Thread lifting in theory and practice

Beauty HUB continues to explore the thread lifting technique.

Technique for placing threads

Before the procedure, the facial skin should be treated with an antiseptic (chlorhexidine). Limitation of the surgical field is mandatory. For this purpose, a disposable head cap and surgical drapes are used. Particular attention should be paid to markings showing the direction of the threads. The markings appear in the form of vectors with a mark for the insertion and, in the case of bidirectional threads, the output of the thread (photo 1). This marking depends on the technique used and individual indications. The injection site is anesthetized with 1% or 2% lidocaine. The skin is punctured with a needle, then a cannula with a thread enclosed in it is inserted into this hole. In this case, the diameter of the needle should be slightly larger than the diameter of the cannula, which facilitates its insertion. The cannula is first inserted perpendicularly to a depth of 5 mm, and upon reaching the hypodermis, it is deployed parallel to the skin and advanced along the vector subcutaneously. After all the threads are inserted, they are slightly tightened, like a drawstring, making sure that the tension is symmetrical on both sides. Wrinkles that may form as the threads are pulled can be eliminated by lightly pressing the skin where the unevenness appears. After the procedure is completed, the site where the threads were inserted is covered with an adhesive bandage (Steri-Strip), which is left for 24-48 hours.

Important points

The result of the procedure largely depends on the type of skin and the severity of signs of aging. For example, the result of thread lifting of very thin, wrinkled skin with pronounced excess is unlikely to be satisfactory. In this case, it is better to remove excess skin surgically. Pronounced subcutaneous fat in a “heavy” face in overweight patients will make it difficult to firmly fix the threads. Moreover, the result will not be durable, since the thread will not support the weight of the leather and the leather will quickly sag. Very thin subcutaneous fat tissue, in turn, makes it much more difficult to find the correct depth of insertion of the threads. There is a risk of drawing the thread either too deeply or too superficially. In this case, it is recommended to fill it with volumetric fillers before the procedure of introducing threads, which will improve the quality of the skin and make it denser.

Regardless of the type of threads used, there is always the possibility of side effects, which, as a rule, are temporary and are not regarded as complications, but as a normal postoperative process. These include bleeding at the sites where the threads were inserted, swelling, temporary loss of sensitivity in the skin of the face, raised skin or depressions at the site where the threads were inserted. Such phenomena disappear a few hours, sometimes days, after the procedure and are observed much less frequently as the specialist gains experience. The literature describes long-term asymmetry and hypo-/hypercorrection during brow lifting. Inflammation or the appearance of inflammatory granulomas, infection, paresthesia, damage to blood vessels and the facial nerve are regarded as the result of a violation of the insertion technique - too deep or superficial.

It is very important to maintain the correct insertion depth when installing threads. The thread should be inserted subcutaneously, but superficial to the SMAS. Since there are no nerve endings in the hypodermis, correct insertion of threads is virtually painless. Therefore, only the puncture site needs to be numbed. Carrying out anesthesia throughout the entire insertion of the thread is not only not recommended, but even harmful, since maintaining sensitivity can serve as a kind of control over the depth of insertion. If the patient feels sudden pain during the insertion of the thread, this indicates that the cannula with the thread either entered the superficial layers, the dermis, or entered too deeply, which poses a risk of damage to nerves and blood vessels. However, when installing threads for the purpose of eyebrow lifting or neck tightening, infiltrative anesthesia along the thread is desirable, since thin skin and poorly defined hypodermis make it difficult to control the depth of application, and lifting the skin as a result of lidocaine infiltration facilitates control.

Postoperative care

Immediately after insertion of the threads, slight swelling, hematomas, and skin unevenness may appear. These phenomena disappear after a few days. It is recommended to use an antibiotic cream locally at the site where the threads were inserted, twice a day for five days. Immediately after the procedure, ice or a cold compress is applied to the area where the threads are inserted for 5-10 minutes. In case of persistent pain, it is recommended to take anti-inflammatory drugs for 2-3 days after the procedure. For 3 nights after the procedure, it is recommended to keep your head elevated (sleeping on a high pillow) and sleep on your back for 5 days. Daily cleansing of facial skin should not be aggressive. You should also apply makeup, shower, and wash your hair carefully for 5 days after the procedure. Sunbathing should be avoided for 2 weeks. For 3 weeks, no aesthetic procedures on the face or active sports are recommended. During this period, sauna, hammam, dental procedures, and very active facial expressions are also undesirable.

Interaction with other cosmetic procedures

Most cosmetic procedures, including injections (botulinum toxin, hyaluronic acid fillers, lipofilling), laser and physiotherapy procedures are recommended to be stopped a month before the introduction of threads. With the exception of hyaluronic acid injections, which can be done a week after the insertion of threads, other procedures can be resumed no earlier than a month later.

results

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1. Patient S., 44 years old, coarse-wrinkled type of aging, slight ptosis of soft tissues, worsened after weight loss (4 kg). Eight threads (barb treads 4-0, 160 mm, made in Korea) were introduced into the area of the lower third of the face.
2. Patient M., 42 years old, with post-traumatic asymmetry of soft tissues in the chin area. Eight threads (barb treads 2-0, 160 mm, made in Korea) were introduced into the area of the lower third of the face.
3. Patient M., 45 years old, with post-traumatic asymmetry of soft tissues, minor age-related ptosis and persistent spasm of the m.mentalis. 16 threads (barb treads 4-0, 160 mm and 2-0, 160 mm manufactured in Korea) were introduced into the area of the middle and lower third of the face and botulinum toxin A was injected into the area of the mental muscle (5 units).

Author: Yana Goncharova, MD, leading specialist at Queen Medical Clinic (Qatar), member of the European and French Society of Dermatovenerologists.