Thread lifting in theory and practice

The idea of ​​using threads to correct age-related changes is not new and dates back almost a hundred years. The first threads were very primitive. They were injected intradermally or subcutaneously, creating a kind of frame or mesh to support the sagging skin. At first they used threads made of gold, catgut, and horsehair. Unfortunately, the result of tightening and improving skin tone after using such threads was insignificant. Moreover, the procedure was often accompanied by complications of an inflammatory and infectious nature, which caused some disappointment. However, with the advent of absorbable polydioxane sutures (PDO), the technique of the procedure became more advanced and again attracted the attention of specialists. True, there were still problems associated with insufficient lifting effect, the risk of fibrosis, and the development of inflammatory granulomas. Later, the idea of ​​introducing threads in loops arose in order to enhance the effect of skin tightening, but thin threads cut through the skin like a fishing line cutting butter, so the effect of such a procedure was short-lived, from several weeks to several months. The situation changed in 1956, when the American surgeon JHAlcamo received a patent for threads with “barbs” that, clinging to the skin, remained in it for a longer time. In 1997, this idea was picked up by H.Buncke, and in 2001 it became widespread thanks to Sulamanidze’s barbed threads, which were first unidirectional and later bidirectional. Threads with this structure served as small “anchors”, which, clinging to the subcutaneous tissue, provided skin tightening.

Today, skin tightening using threads is experiencing a real boom, which is associated with the constant improvement of the materials from which the threads are made. Thanks to the intactness and hypoallergenic nature of modern materials, the likelihood of developing inflammatory granulomas and other complications has significantly decreased, and methods for introducing threads have been diversified. Improving and simplifying the technique of the procedure has made it possible to expand the circle of specialists proficient in this method. Now these are not only plastic surgeons, but also dermatologists, as well as other specialists involved in aesthetic medicine. The most widely used threads at present are Silhouette threads (SOFT and LIFT) made in the USA, Promoitalia (Italy), PDO barb threads (Korea).

Physiology of facial aging

To better understand the mechanism of action of threads, let's consider the main points of physiological aging of the face. Modern studies have shown that with age, the facial skull undergoes “verticalization” of the frontal bone and the walls of the sinuses of the upper jaw. At the same time, the periorbital region, lower and upper jaws lose bone mass. Facial adipose tissue is represented by three layers. The most superficial layer, located between the dermis and the superficial musculoaponeurotic system (SMAS), accounts for 57% of buccal fat. This is hypodermal fat that does not change with age, but its amount decreases with weight loss. Deep fat, located under the aponeurosis, is located around the muscles, facilitating and cushioning their contraction. Starting at age 40, deep fat decreases by approximately 1% each year. Muscles also lose volume with age. They shorten due to the fact that with age they begin to be in a state of permanent contraction. Shortening of muscles combined with loss of fat tissue volume leads to displacement of fat accumulations, but this displacement is limited to a certain extent by the ligaments and fibrous partitions between fat accumulations. Superficial fat is also involved in this process, which leads to the formation of nasolabial furrows and sagging cheeks. Based on this theory, the most effective correction of age-related changes is tissue reposition using threads and restoration of the volume of lost adipose tissue.

Effects of the procedure

What should you expect from the introduction of threads? The main effects of this procedure are tightening and stimulation of skin regeneration. In this case, the effect of skin tightening is visible almost immediately. It occurs due to the fact that immediately after introducing the threads under the skin, the specialist tightens the thread, which clings to the soft tissue with its teeth and drags them in the direction of tension. The regenerative function of the threads is associated with the stimulation of fibroblasts, which synthesize collagen, which replaces the gradually absorbable threads. New collagen fibers become a scaffold that strengthens the soft tissue structure. The introduction of threads allows you to lift (reposition) soft tissues and slightly increase their volume. The procedure is minimally invasive, performed under local anesthesia on an outpatient basis, maintaining the sterility of the threads, and takes from 15 to 45 minutes.

Indications, contraindications, compatibility

The best results can be expected with drooping of the soft tissues of the face, loss of volume in the tissues of the zygomatic region, drooping in the projection of the lower jaw, sagging neck skin, drooping eyebrows. Moreover, the threads make it possible to correct post-traumatic asymmetry of soft tissues and asymmetry due to facial paralysis. Relative contraindications are excess skin in the chin area with thick and heavy skin, very pronounced age-related sagging with thin skin, excess skin in the chin and lower jaw in combination with the hypertrophic type of age-related changes, very thin skin in the absence of a fat layer. Patients with such problems are not ideal for this procedure. The efficiency of threads can be significantly improved by using a combination of different techniques. For example, in order to restore the lost volume of soft tissue in the zygomatic, temporal, and chin areas, threads can be combined with the introduction of fillers (high-reticular hyaluronic acid or calcium hydroxyapatite). For severe skin wrinkling, a combination of threads with injections of botulinum toxin A and/or low-reticular hyaluronic acid can be used.

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