Thread Lift

Who Should Consider a Thread Lift?

As we age, our facial support structure weakens, and we lose facial fat. The affected areas generally include the cheeks, the eyebrows and other areas around the eyes, the jowls and the neck. The result is a longer, older-looking face.

Younger people may experience cheek and brow ptosis (sagging caused by weakened muscles) as well. For these people especially, a thread lift may be a good alternative to the more invasive procedures necessary to correct problems in older people's faces.

Ideal candidates for thread lifts include people with minimal signs of aging who need just a small lift. Most people who undergo thread lifts are women between 35 and 45. They choose a thread lift because they have begun to see more prominence of the jaw, a relaxed (or minimally sagging) midfacial appearance or slight bags under the eyes or on the neck. Older people may undergo a thread lift during the more aggressive facelift procedure to provide additional support for the soft tissue area that was elevated in the facelift.

Other thread lift candidates include those who have had some relapse from a previous plastic surgery procedure such as a facelift or neck lift. Dr. Rothfeld has combined thread lifts with other procedures, such as chin lifts, neck lifts and brow lifts, for a customized approach to facial rejuvenation.

To be an ideal thread lift candidate, you should understand and accept the possibility of the risks and complications outlined below.

Thread Lift Basics

In a thread lift, barbed sutures (threads) are used to lift sagging eyebrows and eyelids, deep nasolabial folds (those furrows between your nose and the corners of your mouth) or aging neck tissues. Your surgeon would use a thin needle to insert the sutures under the facial tissues. The barbs on one end of the thread grab and lift the sagging skin, and the teeth on the other end anchor the skin to the underlying facial tissues. No incisions or stitches are required, and no scars are produced.

Two types of thread lift procedures are currently being performed in the United States: the Contour Threadlift and the FeatherLift or Aptos Thread lift. It's estimated that as many as 9,000 thread lifts have been performed nationwide with Contour Threads, which were approved by the U.S. Food and Drug Administration in September 2004, with current indications for elevation and fixation of midface, brow and neck. The Aptos Thread, which was developed overseas, received its premarket approval from the FDA in March 2005. The American Society of Plastic Surgeons reports that its members performed more than 5,000 thread lifts in 2006.

The main difference between the two is design. Contour Threads are unidirectional and fixed in the area of initial access, whereas Aptos Threads are bidirectional.

The Contour Thread material, clear polypropylene, has been used in other medical applications for many years. It has barbs along the thread that act as cogs to allow the surgeon to grasp, lift and suspend a relaxed facial area. The barbs open like an umbrella to form a support structure that lifts the sagging tissue. The Aptos thread has barbs on the entire length that are inserted under the skin to gather tissue to fill out and lift the cheeks and sagging skin.

The Thread Lift Procedure

Dr. Rotheld may instruct you not to eat or drink after midnight before the thread lift. Dr. Rothfeld may prescribe an antibiotic to take beforehand and tell you to cease taking certain other medications.

During the procedure, Dr. Rothfeld will make small incisions in key locations and insert a threaded needle to lift the subcutaneous tissue and suspend the lift with the thread. The barbs on these threads will lock in place and encourage collagen formation upon insertion to lift very specific areas.

Several variations of the technique exist. In general, the "closed" technique involves molding the soft tissue over the suture in multiple location points until it catches in the appropriate location to provide the best result. During an "open" technique, the surgeon will use instruments under the skin to create a raw surface so that when the sutures are pulled up, the lift is more likely to remain in the appropriate position.

Other surgeons have developed a combination technique that uses sutures at multiple tissue levels to catch all the barbs and create a suspension that cannot be accomplished with a nonbarbed suture. Depending on your needs, the number of threads used can range from two to 20.

Thread lifts are often performed in an outpatient basis.  Because the procedure is minimally invasive, general anesthesia is not required, so you can remain awake. One benefit is that the cosmetic surgeon can give you a mirror as the thread is pulled back, allowing you to give feedback. Usually an oral antianxiety medication, along with local anesthesia, is all that is required. Most people tolerate this well and avoid any "postanesthesia hangover."

Thread Lift Recovery

Dr. Rothfeld will provide complete postoperative instructions that you must follow to reduce the risk of complications during recovery. These instructions may include an escort to drive you home and assist with daily activities for at least 24 hours, as well as diet restrictions (soft foods) for seven days. Pain can be managed with oral medications such as acetaminophen. Ibuprofen is avoided to limit bruising. Your surgeon may recommend elevating your head to reduce swelling for the first day.

The day following the procedure, you can resume nonstrenuous activities, and all normal activities can usually be resumed within seven days. You probably won't be comfortable in social situations for up to one week — three weeks for weddings, reunions and other formal occasions.

Risks and Complications

The thread lift is a relatively new procedure, and its techniques are still being developed. Results have varied greatly among patients, but continue to improve.

A significant risk of the thread lift procedure is that you may not notice any improvement. In this case, you would want to proceed with a traditional brow lift, facelift, or neck lift for a noticeable improvement. Some thread lift patients with thin skin have reported that the sutures became visible under the skin shortly after the procedure. On the other hand, plastic surgeons with more experience say this represents poor techniques or patient selection.

You may experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.

Infection in the treatment area is an infrequent complication. If an infection develops, your surgeon will treat it with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible.

Dr. Rothfeld has noted rare migration of the sutures, causing an unbalanced facial appearance. With this, or if the thread may break, a simple reinsertion solves the problem.