Neck Rejuvenation with Thread Lift

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196 196 © 2019 Journal of Cutaneous and Aesthetic Surgery | Published by Wolters Kluwer - Medknow
Correspondence
Neck Rejuvenation with Thread Lift
Aging is a universal phenomenon and inevitable. Skin too
ages just as other organs of the body. In addition to generic
body aging, extrinsic factors such as sunlight (visible,
ultraviolet, and infrared), smoking, and air pollution
induce aging due to their direct impact along with ethnic
skin characteristics, which are unique to individuals.[1] In
addition to these, age-related structural changes in the
bones, ligaments, fat pads, muscles, and skin all add to the
aged skin look. Neck region is a perfect example of how
skin in an exposed area is affected by all the above factors,
resulting in textural changes with wrinkled blotchy, loose,
inelastic, sagging skin; increase in neck volume with
platysmal bands and Venus rings; and/or blunting of the
cervicomental angle.[2]
Chronological aging cannot be prevented. It can be
delayed and accepted in a more elegant manner, whereas
photoaging may be prevented to a certain extent by the
use of the correct amount of sunblock starting at the
right age. However, structural correction, which is just
as important, can be addressed to take care of the third
inevitable change, which needs correction of superficial
as well as deep layers to get a natural and harmonious
result.[3]
Twenty female patients with various signs of neck aging
that attended a dermatology center between March 2017
and June 2018 were treated for neck rejuvenation using
different types of threads. Those having received any
other cosmetic procedure for neck rejuvenation, history
of keloidal or bleeding tendencies, and pregnant and
lactating patients were excluded.
Neck aging assessment, in the form of neck wrinkling
was carried out by six-point wrinkle assessment scale
by Lemperle et al.[4] (0: no wrinkles, 1: just perceptible
wrinkle, 2: shallow wrinkle, 3: moderately deep wrinkle,
4: deep wrinkle with well-defined edges, and 5: very deep
wrinkle with redundant fold) and in the form of neck
volume was carried out by five-point assessment scale by
Sattler etal.[5] [Figure 1]. All cases were photographed pre-
procedure and at 3months post-procedure.
The most common signs of the neck aging treated were
wrinkling of the neck skin, textural changes, platysmal
bands, and double chin. Five patients with double chin
and obliteration of the cervicomental angle were initially
treated with two sessions each of injection lipolysis with
deoxycholate, followed by threads. Three patients with
excessive cord-like platysmal banding were initially treated
with botulinum toxin, followed by neck rejuvenation with
threads. We used both polydioxanone (PDO) (mono,
screw, and barbed) as well as poly l-lactic acid (PLLA)
threads with bidirectional cones. Choice of thread used
was based on the primary indication.
When just rejuvenation of the neck in terms of textural
improvement was desired, monofilament or screw
PDO threads were used, as these threads improve
microcirculation and collagenosis and thus the texture of
the skin and mild wrinkling is corrected. When reduction
in volume due to a double chin was desired, monofilament
PDO threads were used in a crosshatch technique to
aid in lipolysis, along with tightening the skin, thus
attempting to restore the optimal cervicomental angle.[6]
To improve sagging and severe wrinkling, more stretch in
the horizontal plane was desired, and hence to redrape
the skin, we used PDO bidirectional barbed or PLLA
bidirectional cone threads.
To give a long-lasting result, PLLA was chosen over PDO
threads in patients who could afford, as it has a longer
half-life of 18months as compared to 6months of PDO.
A crosshatch technique was used where more surface
area was required to give greater textural improvement
and also as optimal vectors for double chin. Ahammock
technique was used to stretch the skin where laxity was
more, and to give a good anchoring at the mastoid fascia.
Linear threading was used where just volumization with
threads was desired as in Venus rings [Figure 2].
Figure 1: Sattler, neck volume five-point assessment scale

Correspondence
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 12 ¦ Issue 3 ¦ July-September 2019 197
Procedural steps followed were as follows: Topical
anesthesia using eutectic mixture of prilocaine and
lidocaine was used as a local anesthetic for 1 h before PDO
under aseptic precautions. For insertion of cog threads,
local infiltration using 2% lignocaine with adrenaline
1:200,000 was given for points of insertion and an
18-gauge needle was used to make the entry point. Thread
insertion was thereafter done under aseptic precautions.
Post-procedure advice included ice pack application for the
anticipated swelling and edema. Capsule amoxicillin (625 mg)
with clavulanic acid (125 mg) was given three times a day for
5 days. Patients were advised against wide mouth opening
for 48 h and to abstain from smoking, vigorous exercises, and
cosmetic procedures in the treated area for aweek.
Results were assessed based on the patients’ response to
treatment and recorded according to the visual analog
scale (VAS) (4+, >75% improvement; 3+, 50%–75%
improvement; 2+, 25%–50% improvement; 1+, 0%–25%
improvement; and no response). Neck wrinkling and
volume assessment change as per the aforementioned
scales were also carried out and compared using the paired
t-test. Complications, if any, were recorded.
Figure 2: Techniques used for thread insertion. (A, B) Crosshatch. (C, D) Hammock. (E) Linear threading

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198 198 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 12 ¦ Issue 3 ¦ July-September 2019
Twenty female patients were treated [Table 1] [Figures3
and 4]. The mean pre-procedure neck wrinkling
and volume assessment was 3.65 and 2.45, whereas
post-procedure was 1.4 and 1.1. These were statistically
significant (P < 0.0001 and P < 0.001). Fifteen cases
were satisfied with their procedure (VAS >2+), whereas
one failed to respond due to severe platysmal laxity.
Post-procedure bruising was seen in 11 cases and edema
was observed in all as a sequela, which lasted for 48–72 h.
No other complications were observed.
PDO and PLLA threads stimulate fibroblast,
collagenization, and neo-angiogenesis, which improve
the skin texture and laxity. Repeat sessions may be
needed similar to other aesthetic procedures to achieve
and maintain the desired result. They can thus be used
for improving skin texture as well as wrinkling and
laxity to achieve the ideal aesthetic appeal: skin of the
neck and face to be in sync, with minimal discomfort or
downtime.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal.
The patients understand that their names and initials will
not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Gulhima Arora, Sandeep Arora1
Department of Dermatology, Mehektagul Dermaclinic, New Delhi,
1Department of Dermatology, Command Hospital Air Force, Bengaluru,
Karnataka, India
Table 1: Summary of cases and pre- and post-procedure assessment
Serial
number
Age
(years)
Sign of aging NW grade
pretreatment
NW grade
posttreatment
NV grade
pretreatment
NV grade
posttreatment
VAS Types of thread used
1 35 Textural change 1 0 0 0 4+ Monolament
2 58 Wrinkling + platysmal
bands
4 2 3 2 2+ Screw
3 45 Wrinkling + Double
chin
4 2 4 2 4+ Monolament
4 44 Venus rings 5 2 1 0 3+ Monolament + screw
5 52 Wrinkling + textural
changes
4 2 2 1 2+ Monolament
6 46 Wrinkling + textural
changes
3 1 2 1 4+ Screw
7 35 Textural change 1 0 0 0 4+ Monolament
8 60 Wrinkling + platysmal
bands
5 2 4 3 2+ Screw
9 44 Textural changes +
wrinkling
4 1 2 0 4+ Cog + monolament
10 48 Wrinkling + neck
sagging
3 1 2 1 4+ PLLA
11 52 Wrinkling + platysmal
bands
5 3 4 3 1+ Cog
12 37 Textural change 3 0 0 0 4+ Monolament
13 63 Wrinkling + platysmal
bands
4 2 3 2 3+ Cog + monolament
14 45 Wrinkling + textural
changes
4 1 2 0 3+ Cog
15 44 Wrinkling + double chin 3 1 3 1 3+ Cog
16 52 Wrinkling + turkey neck 4 2 4 2 3+ PLLA
17 49 Wrinkling + turkey neck 5 3 4 1 3+ PLLA
18 41 Wrinkling + double chin 2 0 1 0 4+ Cog
19 52 Wrinkling + double chin
+ turkey neck
4 1 4 2 3+ Cog + monolament
20 47 Wrinkling + double chin
+ turkey neck
5 2 4 2 2+ Monolament + PLLA
NW=neck wrinkles, NV=neck volume, VAS=visual analog scale

Correspondence
Journal of Cutaneous and Aesthetic Surgery ¦ Volume 12 ¦ Issue 3 ¦ July-September 2019 199
Figure 3: Pre-procedure (left) and post-procedure (right) of cases 3 (above) and 8 (below)
Address for correspondence: Dr. Sandeep Arora,
Department of Dermatology, Command Hospital Air Force,
Bengaluru 560007, Karnataka, India.
E-mail: aroraderma@gmail.com
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Figure 4: Pre-procedure (left) and post-procedure (right) of cases 17 (above) and 19 (below)

Correspondence
200 200 Journal of Cutaneous and Aesthetic Surgery ¦ Volume 12 ¦ Issue 3 ¦ July-September 2019
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DOI:
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How to cite this article: Arora G, Arora S.Neck rejuvenation with
thread lift. J Cutan Aesthet Surg 2019;12:196-200.