Thread Lifts: A Critical Analysis of Treatment Modalities

April 2020 | Volume 19 | Issue 4 | Original Article | 413 | Copyright © April 2020

Published online March 2, 2020

Amani Adam , Dimitrios Karypidis , Ali Ghanem

aQueen Marry University of London, London, United Kingdom bQueen Mary University of London, London, United Kingdom; Cardiff University, Cardiff, United Kingdom

Abstract
Background: Thread lifting procedure was developed to reverse the aging process and restore youthful appearance by retightening and lifting the skin. Different models of absorbable and non-absorbable threads are universally available and promise quick results with minimum downtime.

Objectives: To evaluate the efficacy, safety, and cost effectiveness of the commonly used threads for facial lifting and rejuvenation using an evidence-based review.

Methods: A comprehensive search of the literature was done using numerous databases (including Cochrane Collaboration, PubMed, Ovid, and Google Scholar). Thread lift for non-aesthetic purpose, open surgical procedure, animals or cadaver studies were excluded. 16 relevant studies were included. The extracted data included significant details related to the review question.

Results: Several types of threads with different designs and properties are available for facial rejuvenation, provided by many companies all over the world. Higher quality evidence was found for Contour thread (III). Available studies for the other various threads were level IV. Thread lifting procedure was found to be safe and effective, with minor and mostly self-limited complications. The longevity of results varied from months to years, with more focus related to the technique and patient selection rather than the type of thread.

Conclusion: Comparatively high quality long-term multicentre standardized studies are required to help aesthetic doctors to choose the appropriate thread type based on optimum aesthetic outcomes.

J Drugs Dermatol. 2020;19(4): doi:10.36849/JDD.2020.3646

INTRODUCTION

Aging is a natural result of gradual anatomical changes in all facial layers. The most dramatic alterations occur in subcutaneous fatty layer.1 In the normal individual, fat deposition in specific compartments gives the face its youthful contours.1 However, the action of muscles in forming facial expression over time leads to fat compartments shifting, resulting in the consequent appearance of wrinkles and folds, loss of jawline demarcation, and loss of plump cheeks.2 Facial skin is well attached to the underlying fat, therefore traction and suspension of the sagging tissue significantly retightens the face.2 Under this logic, thread lifting sutures are used to reposition the soft tissues for a natural appearance, without disturbing underlying ligaments.3

Threads for facial rejuvenation are commercially available throughout the world with different designs and characteristics.4 Sutures may contain barbs or cones made of polypropylene non-absorbable material such as Aptos thread, Contour thread, and Silhouette lift thread, or made of absorbable threads represented by Silhouette Soft thread (poly-I-lactic acid or polydioxanone thread (PDO)).5 Barbed suture was released by Alcamo in 1964 for surgical, non-aesthetic purposes, and further improved by Fukuda (1984) and Ruff (1994).6,7 The use of barbed suture for minimum invasive facial rejuvenation was introduced by Sulamanidze (1998),8 called Aptos (anti-ptosis) threads (Aptos Ltd., Moscow, Russia).9 This was further modified to the second generation Aptos Thread 2G, with double the length of original thread and a double-edged needle.9

Sulamanidze (2003) evolved a spring thread named Aptos Springs for lifting dynamic parts in the face, such as the perioral area.10 Subsequently, several designs of barbed sutures were introduced to the market,11 including Contour threads, commercially known as Featherlift Extended Aptos Length Threads,8 developed by Dr Gregory Ruff and approved by the FDA in 2004.12 Contour threads (Surgical Specialties, Inc., Reading, Pa.) are polypropylene sutures with unidirectional barbs with a long Keith needle at one end and a curved needle at the other.12 Contour threads aim to overcome complications associated with Aptos sutures, such as asymmetries and thread extrusion.13 However, Contour thread lifting procedure requires longer recovery period than with Aptos threads.14 Another type is Happy Lift (Promoitalia International Srl, Rome, Italy), with bidirectional barbed thread, which may be either absorbable or non-absorbable.3 Additionally, Beramendi threads are double-convergence polypropylene monofilament sutures, made in Brazil.15

Polydioxanone (PDO) threads for facial rejuvenation include non-barbed mono filament PDO thread, coiled single monofilament