Physician perspective on thread lifts

As might be expected with any new cosmetic procedure, suture suspension, popularly known as "thread lift," has engendered significant media attention. Thread lift has been promoted on "Oprah," "Today" and "Good Morning America" as a "lunch-time facelift." More recently, articles in The New York Times and Allure magazine have questioned the predictability and longevity of results, and the potential for complications.

This technique for elevating ptotic eyebrows and lifting sagging skin of the midface, jawline and neck, relies on barbed polypropylene threads to maneuver skin to a higher position, thereby creating a more youthful appearance. Despite some recent reports, suture suspension procedures offer many benefits to patients interested in minimally invasive facial rejuvenation. Compared to rhytidectomy done with IV sedation, they can be performed with local anesthesia in an outpatient setting, require less post-operative downtime and pose fewer serious risks.

Kinds of threads

In the fall of 2004, the first and only device approved by the Food and Drug Administration, the contour thread, was introduced by Dr. Gregory Ruff. Contour Threads have a number of distinct advantages over their predecessors. They are transparent and therefore less likely to show through the skin. The barb size, unidirectional helical configuration, and concentration of barbs per unit thread length have been scientifically designed to maximize tissue holding strength. Finally, the threads are fixated to deep fascia, which allows for greater tissue tightening while minimizing the likelihood of suture migration. Though I have been trained to perform six different suture suspension procedures, I currently use Contour Threads exclusively for these reasons.

Immediate results

Patients who undergo suture suspension experience immediate visible skin tightening. There is an initial "over-correction" which creates a stretched appearance that typically resolves in three to five days. Skin bunching in the temples and posterior neck resolves in three weeks and is easily camouflaged with the patient's hair. Though difficult to quantify, the resulting degree of tightening is estimated to be 40 percent to 80 percent of rhytidectomy. The overwhelming majority of my patients have been extremely pleased with their results.

The risks associated with suture suspension are minimal compared to those of cosmetic procedures that require skin excision. Bleeding and bruising can be prevented with pre-operative avoidance of anticoagulant drugs and supplements, and infections are unusual. The 2 mm stab incisions that are used for suture deployment and fixation are hidden in the scalp, eliminating any risk of visible scarring. More serious risks, such as injury to nerves and other deep structures, have been rarely reported and are avoidable with prerequisite knowledge of the surgical anatomy of the face and neck.

Complications occur infrequently and are easy to manage. "Suture bumps" caused by thread migration are treated by trimming the distal thread tip through a small stab incision. Suture failure is preventable with proper knot tying, but does require thread replacement.

Patient selection

Insuring a good outcome begins with proper patient selection. Results vary on an individual basis (as with any other cosmetic procedure), and this should be made clear during the initial consultation. "Before" and "after" photography is essential for documentation and management.

The ideal patient has a moderate amount of skin laxity and skin that moves easily with fingertip manipulation, and is not interested in more invasive surgery. Patients with minimal sagging are not likely to see a significant change, while patients with "end stage" wrinkling should consider rhytidectomy. A patient with a full, round face and tight skin is not a good candidate, as there is too much resistance to the holding strength of the threads. It should be emphasized to all patients that thread lift results are not equivalent to facelift results.