital Bölgede İp Uygulamaları Thread Applications in the Periorbital Region ÖZET Göz çevresi, statik ve dinamik kırışıklıkların yanı sıra deri altı dokusu ve kemik yapısında hacim kaybı ile yaşlanma belirtilerini gösteren vücudun ilk bölgelerinden biridir. Karmaşık anatomisinin olması, yüzün diğer bölümleri ile olan sıkı ilişkisi, dinamik kaslar ile olan bağlantısı ve oluşturduğu yüz ifadesi nedeniyle tedavi edilmesi zorlaşır. İnsanlar birbirleri ile karşılıklı olarak veya dijital platformda gözle-rine bakarak iletişim kurdukları için yüzde en dikkat çekici yer olarak karşımıza çıkmaktadır. Göz çevresindeki yaşlanmaya bağlı oluşan; doku kayıpları, kırışıklıklar, göz kapağı ve kaş düşüklükleri, torbalanmalar, lekelenmeler için son zamanlarda cerrahi tedaviler dışında non-invazif metodlar olan botulinum toksin, dermal dolgu, yağ transplantasyonu, lazer tedavileri, peeling, mezoterapi, PRP ve ip tedavileri uygulanmaktadır. Bu bölümde göz çevresinde görülen yaşlanma belirtilerine karşı yapılabilecek ip çeşitleri ve uygulamaları anlatılacaktır. Anahtar Kelimeler: Göz çevresi; ip uygulamaları; gençleştirme; kaldırma ABSTRACT: The eye area is one of the first areas of the body that shows signs of aging with volume loss in the subcutaneous tissue and bone structure, as well as static and dynamic wrinkles. It is difficult to treat because of its complex anatomy, tight relationship with other parts of the face, its connection with dynamic muscles and the facial expression it creates. It is the most remarkable place because people communicate with each other or by looking into their eyes on the digital platform. Occurring due to aging around the eyes; Botox, dermal filling, fat transplantation, laser treatments, peeling, mesotherapy, PRP and thread treatments, which are recently non-invasive methods for tissue losses, wrinkles, eyelid and eyebrow dropouts, bagging, and spotting, are applied outside of surgical treatments. In this section, the types of thread that can be applied against the signs of aging around the eyes and their applications will be explained.
... 18 In a study previously conducted by Rezaee et al, in 2018, it was found that the highest rate of complications was related to ecchymosis (79 cases, 40.9%) followed by dimple (55 cases, 28.5%), tumefaction (35 cases, 18.1%), and pain (10 cases, 5.2%), respectively. 5 These results were in line with the results of this study in terms of the possible postoperative complications. The only difference was in the frequency of complications, as in the previous study, dimple was the second most common complication after surgery, but dimple in this study was the least reported complication after surgery. ...
... Also, systemic reviews, case reports, and open surgery studies excluded from the analysis. We found four new studies that evaluated the thread lift treatment alone [9,[11][12][13], and all demonstrated satisfactory results, high patient acceptance, and low complications. Following P(LA/CL) monofilament thread insertion, the progressive formation of fibrous Values are presented as n (%). ...
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Background : : Overlooked compensatory brow ptosis can lead to patients dissatisfaction and poor surgical results. Objective: To evaluate the quantitative changes in periorbital dimensions in 11 patients with mild to moderate brow ptosis after browlift with Poly(Lactic Acid/Caprolactone) (P[LA/CL]) sutures. Method: Retrospective analysis and data collected from reviewing clinical records, 11 patients, with mild to moderate brow ptosis, whom only has P(LA/CL) browlift, fulfilled the criteria and included in the analysis. All patients had 2-dimensional clinical photos and 3-dimensional clinical pictures in 5 standard views at baseline and follow-up. All periorbital measurements determined by the computer and collected for analysis. Results : : There was a significant difference in all periorbital measurements at 4 to 6 months’ follow-up when compared with baseline (p
... Recent research results show that thread lift for facial rejuvenation was safe, effective, and has fewer complications. 1 Initial use of nonabsorbable threads produced side effects and had a frequent complication and revision rate. Newer published methods using absorbable sutures have shown safer and more effective. ...
... Some optimistic articles lacked a clear efficacy time frame [34] or suffered from a short follow-up. [35] In a recent systematic review, [36] authors demonstrated that, within the past decade, little or no substantial evidence has been added to the peer-reviewed literature to support thread-lift sutures in terms of efficacy or safety. In fact, all included literature in the review, except two studies (prone to conflict of interest), demonstrated none or very limited durability of the lifting effect. ...
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Article
None of brow lift techniques are completely satisfactory because of their limited effectiveness, lack of longevity, and potential complications. The aim of this study was to provide a comprehensive review of the literature on the pros and cons of the most popular techniques in brow and forehead lift. Relevant original articles in the PubMed database (English language) were sought using the search terms “eyebrow lift”, “forehead lift”, ”periorbital rejuvenation”, ”eyebrow ptosis”, ”blepharoplasty and eyebrow change”, ”surgical eyebrow lift”, and ”non-surgical eyebrow lift”, No date limitation was considered. Titles and abstracts were scanned to include the most pertinent articles. Subsequently, full texts of included articles (111 articles) were skimmed and finally 56 references were selected for the review. A narrative synthesis of data was finally undertaken with particular attention to the indications, techniques, and common complications of the eyebrow lift procedures. Ten popular techniques including two nonsurgical methods (Botulinum toxin A and soft tissue fillers) were reviewed in this article. In general, non-surgical methods of forehead/brow lift are temporary, need less experience and correction would be easier should any complication occur. Surgical methods are divided into three categories: trans-blepharoplasty eyebrow lift, direct eyebrow lift, and trans-forehead eyebrow/forehead lift. Currently, the most popular method is the endoscopic forehead lift approach even though its longevity is limited. Direct brow-lift is particularly useful in patients with facial palsy and those who are more likely to be accepting of the scar (male gender, high forehead hair line).
... 18 In a study previously conducted by Rezaee et al, in 2018, it was found that the highest rate of complications was related to ecchymosis (79 cases, 40.9%) followed by dimple (55 cases, 28.5%), tumefaction (35 cases, 18.1%), and pain (10 cases, 5.2%), respectively. 5 These results were in line with the results of this study in terms of the possible postoperative complications. The only difference was in the frequency of complications, as in the previous study, dimple was the second most common complication after surgery, but dimple in this study was the least reported complication after surgery. ...
Article
Introduction To evaluate the surgical efficacy and outcomes related to midface, mandible, neck (and double chin), and nose lifting with APTOS thread lift. Methods In this prospective review chart study, a total of 58 patients were included (from July 2018 to July 2019). All participants underwent facial thread lifting using APTOS. The patients were followed up first week, third, and sixth month after lifting surgery. Outcomes were assessed by two surgeons and patients based on the GAIS score. All data were analyzed by SPSS‐17 software with chi‐square test. Results A total of 58 patients (Mean ± SD: 52.52 ± 10.58) (F: 45, Mean ± SD:53.13 ± 11.27 years, M:13, Mean ± SD: 50.38 ± 9.43 years) were included in the study. The most common sites for the face‐lifting surgery were midface and mandibular (N = 45, 77.5%), neck (N = 10, 17.3%), and nose (N = 3, 5.2%), respectively. The level of satisfaction remained unchanged (after 6 months), about 80%, for the patients, increased from 90.7% (first week) to 94.8% (sixth month) after surgery, and increased from 93.1% (first week) to 94.8% (sixth month after surgery). The highest rate of potential complications after the surgery was related to ecchymosis (17 cases, 30%), followed by complications of pain (N = 10, 17.2%), tumefaction (N = 4, 6.9%), and dimple (N = 1, 1.7%) were reported. Conclusion The results showed that satisfaction in patients and surgeons increased over time (after 6 months). Postoperative (minor) complications were also assessed and ecchymosis was found to be the most common complication. However, the proportion of postoperative complications was relatively low.
Chapter
The results of thread lifting are dependent on the doctor’s expertise, vectors, and the patient’s condition. Thread lifting can be done by either cogged thread or plain thread, dependent on the required mechanical traction force and chemical effects. The cogged threads can be further divided into the fixed type and floating type. In this chapter, we will discuss the crucial factors and various techniques for thread lifting.
Article
Background: Aging is an inevitable process. Eyebrows, cheeks, mandible, and neck are the areas that are the most vulnerable to the aging process. The most commonly thread lifted areas of the face are the jawline, midface, eyebrows, and the neck. Patients and method: In this retrospective study, patients who were treated with thread-lifting between January 2018 and April 2020 were evaluated and the following were noted: the age and gender of the patient; the type of thread used; number of threads used; treatment area; patient satisfaction; and complications. The effects of age, type of thread used, number of threads used, and treatment area on patient satisfaction were analyzed statistically. Results: The relationship between age and patient satisfaction is statistically insignificant, p = 0.697. The relationship between patient satisfaction and the type of the thread used was insignificant, p = 0.533. There is no relationship between the number of threads used and patient satisfaction, p = 0.783. There is no difference in patient satisfaction between treatment areas, p = 0.930. The most commonly observed complications were edema, pain, and ecchymosis. Conclusion: We report that the patient satisfaction in thread-lifting is independent of the patient's age, treatment area, type of thread used, and the number of threads used. Our study is novel as it is the first study to report that the age of the patient and the thread type do not effect patient satisfaction.
Article
Introduction One of the most frequently performed anti-aging surgical procedures is thread facelift. Since the 2010s, thread lifts using absorbable polydioxanone (PDO) thread were developed and have become increasingly popular. This research aims to identify the changes in and the mechanisms of absorbable thread-lifting components, namely, PDO (polydioxanone) and PCL (polycaprolactone), with varied absorption periods in the body. Methods Four different types of threads, namely, single-stranded thread, 4-stranded thread, 12-stranded thread, and barbed Cog thread, were used for each component. Histological changes in the thread and neighboring tissue of rat model were investigated for 2-week interval, and PCR was conducted for genes related to fibroblast proliferation including type 1α1 collagen, type 3α1 collagen, transforming growth factor beta 1 (TGF-β1). Results An increase in the collagen formation in all types of PDO and PCL groups was observed during the first 12 weeks and decreased afterward. Collagen formation decreased later in the PCL thread group significantly than the POD group. PCL thread remained logner in the tissue for over a year regarding POD requiring around 24 weeks of absorption–degradation. A larger surface area between the thread and the tissue induces a greater response in the tissue, resulting in an increase in inflammatory cells, myofibroblasts, and fibroblasts. Results showed a similar pattern of increase in type 1α1 collagen and TGF-β in the PDO thread group. This suggests that TGF-β signal transduction leads to fibroblast proliferation that stimulates collagen formation and tissue re-formation. In contrast, only type 3α1 collagen increased in the PCL thread group. Conclusion More collagen formation and tissue responses are induced by PCL thread, remaining longer in the tissue than PDO, leading to more tissue tightening effects that is one of the most important points of face lifting. Morphological comparison of threads shows that not only an increase in surface area between thread and tissue but also multi-strand increase tissue response, which in turn increases tissue maintenance effects.
Article
Background: Facial thread lifting technology has been applied for more than 30 years, with relatively few complications. In 2014, China approved polydioxanone thread (an absorbable barbed thread) for large-scale nonsurgical facial lifting. However, due to surgeons' lack of overall experience, the complications of polydioxanone thread facelift have been relatively high. Methods: From April 2014 to January 2020, a total of 190 patients with postoperative complications of facelifts were treated after they underwent thread lifting in other hospitals. Of these, 189 patients were women and one was a man; the age of patients ranged from 28 to 62 years, with an average age of 37.4 years. Results: Patients were mainly treated in our outpatient clinic for the following complications: skin dimpling (77 cases, 40.5%); contour irregularity (32 cases, 16.8%); visible threads (31 cases, 16.3%); thread extrusion (10 cases, 5.3%); infection (17 cases, 8.9%); swelling (nine cases, 4.7%); incomplete facial paralysis (five cases, 2.6%); hyperpigmentation (four cases, 2.1%); hematoma (four cases, 2.1%); allergy (one case, 0.05%). Follow-up was scheduled 1-24 weeks after treatment. Conclusions: The most common complications of facial thread lifting are, in the following order, skin dimpling, contour irregularity, visible threads, and thread extrusion. The reasons for complications are mainly unfamiliarity with facial anatomy, unskilled surgical operation, and misunderstanding of the facial aesthetics of Asian women.
Article
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.
Article
Background: Facial thread-lifting (FTL) has gained more popularity, but the incidences of complications following FTL remain controversial. We aimed to perform a meta-analysis and systematic review to estimate the incidences of complications and to compare the short- and long-term satisfaction rates following FTL. Methods: We searched PubMed, Web of Science, Embase and Cochrane library for eligible studies. The primary outcome was the incidences of complications following FTL. The secondary outcome was the satisfaction rate immediately and 6-month after FTL. The pooled incidences of complications and 95% confidence intervals were estimated using random-effects models. Results: A total of 26 studies were included in this meta-analysis. Swelling was the most commonly reported complication with a pooled incidence of 35%, followed by skin dimpling (10%), paresthesia (6%), thread visibility/palpability (4%), infection (2%), and thread extrusion (2%). Absorbable threads were associated with a significantly lower risk of paresthesia (3.1% vs. 11.7%) and thread extrusion (1.6% vs. 7.6%) than non-absorbable threads. Patients older than 50 years had a significantly higher risk of dimpling (16% vs. 5.6%) and infection (5.9% vs. 0.7%) than their younger counterparts. In addition, the pooled long-term satisfaction rate was significantly decreased compared to it immediately after FTL (88% vs. 98%). Conclusion: Non-absorbable threads and older age of patients are associated with higher risks of complications. Therefore, we recommend a judicious use of non-absorbable threads and FLT in older patients. Furthermore, it should be discussed with patients preoperatively that the rejuvenation effect of FTL may not maintain in the long-term. Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Article
Background It would be mandatory for plastic surgeons to consider anthropometric and anatomical differences between Asians and Caucasians in performing facial rejuvenation procedures using absorbable threadlifts in Asians. Methods A consensus meeting was convened to discuss indications, treatment procedures, possible combination treatments, clinical outcomes and safety of an absorbable polydioxanone (PDO) monofilament threadlift (Mint Lift®; HansBiomed Co. Ltd., Seoul, Korea), for which the “Mint Aesthetics Expert Group” was organized with four Korean board‐certified specialists in plastic and reconstructive surgery. Results Our recommendations are as follows: First, the entry and exit points should be determined considering anatomical characteristics of the face (Level of evidence III). Second, treatment procedures may vary depending on indications (Level of evidence III). Third, short‐term efficacy and safety of facial rejuvenation using the Mint Lift® have been well documented (Level of evidence I and III). Third, facial rejuvenation using the Mint Lift® may be combined with a liposuction (Level of evidence III). Conclusions Here, we propose expert consensus on facial rejuvenation using a novel absorbable PDO monofilament threadlift in Koreans. Of note, this is the only expert consensus prepared by board‐certified specialists in plastic surgery in Korea. But more evidence‐based efforts should be made to update and to expand the current recommendations.
Article
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.
Article
We conducted this study to assess the short-term treatment outcomes and safety of facial rejuvenation with the YVOIRE volume plus (LG Chem Ltd., Seoul) in Asian women. In this multicenter, retrospective study, we evaluated a total of 291 women (n = 291) who received a facial rejuvenation with the YVOIRE volume plus. We monitored time-dependent changes in the mean Global Aesthetic Improvement Scale (GAIS) scores at 3, 6, 9, and 12 months. In addition, we estimated the duration of efficacy based on the Kaplan-Meier survival analysis. Furthermore, we analyzed incidences of postoperative complications. Our clinical series of the patients achieved mean GAIS scores of 3.44 ± 0.69 points. There were no significant time-dependent changes in the mean GAIS scores ( P > .05). Moreover, the duration of efficacy was estimated at 242.71 ± 17.85 days (95% confidence interval: 228.59-263.44). A total of 37 cases (12.7%) of postoperative complications occurred, all of them were of mild severity. In conclusion, our surgical technique, combined with YVOIRE volume plus, is of significance in that it attempted to address both dynamic and static aspects of the facial rejuvenation. But this deserves further studies using 3-dimensional imaging modalities.
Article
PurposeInterest in noninvasive facial rejuvenation procedures continues to grow. With the advent of the so-called lunch-time face-lift, suture suspension facial rejuvenation has gained prominence and much popularity largely patient driven rather than data driven. We have published a decade ago a review about this rejuvenation technique. Despite its popularity at that time, serious long-term studies and peer-reviewed data about longevity and patient satisfaction were lacking to our surprise. As 10 years have passed, we have conducted a new systematic PubMed database search limited to the last 10 years interval.Methods The search identified 192 publications. After screening the titles and abstracts, 20 clinical and 2 experimental studies met the inclusion criteria and were selected for this review.ResultsThough thread lift facial rejuvenation is considered to be a promising modality, no new evidence has been added to the literature to support its use.Conclusion Until evidence-based efficacy and robust data are objectively documented, patients requesting percutaneous facial rejuvenation must be well informed about adverse events, longevity of effect, and limited available data on efficacy.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Article
Embedding thread lift rhytidectomy, also known as “thread lifting” in China, with the natures of simple operation, less trauma and quick recovery, is progressively used in clinical practice as a new technology of face lifting. Herewith, a brief introduction of the previous advances of thread lifting techniques and materials in the facial beauty industry, combined with the discussion on various types of sutures, common complications, and the site of actions were provided. The main limitations of present thread lifting material include: (1) the use of non-absorbable sutures is liable to cause allergies and a series of complications; (2) the absorbable sutures are easily degradation, and people need to reshape in a relatively short period. Therefore, the high biocompatible spider silk was proposed as a novel material of thread lifting suture and related devices, the advantages and preliminary achievements on spider silk were also addressed. Graphic Abstract
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Article
Thread lifting is one of the widely chosen procedures for minimally invasive facial rejuvenation. Traditional facial thread lifting has nearly inevitable side effects e.g. facial edema, facial bruising, prolonged recovery, skin puckering, and visible and/or palpable threads, as well as less common complications e.g. damage of facial vital structures. Applying the extrafacial loose areolar (XFLA) thread lifting technique by using loose areolar connective tissue, the fourth layer of the scalp, as insertion medium for the threads to be anchored to the layer above (epicranial aponeurosis or galea aponeurotica) and the layer below (pericranium), could help minimize most of the previously mentioned side effects. In this manuscript, technique steps will be detailed to prove its novelty.
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One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.
Article
Background To investigate the efficacy and outcomes associated with eyebrow, midface, mandibular, and neck lifting using the innovative techniques. Materials and Methods In this prospective review chart study, a total of 151 patients, were included in the study from January 2016 to May 2017. All participants underwent thread lifting using our innovative thread‐lift technique for head and neck. The patients were followed up first week, first, third, and sixth month after lifting surgery. Outcomes were assessed by two surgeon and patients based on the GAIS score. All data were analyzed by SPSS‐17 software with chi‐square test. Results A total of 151 patients (mean age: 52.49 ± 10.67, range: 27‐78 years), 16 (10.6%) men and 135 (89.4%) women, were included in the study. The most common sites for the face‐lifting surgery were the mandible (49.7%), midface (37.1%), neck (7.9%), and eyebrow (5.3%), respectively. The level of satisfaction increased from 77.5% in the first week after surgery to 89.4% in the sixth month after surgery for patients, remained unchanged, 96% for the surgeon, and increased from 74.8% to 94.7% for the independent surgeon. The highest rate of potential complications after the lifting surgery was related to ecchymosis (23.2%), followed by complications of tumefaction (6.6%), pain (6.6%), and pain (5.2%). Conclusion The results showed that the level satisfaction of patients and surgeons increased over time. It seems that facial rejuvenation thread lifting with this innovative technique is effectiveness, safe, and cosmetically more acceptance with minor complications than other face‐lifting techniques.
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Article
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.
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Article
Aging skin is an issue of concern to many patients. In this review aging and photoaging are defined, mechanisms which underlie these processes explored, and available treatment options discussed.
Article
This article presents a specific method of autologous fatty tissue transplantation, Lipostructure, which incorporates the technique of syringe liposuction with an intricate layering of autologous fatty tissue. The presented methods of infiltration of fatty tissue allow precise control over the contours of the face to replace atrophied or missing structures and enhance facial contours. Autologous fatty tissue harvested, refined, and placed in the specific fashion described is presented as an exemplary agent for augmentation in soft-tissue facial recontouring.
Article
Background: Techniques in rejuvenating the aging face have evolved, involving various types of threads. Facial rejuvenation with absorbable polydioxanone is popular in aesthetic clinics in Korea. Aim: The purpose of this study was to describe our polydioxanone thread method and to evaluate the outcomes of facial rejuvenation. Patients/methods: A retrospective chart review was performed over a 12-month period. Thirty-five Asian patients were included. All participants underwent thread-lifting using polydioxanone. On each side, five 360° spiral cog threads were used in the procedure. The results were evaluated using photography and patient satisfaction. Results: Thirty-three patients (94.3%) were satisfied with the outcomes. Objective outcomes using photography were categorized as very much improved (68.6%), much improved (25.7%), and improved (5.7%). Subjective outcomes using patients' satisfaction were categorized as excellent, very good, good, fair, and poor. The incidence of complications was low, and the complications resolved spontaneously without any surgical interventions. Asymmetry, however, was noted. Conclusions: Using our technique, we could achieve the desired facial rejuvenation. Our method demonstrated an excellent success rate in patients with moderate degree laxity. We believe that facial rejuvenation with polydioxanone thread for Asians is a safe and effective treatment method.
Article
Background Absorbable suture suspension (Silhouette InstaLift, Sinclair Pharma, Irvine, CA) is a novel, minimally invasive system that utilizes a specially manufactured synthetic suture to help address the issues of facial aging, while minimizing the risks associated with historic thread lifting modalities. Objectives The purpose of the study was to assess the safety, efficacy, and patient satisfaction of the absorbable suture suspension system in regards to facial rejuvenation and midface volume enhancement. Methods The first 100 treated patients who underwent absorbable suture suspension, by the senior author, were critically evaluated. Subjects completed anonymous surveys evaluating their experience with the new modality. Results Survey results indicate that absorbable suture suspension is a tolerable (96%) and manageable (89%) treatment that improves age related changes (83%), which was found to be in concordance with our critical review. Conclusions Absorbable suture suspension generates high patient satisfaction by nonsurgically lifting mid and lower face and neck skin and has the potential to influence numerous facets of aesthetic medicine. The study provides a greater understanding concerning patient selection, suture trajectory, and possible adjuvant therapies. Level of Evidence: 4
Article
A careful study of the aging face reveals it to be more than just surface textural wrinkling or loose skin. Changes in three-dimensional topography are responsible for the distinctive phenotypic presentation of the face throughout life. These geometric alterations are secondary to apportioning in the fat compartments and result in the fat dysmorphism characteristic of senescence. Redistributing this fat can rebalance the facial fat compartments and mimic the facial structure present in youth.
Article
Background and aim: In the evolution of facial rejuvenative methods, thread lifts have gained popularity among patients who require mild degree of cosmetic improvement. The REEBORN (PrestigeMedicare, South Korea, Gyeonggi-do) is a newly developed type of mesh suspension thread composed of implantable mesh and barbed thread. In this article, we presented our experience with midface rejuvenation using novel modified mesh suspension thread including reliable esthetic results and minimal complications. Methods: Prospective record analysis was conducted for 20 female patients who underwent REEBORN thread Lifting. To validate acceptable surgical results, three physicians rated the severity of nasolabial folds and marionette lines of patients. The patients were also asked to complete a questionnaire about satisfaction with this procedure and following adverse effects. Results: The mean operation time was 40 min, and surgery-related complications included two minor complications. Significant improvement in wrinkle severity was observed at 6 months after thread lifting (P < 0.0001). Patients showed high satisfaction with surgical results (≥90%) and procedure (≥80%). Conclusions: Although further follow-up and more studies are required to prove long-term efficacy of emerging technique, our early experience has been positive. We are expected to provide sufficient holding power apart from cogs; in addition, fixation mesh is ensured by the implantable distal mesh that provides long lasting maintenance in thread lifting rejuvenation.
Article
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.
Article
The process of aging induces the transformation of the face with changes that are usually classified as either chronological or photo induced and that affect the shape, the texture, and the color of the face. Facial shape is mainly transformed by the evolution of bones and soft tissues (muscles, fat, and skin) in addition to noticeable effects of gravity. Skin texture is mainly determined by wrinkles, which arise from atrophy of the skin layers, elastosis, and facial expressions. Skin color is related to the distribution of skin chromophores and the structure of the dermis, which affects light scattering. All facial changes are dependant on sex, ethnicity, and lifestyle. They affect self-perception and social interactions and can sometimes be slowed down or reversed using appropriate clinical procedures (e.g., dermatological, surgical, and cosmetic interventions).
Article
Thorough preoperative evaluation with meticulous surgical planning to achieve facial aesthetic balance between the forehead, eyelids, and midface is imperative to avoid or decrease potential functional and/or cosmetic complications in cosmetic periocular surgery. Before performing surgery, the physician should be aware of the patient's history of dry eyes, previous facial trauma, previous injection of Botox Cosmetic, history of previous laser-assisted in situ keratomileusis, and past facial surgery. A full evaluation should be performed on the upper eyelid/brow region to assess for the presence of brow ptosis, brow/eyelid asymmetry, dermatochalasis/pseudodermatochalasis, eyelid ptosis, and deep superior sulcus. On the lower eyelid/cheek examination, special attention should be directed to the diagnosis of underlying negative vector, dry eyes, prominent eyes, lower lid retraction, ectropion, lateral canthal dystopia, lower eyelid laxity, scleral show, and lagophthalmos, with a rejuvenation goal that focuses on obtaining a youthful fullness through repositioning and reinforcing efforts to avoid the negative effects of hollowness. Intraoperative and postoperative medical and surgical management of cosmetic periocular surgery complications focus on decreasing the risk of postoperative ptosis, lagophthalmos, lid retraction, and lid asymmetry, with special attention to limiting the risk of visual loss secondary to orbital hemorrhage.
Article
Barbed suture lifting is a minimally invasive procedure for rejuvenation of the aging face. Few studies have examined its efficacy and associated risks. To evaluate the morbidity associated with this procedure and its long-term effects. A retrospective review of 29 cosmetic patients who underwent thread lifting was conducted. A chart review provided information on patient demographics, surgical technique, and postoperative course. Analysis demonstrated that adverse events occurred in 69% and early recurrence in 45% of the patients in the study group. The incidence remained high upon extraction of independent variables, including technique used, location of thread placement, and number of threads placed. Indications for performing minimally invasive cosmetic surgery include obtaining outcomes comparable with those of an established widely used criterion standard. The goal for new procedures should be to deliver predictable long-term results while providing less morbidity, less downtime, and greater patient satisfaction. The results of this study indicate that the barbed suture lift was unable to accomplish these goals. This study also reflects the importance of a critical review of the ever-expanding options available to aesthetic surgeons.
Article
The author describes barbed sutures as a unique wound closure tool. Their advantages include the closure of wounds without any knots or the need for a third hand. They are also capable of shifting tissues differentially along the suture to redistribute tensile and compressive forces. The author discusses the development of these tools and their application.
Article
Barbed sutures, either used alone in a closed approach or as part of an open face lift procedure, may be combined with malar implants, soft tissue fillers, chemical peeling, and laser resurfacing. Because cephalad cheek repositioning affects adjacent facial areas, results may include shortening of the lower eyelid distance, flattening of the nasolabial fold, elevation of the submalar tissue, improvement of jowling, and decrease in submalar area fullness. Copyright © 2005 by The American Society for Aesthetic Plastic Surgery, Inc.
Article
Lipostructure is a natural, long-lasting method of filling and supporting the face using intricate layering of infiltrated autologous tissue. This method allows the tissues to be sculpted to enact three-dimensional augmentation of facial elements. Because the grafted fat becomes integrated into the host tissues, it is almost undetectable after transplantation, except by photography. To successfully use fatty tissue as such a graft, attention must be paid to the nature of fatty tissue; to the methods of harvesting, transfer, and placement; and to the preparation of the patient. Fatty tissue is a complex, delicate structure that is easily damaged by mechanical and chemical insults. Successful fat transplantation demands that every step be practiced with attention to this fragile nature of fatty tissue. Precision is an important consideration in the augmentation of millimeters of facial elements. The true volume of infiltration is difficult to judge if too much blood, lidocaine, or oil is present in the tissue being placed. Fat is living tissue that must be in close proximity to a nutritional and respiratory source to survive. Therefore, placement of small amounts of fatty tissue in multiple tunnels assumes the utmost importance in the quest for both survival of fatty tissue and an aesthetically appropriate correction. Successful, three-dimensional sculpting requires attention to patient preparation, meticulous planning, and fastidious photographic evaluation. The potential applications in aesthetic and reconstructive surgeries of this new tool are profound. Lipostructure represents an important advance in plastic surgery: a safe, long-lasting method of recontouring the face with autologous tissue.
Article
A careful study of the aging face reveals it to be more than just surface textural wrinkling or loose skin. Changes in three-dimensional topography are responsible for the distinctive phenotypic presentation of the face throughout life. These geometric alterations are secondary to apportioning in the fat compartments and result in the fat dysmorphism characteristic of senescence. Redistributing this fat can rebalance the facial fat compartments and mimic the facial structure present in youth.
Article
The use of the APTOS threads for lifting the tissues of the face and neck is a simple, conservative, cost-saving, and time-sparing procedure that leaves no visible traces of intervention on the skin. At the same time, the proposed technique proved efficient for correction of the jaw line and for lifting the flabby ptosed tissues in involutional facial alterations. Our experience proves that the described method can be an alternative technique to the classic methods of lifting and contour plasty of the jaw line with various implants.
Article
The use of nonabsorbable sutures for lifting lax, aging skin is an increasingly popular option for cosmetic surgeons. Contour Thread (Surgical Specialties Corp.) are novel modified polypropylene sutures recently approved for this purpose by the US FDA. Design and technical modifications incorporated into this implant may reduce complications and limitations seen with previous, similar products. Early experience has been positive, although the durability of cosmetic effect and the potential for long-term complications remain to be seen.