A New Approach to Thread Facelifting

October 2021 | Volume 20 | Issue 10 | Original Article | 6139 | Copyright © October 2021


Published online September 15, 2021

Mariano Busso MD

Miami Rejuvenation Institute, Miami, FL

Abstract
Background: Facial rejuvenation has traditionally been achieved by repositioning soft tissue via invasive surgery.
Objectives: The present work describes a thread-based, face-lifting (TBFL) technique (BussoLyft™ that has provided reproducible and predictable results for 200 to 300 patients.
Methods: To reposition the orbital, nasolabial, and jowl fat pads, three primary vectors (one vertical, two oblique) are established on the side(s) of the face that requires lifting. The vertical vector for the orbital fat pad is volumetric and the oblique vectors for the nasolabial and jowl fat pads lift by thread-tissue engagement and repositioning.
Results: Repositioning the superficial fat pads of the orbital, nasolabial, and jowls areas results in a pleasant cosmetic outcome. In the treated nasolabial and jowl fat pads, the primary repositioning vector results from engaging cogs with fat septa, which places fat in a cosmetically optimal position. The primary mobilization of the superficial fat pad through the septal attachments to the dermis and superficial fascia creates a secondary movement and repositions the overlying skin and underlying superficial muscular aponeurotic system (SMAS). Very few threads are needed to reposition full-face superficial fat.
Conclusions: By optimizing every step of thread placement, the TBFL technique provides an efficient and effective method to reposition facial fat pads.

J Drugs Dermatol. 2021;20(10): doi:10.36849/JDD.6139

INTRODUCTION

Facial aging is associated with gravitational redistribution of facial soft tissue. To date, rejuvenation has been achieved by repositioning soft tissue via invasive surgery. A more recent approach is thread lifting, a closed facial lifting technique in which threads are inserted and passed under the skin surface, pulled to lift the ptotic tissue, and anchored at the point of entry.1,2

Thread lifting, or suture suspension, has yielded variable results1,3 and progress in its application has been questioned.4 Nevertheless, suspension sutures have progressed from non-absorbable polypropylene5,6 to resorbable multianchor suspension sutures with knots,7 absorbable poly-L-lactic acid,8 polydioxanone (PDO),9,10 and from barbed threads5 to threads with cogs or cones4,11 specifically designed to hold tissue in place.

As important as thread and cannula design are for a successful lift, the technique of thread placement is also important. In general, thread placement publications fail to address the details of technique.12 The present work describes, in detail, a thread-based, face-lifting technique that has provided reproducible and predictable results for 200 to 300 patients.

MATERIALS AND METHODS

Patients
Adult patients with descended superficial fat pads are candidates for a new thread-based, face-lifting (TBFL) technique (BussoLyft™) regardless of age, skin thickness, and body weight. Thin patients with significant fat pad descent and skin laxity achieve the most dramatic results.

Thread Design
Volumetric PDO threads (50 mm mesh) and tissue-engaging PDO threads (60-mm harpoon and 100-mm harpoon) were purchased (Medyglobal America, Miami, FL) for use in three primary vectors (Figure 1). Knowledge of different parts of a thread and their distribution in a cannula (Figure 2) is essential for performance of the TBFL.