The field of facial rejuvenation by injection of substances aimed at stimulating collagen production has recently seen the rise of the so-called biostimulating thread lift, which employs a variable number of small caliber surgical threads made of polydioxanone, a substance able to stimulate collagen production in a time frame of 2 to 3 months, inserted in the dermis or superficial subcutis.1
We wanted to provide an equally efficient but cheaper alternative to the costly, commercially available biostimulating thread lifts; in an economic crisis environment, many people curious about thread lifts are forced to give up because of the high costs involved, as is the case in our country.
The necessary tools are polydioxanone suture, a 1-mm lipofilling cannula, and a small piece of polystyrene (see Supplemental Digital Content 1, http://links.lww.com/PRSGO/A251). The suture is sterile, whereas the cannula and the polystyrene are sterilized at 121°C. We cut the needle from the suture and insert the latter in the cannula, fixing the bent portion of the thread with the small piece of polystyrene in which a hole has been cut using an 18-G needle (see Supplemental Digital Content 2, http://links.lww.com/PRSGO/A252).
We insert a series of variable caliber threads using the known techniques (parallel, crossed, etc.; Fig. 1A). The insertion plane is just below the dermis in the subcutaneous tissue. We believe that such a plane results in excellent dermis stimulation, while providing good gliding of the cannula and no risk of thread visibility on the skin surface (Fig. 1B). An added advantage of our method relies on the use of the blunt cannula, which requires a previously made access, but successfully avoids ecchymosis and hematomas as it glides over the vessels. On the other hand, the vast majority of commercial biostimulating threads use needles, with all the foreseeable associated adverse effects.
The main limitation of this technique is that it is more time consuming when only 1 lipofilling cannula is available, as the thread has to be “recharged” after each application. This is why, in our opinion, this home-made alternative excels when used with a relatively low number of longer and larger caliber threads. We usually insert 2 to 6 threads (caliber 2/0 or 3/0) per face side as shown in Figure 1A, with satisfactory cosmetic results visible at 3 months post procedure (Fig. 1B). We have been treating over 100 patients in the last 2 years with this method with good outcomes and no significant adverse events.
The patient provided written consent for the use of her image.
1. Suh DH, Jang HW, Lee SJ, et al. Outcomes of polydioxanone knotless thread lifting for facial rejuvenation. Dermatol Surg. 2015;41:720725.