Our Technique of Thread Lifting for Facial Rejuvenation

INTRODUCTION

Thread lifting of the facial soft tissues without undermining has earned a controversial reputation.¹ This may be due to the overly enthusiastic promotion of this “lunch-time” procedure without proper patient selection for commercial reasons. However, growing patient interest in mini-invasive techniques has made us consider thread lifting among other methods of facial rejuvenation. We distinguish 2 facial zones with different aging mechanisms: the central oval, which ages by deflation, and the lateral face, where gravitational changes predominate.² Hence, the very idea of lifting may be productive in lower lateral facial zones but not in the central oval.

MATERIALS AND METHODS

We used the “Spring” threads (polyether covered by silicone, with hogs) and “Happy lift” threads (L-polylactic acid with hogs) in 42 patients (mean age, 41.4 years) of the Baker II and III aging groups in the lateral facial zones from 2012 through 2014. We implanted 6 or 7 threads on each side (depending on the distance between the jowl and the mandible angle) with 2 straight needles (sharp or blunt). The threads entered the sideburn area, 1 needle directed upward within the temporoparietal fascia up to the parietal area, and another, under the skin, downward up to 1.5 cm below the mandibular margin. The key moment of our approach was the vertical vector, which provided for even-tissue elevation from submandibular to the temporal area with no folds or dimpling. The number of threads was sufficient to evenly distribute the load on each one and to stabilize the elevated tissue.

RESULTS

The patient-reported outcomes 1 year after the procedure showed overall satisfaction in 91% of the Baker II group of patients with less marked aging and in 86% of the Baker III group with more advanced aging changes. We did not use the thread lift in the Baker IV group of patients. Interestingly, the type of threads did not correlate with the satisfaction rate. Among the complications, the local fibrosis was noted in 3 cases 6–8 months after the Spring thread implantation. One patient developed a hematoma after implantation of Happy lift threads with sharp 3-edged needles.

CONCLUSIONS

The thread lifting is effective in the lateral facial zones, including the temporal, masseteric, and lower cheek, provided the vertical elevation vector is respected. The effectiveness is higher in the Baker II group of patients.