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
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
