We all want to look younger with no downtime, no bruising, and it will last forever. (Cue the Disney music here.)
To this end, the suture facelift was made. In this lift, you do not have a giant scar and lots of recovery time. For a thread lift, you make a tunnel and in key points you use a barbed suture to lift the sagging tissue. Think of it like a marionette string drawing up the tissues. This is also called “the lunchtime facelift,” “threadlift”, “thread facelift” “barbed suture facelift.” The cost of these is about 40% of the cost of a true facelift.
This is not a new thought- variations of this have been done for years, starting when I was in residency (20 years ago) with the Giampapa stitch. I have not been a fan of them, because for the cost, I didn’t feel like the difference was big enough or lasting enough. And if the suture breaks (which is minimized by using the barbed suture, so it can’t “fall” as much), then you end up with asymmetry. They keep trying to make better sutures- improved barbs, cones, and other things. Anytime they show barbed suture lifts at my meetings, which they still do, I have not been moved to try it. I guess I am a fan of old fashioned facelifts as they make sense to me why they work- they are two layers, you are tightening the SMAS and the skin, cutting out skin, and creating a broad plane that glues itself back together, so it can’t “fall” in the same way. Fast forward to today, March 2019, where people are still doing the threadlifts. The big question- DO THEY WORK?
Aesthetic Surgery Journal, March 2019, had a study based just on this. “Effectiveness, Longevity, and Complications of Facelift by Barbed Suture Insertion.”
Study:
- 160 consecutive facelifts
- For cheek or nasolabial grooves, 2-3 PDO 23 gauge threads were place per side.
- For treatment of mandibular lines, 2-4 PDO 21 gauge threads placed per side.
- Pre op evaluation confirmed they were good candidates: soft tissue thickness was thick enough to hide the threads, they were not smokers or had prior surgical or nonsurgical facial procedures.
- Mean age was 51.
Findings?
- immediately after: improvement in drooping
- 1 month after: improvement in drooping
- This result declined noticeably by 6 months and was absent at one year.
- Complications:
- 34%
- 11% had superficial displacement of the barbed sutures
- 9% had transient redness
- 6% had infection
- 6% had skin dimpling
- 1% had temporary facial stiffness.
- 34%
Their conclusion?
Don’t do it, unless someone can’t have a true facelift for other reasons.
“Placement of barbed threads yields instantaneous improvement in facial ptosis that is no longer apparent by 1 year. Given this transient benefit and the complication rate of 34%, we recommend limiting this procedure to patients with contraindications for more invasive facial surgery.”
Of bigger importance, in their discussion, they state 25% of patients were disappointed, and went on to have nonsurgical facial procedures to improve the result. 10% of the patients went on to do a true facelift.
In the commentary critique of the journal article, another author states, “This reflects what many of us who are actively involved in threadlifts have believed: dissolvable threads do not last and as they dissolve, all benefits are lost.” This commentator uses a different thread, called “Woffles”, which uses a permanent thread with bidirectional barbs. He feels this is more effective and is harder to pull out or loosen. “But the Woffles thread is not commercially available.” Even with his permanent suture, he tells his patients this is a temporary facelift, that needs to be repeated, with more threads being added as resagging occurs.
My thoughts?
These are marionette strings. I am a huge fan of a traditional facelift combined with fat grafting. Any of these barbed sutures and tunnels which create scarring in the subcutaneous plane may affect my ability in the future to do facelift or fat grafting in the way I would like. And these procedures are not cheap. They cost about 40% of the cost of a facelift, and by all authors accounts, the barbed suture lift effects are temporary.
Easy fix = not a fix. Just do the right thing the first time.