Most of us want to live younger and stronger longer. At the same time, most of us feel better if we look better. What are safe alternatives to facelifts? Earlier this year I shared my experience of doing an intense CO2 laser facial treatment with my Premium Level subscribers. (Links to my Substack postings below.) Turns out that non-invasive threads used in facial tightening, are just one more option.
What’s the history of thread lifts?
In the 1990s, clinicians used non-absorbable sutures for thread lifts, including polypropylene-barbed threads, which caused adverse events ranging from extrusion and migration to thread expulsion, dimpling, granuloma formation, and prolonged pain. As a result, the Food and Drug Administration withdrew its approval of contour thread aesthetic procedures in 2009. Since then, the development of absorbable threads made from a hybrid of poly-l-lactic acid (PLLA) and polyglycolide/l-lactide (PLGA), and from polydioxanone (PDO) has led to renewed interest in thread lift procedures. While a surgical facelift remains the gold standard, "this is one safe option for noninvasive tightening.
Thread lifts, or suspension sutures, have minimal downtime and are less costly, but the results are subtle. PLGA/PLLA threads consist of an 18% PLGA and 82% PLLA monofilament with bidirectional cones that shift the tissue. The threads are available in 8, 12, or 16 cones, spaced 5-8 mm apart on either side of a 2 cm central cone-free area. There is a 12-cm, 23-gauge needle on either side of the thread to allow for insertion.
These cones stimulate types I and II collagen, which results in collagenesis. Whatever boosts collagen, turns back the clock. The skin encapsulates the cones, resulting in lasting volume and contour. PDO threads are biodegradable by hydrolysis over 4-8 months. They are inserted with a cannula or a needle and vary based on length, diameter, twined vs. braided, coned vs. barbed, and twisted vs. smooth. Barbed PDO threads are what many facial specialists use the most. They provide slight tissue repositioning by anchoring and gripping.
Research on this?
In 2019, Korean scientists published the results of a study that evaluated the collagen-producing effects of powdered PDO injection, compared with PLLA injection, in a murine model. They found that while both PDO and PLLA induced granulomatous reactions and collagen formation, they demonstrated that PDO resulted in slightly more collagen formation than PLLA. Up with collagen! That’s our mantra.
BTW, estrogen boosts collagen and this is why women on hormonal therapies look younger for longer. Men can use estrogen, too. Mostly as the less potent form - estriol.
Dr. Catherine M. DiGiorgio, MD, MS., a laser and cosmetic dermatologist who practices in Boston, said at the annual Masters of Aesthetics Symposium, “that both are effective.”
"I find PDO threads to be easier. They're less costly for me, they're less costly for the patient, and the results are about equivalent."
Absorbable threads are indicated for the cheek, jawline, neck, lips, forehead, and brow.
She finds them most useful "for the lower face, below the nasolabial fold down to the jawline, for improvement of the jowls," she said.
"I don't think they really work on the neck."
As with any cosmetic procedure, patient selection is key. According to Dr. DiGiorgio, the patient should have specific and segmental areas of facial laxity amenable to lifting and recontouring along a straight-line vector, adequate dermal thickness, and appropriate expectations for the level of correction.
"I like to re-volumize with filler before performing thread lifts to make sure that volume is restored, because you can't really provide lift to someone with significant volume loss.
How Dr. G. Does It
Before the procedure, Dr. DiGiorgio marks the area to be treated while the patient is seated upright and holding a mirror. Then, she pulls back the amount of skin laxity the thread is going to correct. The plane of insertion for barbed threads is at the superficial musculoaponeurotic system (SMAS), and she typically uses 3 to 4 threads on each side of the face.
"How do you know you're in the right plane?" If the patient is experiencing significant pain, "you're too deep, and it's not going to work," she said. "You can see if the thread is too superficial as you do more of these."
After the procedure, Dr. G. asks the patient to sit up prior to trimming the threads. "
I take a look in the mirror with them and have them smile and make funny faces to see if there is any dimpling or crimpling, which is probably the most common side effect," she said.
"If I see that, I will pull the thread immediately, so we don't have a problem. It's a little uncomfortable to pull the thread but not more uncomfortable than the procedure itself, but I think it's worth doing to avoid having a dimple or a crimple that can last up to a year."
In her clinical experience, thread lifts last about 8-10 months. It’s not a longer-term fix like a facelift or the tightening from a CO2 laser. Of course, the tincture of time rules us all. Anything and everything we do has an expiration date.
"I find that my patients will come in about once a year for this procedure, and the treated area feels tight afterward," Dr. DiGiorgio said.
"I think that sensation of feeling tight also provides satisfaction to the patient. Results are very subtle. It's tissue repositioning; it is not a facelift. There's not really any downtime, but further studies are required to see if threads are safe and effective in the long-term."
Well, many are using this without long-term studies so, I found that last sentence unnerving.
“Patients should be seen in follow-up 2 weeks after the procedure consistently, especially when someone first starts performing the procedure," she recommended.
Hmmmmm, I guess if I had been chosen for the Golden Bachelor, which I was not, I might have gotten these then. Ha! For now, I will keep working out at the gym, kayaking, and getting CO2 lasers every 4 years as my dermatologist, who has skin like a teenager, recommended to me.
May the beauty force be inside and outside of you!
Dr. B.
Links to my CO2 Experience
I recorded this series for my Premium Level Subscribers at the beginning of 2023. We have made Day 1, my introduction video, available to both the Premium and Complimentary Levels.
Day-1-CO2-Laser (Available to Premium & Complimentary Level Subscribers)
Day-2-CO2 Laser (Available to Premium Level Subscribers)
Day-3-CO2 Laser (Available to Premium Level Subscribers)
Day-4-CO2 Laser (Available to Premium Level Subscribers)
Day-5-CO2 Laser (Available to Premium Level Subscribers)
Day-6-CO2 Laser (Available to Premium Level Subscribers)
Day-7-CO2 Laser (Available to Premium Level Subscribers)
Day-8-CO2 Laser (Available to Premium Level Subscribers)
Reference:
Thread Lifts an Option for Noninvasive Facial Tightening - Medscape - Sep 25, 2023.
Hello. You previously mentioned the benefits of estrogen for Alzheimer but the KEEP study showed neither risks nor benefits with it. Could you explain more?
I LOVE doing threads. I use the HDPDO threads that are made in Italy. I like to use the 5cm barbed threads and place them vertically along the jawlines to lift up those pesky jowls, and then I can also place some from the naso-labial folds to the cheeks. They really are amazing and with these types of threads I don't have to do pull/cut the thread, so it is a lot less invasive since they are pre-cut and loaded. I can't do filler before the threads though because then the threads don't have anything to hold on to and could cause an infection. I actually like to do threads as the scaffolding and then if people need more volume I use Sculptra which is kind of like if you ground up the threads and added sterile water, except that it is a sugar which is star shaped and causes collagen stimulation over a year. So between the threads lasting 2 years and the sculptra lasting 1 year, people have to do WAY less maintenance and they don't have to come in (unless they want their hormones and gut fixed which is obviously way more important!)