A variety of procedures are being used to make aging-face looks better than it should, such as:
- Botulinium toxin A and B
- Filler to fill up volume deficit
- Radio frequency used to tighten tissue layers
- PRP stem cell, growth factors, mesotherapy used to enhance the skin quality for texture and pigmentation.
The non-surgical facelift is a popular procedure done by our center’s doctors.
As we age, due to the gravity effect, the tissue layers slides down causing droopy face and an aged appearance. Instead of aggressive surgical facelift, a non-invasive method is to use thread for facelift. This thread is a special one with barb or hook on it helping it to hold and anchor the tissue layers lifted. The thread is the only one providing an actual pull and lift. Its cog and barbs actually holds onto different tissue layers after they are being pulled and re-positioned, for fixation to achieve the desired result.
The resulting collagen formed surrounding the thread and the barb holds the pulled tissues even tighter after 3 months. And this will last well beyond the PDO thread is absorbed after 9 months. The effect last longer than that.
Histology slide showing collagen deposit around the thread and its knots
HPE showing collagen formation around the PDO barbed thread
2 categories of coged thread lift
- Bi-directional threads: with no anchoring points, the thread cannot move either way because of the two-way direction of barbs fixing it nicely. The tissue is pulled towards the center of the thread. The direction of the barbs are in different direction with reference to the center point of the thread. Examples are the APTOS® threads
- Uni-directional barbed threads: which are anchored at a higher level fixation point. The direction of the barb is one direction only. Examples are the Contour® and Silhouette® threads
Uni-directional Cogs (Courtesy Silhouette®)
Right candidates for thread lift
Ideal candidates for thread lifts include people with minimal signs of ageing who need just a small lift. Usually, these are women less than 45. The threads are indicated because these patients starts to see
- more prominence of the jaw,
- a relaxed (or minimally sagging) mid-facial appearance or
- slight bags under the eyes or on the neck.
Older people may be advised to undergo a thread lift during the same session of more aggressive surgical facelift procedure. This is for the purpose of to provide additional support for the soft tissue layers that were elevated in the facelift.
Other thread lift candidates include those who have had some relapse from a previous procedure such as a surgical facelift or neck lift.
Ideal patients are also those who understand and accept the possibility of the risks and complications outlined below, who understand the limitations of these threads, have realistic expectations and who are prepared to follow the post-operative regimen.
Poor candidates for barbed thread lift
These are patients who have:
- excessively sagging skin at an
- advanced age will show a very limited improvement.
- obese, or have
- very heavy, rugged skin too will show no improvement.
- contraindications of implants, etc. also hold good here, like multiple
- skin allergic reactions or
- dandruff, hair lice,
- immunologically compromising diseases like cancer/ HIV etc.,
- systemic diseases like diabetes, tuberculosis, etc.
Bi-directional threads lift procedure
A classical example of their use is to lift the cheeks.
The commonly used is local anesthesia. When a lunch time thread lift alone has been planned, only a local anesthetic can be infiltrated along the expected track. At most other times, if the patient is willing for a longer day care stay, twilight IV sedation with local anesthetic is given. The last is the common choice.
A special spinal needle is inserted from the pre-tragal area just in front the ear, in a curved direction to a point below the cheek, and then up again towards a point stopping just short of the smile line the naso-labial line. As this needle is advanced, it is actually progressed in a sinuous manner, moving the needle tip from side to side. Please note that the depth of the needle is at all times maintained at the same sub dermal level, gliding just above the fat layer.
A similar needle is passed about 1.5 centimeters above this line. Through the two needles, the bi-directional threads are inserted.
The thread is then passed through, it is positioned such that the center of the thread gets placed in the center of the track. The needle is then slowly withdrawn. The tissue can be ‘gathered’ over the thread at the center, and once the desired effect has been achieved, the ends of the thread are then cut off.
Bidirectional barbed thread referenced to the center point of the thread
The steps for thread insertion:
- Defining the lowermost cheek point
- Marking the cheek curve
- Ensuring bilaterally symmetrical markings
- Inserting the spinal needle along the curve
- Thread firmly fixed, now does not budge on traction in either direction
- Thread snipped close to the skin
Uni-directional threads laying procedure
Such threads are always placed in pairs. A triangle is marked in the temporal area, with its base parallel to the hair line, and the apex positioned more higher up posteriorly behind and inside the hairline. From the two corners of the line forming the base of the triangle, the uni-directional threads on their long needles are inserted, both parallel to each other, advancing at the same sub-dermal depth and in a sinuous manner, to points stopping just short of the smile lines, the naso-labial line.
Unidirectional barbed thread always has a long needle for deployment, which will be cut & curved needle deployed to stitch into deep layer of temporal fascia, only to reemerge at the point higher to be tied with 2nd thread for anchoring.
The steps involved:
- Parallel markings for a pair of threads for jowl lift
- Zigzag manoeuvre to advance the barbed threads engaging maximum tissue such as doing a Contour® lift.
- The two threads in the temporal area are then brought out together from the third apical point, with the help of the curved cutting needle attached to the tail of the thread, this time taking a very deep sub temporal fascia bite. At this exit point, they are tied together, and the knot buried under the skin, so as to ensure that it is not palpable.
- The threads at the smile line are left about an inch long, taped and the patient sent over to the recovery room.
- Once the patient has overcome all effects of any anaesthesia, maybe even on the second day, she is called back to help in the actual lift. While she holds up the mirror and watches herself, the surgeon holds the end of the thread firmly down and pushes the skin of the cheek back over it, gradually deploying more and more barbs.
- This is done to a desired effect, to which the patient consents. Once both sides are done, both the patient as well as the surgeon agree to the extent of the lift as well as symmetry, etc.
- Only then are the free ends actually snipped close to the skin.
- The area from the temporal area down to the cheeks is taped, in an upward supporting style, to prevent the patient from over animating and undoing the effect of the thread lift. These tapes are preferably left in for about a week
Deploying 2 Unidirectional barbed threads: pulling down thread & pushing up skin in an opposite direction.
- Deployment of the two threads by pulling the thread down and pushing the skin up, to the desired level
Thread Facelift: Tapping After Deploying Unidirectional barbed thread face lift.
- Taping at the end of the procedure to prevent undoing of the lift till some fibrosis occurs
Proper postoperative instructions must be given to reduce the risk of complications during recovery. Furthermore, it can retain the result achieved through proper care.
These instructions include:
- Limited activities should be done for at least the first 24 hours.
- Diet restrictions should be followed (soft foods) for up to seven days.
- Pain can be managed with oral medications such as acetaminophen. Ibuprofen is best avoided as it can cause bruising.
- Thorough asepsis is strictly adhered to. It is preferable to give antibiotics for a period of five days as this is, after all, an insertion of a foreign body.
- Recommend elevating the head on the first day to reduce swelling due to gravitational pulling down. Lying down create the fluid collection.
The day following the procedure, the patient can resume non-strenuous activities, and all normal activities can usually be resumed within seven days of the thread insertion.
Steps taken includes:
- Swelling and Bruising can be prevented by ice packs.
- Movements are strictly restricted by taping the face, especially the area that has been operated. This is best advised for about a week.
- Sleeping on the sides with the face against the pillow, can undo the effect of the procedure. Hence the patient is STRONLY advised to sleep on the back for a week.
- Avoid excessive mouth opening and massage of any kind for three weeks.