Facial thread lifting with suture suspension☆

Tavares, Joana de Pinho; Oliveira, Carlos Augusto Costa Pires; Torres, Rodolfo Prado; Bahmad, Fayez

doi:10.1016/j.bjorl.2017.03.015

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Brazilian Journal of Otorhinolaryngology

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Artigos de revisão • Braz. j. otorhinolaryngol. 83 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.bjorl.2017.03.015 copy

Facial thread lifting with suture suspension^☆ ☆ Please cite this article as: Tavares JP, Oliveira CA, Torres RP, Bahmad Jr. F. Facial thread lifting with suture suspension. Braz J Otorhinolaryngol. 2017;83:712-9.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The increased interest in minimally-invasive treatments, such as the thread lifting, with lower risk of complications, minimum length of time away from work and effectiveness in correcting ptosis and aging characteristics has led many specialists to adopt this technique, but many doubts about its safety and effectiveness still limit its overall use.

Objective:

To analyze data published in the literature on the durability of results, their effectiveness, safety, and risk of serious adverse events associated with procedures using several types of threading sutures.

Methods:

Literature review using the key words "thread lift", "barbed suture", "suture suspension" and "APTOS". Due to the scarcity of literature, recent reports of facial lifting using threads were also selected, complemented with bibliographical references.

Result:

The first outcomes of facial lifting with barbed sutures remain inconclusive. Adverse events may occur, although they are mostly minor, self-limiting, and short-lived. The data on the maximum effect of the correction, the durability of results, and the consequences of the long-term suture stay are yet to be clarified.

Conclusion:

Interest in thread lifting is currently high, but this review suggests that it should not yet be adopted as an alternative to rhytidectomy.

Keywords:
Rhytidoplasty; Lifting; Sutures

Author	Type of thread	No. of patients	Complications	Duration of follow-up	Assessment of results	Ideal patient
Lycka et al.,²³23 Lycka B, Bazan C, Poletti E, Treen B. The emerging technique of the antiptosis subdermal suspension thread. Dermatol Surg. 2004;30:41-4.	Aptos threads	350	47% bruising; 46% bleeding; 43% edema; 14% erythema; 14% discomfort; 3% visible threads; 3% asymmetry	117 patients followed for 12-24 months maintaining 70% of the initial correction; 96 patients followed for 36 months, maintaining 60% of the initial correction.	56.5% very good to excellent; 27.7% good; 13.4% fair; 2.4% unsatisfactory or poor	Young patients with many wrinkles or after rhytidectomy who desire mild to moderate improvement
Wu,⁷7 Wu WTL. Barbed sutures in facial rejuvenation. Aesthet Surg J. 2004;24:582-7.	Aptos threads	102	11% palpable thread tip with pain; 8% thread migration; 5% infection or granuloma; 5% skin retraction or irregularity	Not recorded	No objective elevation measurement	Not recorded
Sulamanidze et al.,⁵5 Sulamanidze MA, Paikidze TG, Sulamanidze GM, Neigel JM. Facial lifting with "APTOS" threads: featherlift. Otolaryngol Clin N Am. 2005;38:1109-17.^,¹⁸18 Sulamanidze MA, Fournier PF, Paikidze TG, Sulamanidze GM. Removal of facial soft tissue ptosis with special threads. Dermatol Surg. 2002;28:367-71.	Aptos threads	157	14.6% skin retraction; 9.5% linear hemorrhage; 9.5% hypercorrection; 7.6% hypocorrection; 2.5% thread expulsion	2 months to 2.5 years	No objective measure of elevation; 12 cases required additional threads	Ptosis, face and neck flaccidity and poorly defined facial contours
Silva-Siwady et al.,²⁸28 Silva-Siwady JG, Díaz-Garza C, Ocampo-Candiani J. A case of Aptos thread migration and partial expulsion. Dermatol Surg. 2005;31:356-8.	Aptos threads	1	Migration and expulsion	28 days	No objective elevation measurement	Not recorded
Lee and Isse,²⁹29 Lee S, Isse N. Barbed polypropylene sutures for midface elevation: early results. Arch Facial Plast Surg. 2005;7:55-61.	Contour threads	44	20% sensitivity in the zygomatic arch; 10% hematoma; 3% bruises; 3% skin retraction	9 months (mean)	No objective elevation measurement	Patient with isolated malar fat ptosis and minimal loss of mandibular contour
Badin et al.,²⁰20 Badin AZ, Forte MRC, Silva OL. Scarless mid and lower face lift. Aesthet Surg J. 2005;25:340-7.	Beramendi threads	52	13.5% skin irregularities; 9.6% extrusion; hyperalgia 3.8%	18 months	No objective elevation measurement	Ptosis of the middle third of the face with palpable adipose tissue
Horne et al.,³⁰30 Horne DF, Kaminer MS. Reduction of face and neck laxity with anchored, barbed polypropylene sutures (Contour Threads). Skin Therapy Lett. 2006;11:5-7.	Contour threads	25	4% 50% loss of thread tensile strength after 11 weeks	12 weeks	No objective elevation measurement	Not recorded
Helling et al.,²⁵25 Helling ER, Okpaku A, Wang PTH, Levine RA. Complications of facial suspension sutures. Aesthet Surg J. 2007;27:155-61.	Not specified	4	1 wound secretion, local pressure, and asymmetry; 1 foreign body sensation and palpable thread; 1 facial paralysis; 1 skin irregularity	1 month, 1 year, soon after 5 months	No objective elevation measurement	Not recorded
Kaminer et al.,⁶6 Kaminer MS, Bogart M, Choi C, Wee SA. Long-term efficacy of anchored barbed sutures in the face and neck. Dermatol Surg. 2008;34:1041-7.	Contour threads	12	58% swelling and bruising; 36% thread visibility; 27% sensation of pinching; 25% ear numbness	6-16 months (mean 11.5 months)	Patient subjective satisfaction classification and independent evaluators of 1-10: mean of 6.9	Not recorded
Sardesai et al.,²⁴24 Sardesai MG, Zakhary K, Ellis DAF. Thread-lifts: the good, the bad, and the ugly. Arch Facial Plast Surg. 2008;10:284-5.	Not specified	75	23% patient dissatisfaction; 19% extrusion requiring procedure for thread excision or repair; 4% skin irregularities	Not recorded	No objective elevation measurement	Not recorded
Garvey et al.,³¹31 Garvey PB, Ricciardelli EJ, Gampper T. Outcomes in threadlift for facial rejuvenation. Ann Plast Surg. 2009;62:482-5.	Contour threads	72	31% revision surgery for cosmetic reasons (mean of 8.7 months later); 11% tip removal from palpable threads	Not recorded	42% needed a secondary thread procedure on average 8.4 months later	Not recorded
Gamboa et al.,³²32 Gamboa GM, Vasconez LO. Suture suspension technique for midface and neck rejuvenation. Ann Plast Surg. 2009;62:478-81.	Silhouette Lift	17	100% temporary edema; 6% submitted to resuspension 4 months later	9 months	90% satisfaction; 11% moderate improvement	Not recorded
Rachel et al.,³³33 Rachel JD, Lack EB, Larson B. Incidence of complications and early recurrence in 29 patients after facial rejuvenation with barbed suture lifting. Dermatol Surg. 2010;36:348-54.	Contour threads	29	69% of adverse events and 45% of early recurrence (6 months), 14% of which had recurrence within 8 weeks	1-25 months	No objective elevation measurement	Not recorded
Sulamanidze et al.,³⁴34 Sulamanidze M, Sulamanidze G, Vozdvizhensky I, Sulamanidze C. Avoiding complications with Aptos sutures. Aesthet Surg J. 2011;31:863-73.	Aptos threads	6098	3% asymmetry; 2.8% contour irregularities; 2.7% ptosis recurrence; 1% skin retraction; 0.2% hematoma	Not recorded	No objective measurement. Results improved as thread quality and techniques improved in 12.5 years	Age younger than 50 with moderately flaccid cheeks
Savoia et al.,³⁵35 Savoia A, Accardo C, Vannini F, Di Pasquale B, Baldi A. Outcomes in thread lift for facial rejuvenation: a study performed with happy liftTM revitalizing. Dermatol Ther. 2014;4:103-14.	Happy Lift	37	62% mild bruising; 40% moderate erythema; 40% slight postoperative swelling; 25% mild bleeding; 6% asymmetry; 6% mild transient anesthesia	6 months	Rating: 1 excellent, 2 much better, 3 better, 4 unchanged, 5 worse. 89% satisfactory results (65% excellent and 24% good) and 11% unsatisfactory results	Moderate ptosis
Park et al.,³⁶36 Park TH, Seo SW, Whang KW. Facial rejuvenation with fine-barbed threads: the simple Miz lift. Aesthet Plast Surg. 2014;38:69-74.	Polypropylene developed by the authors	102	2% dissatisfaction, 1% skin irregularity, 1% weakness of the facial temporal branch	5-18 months	98.1% patient satisfaction. Surgeon's Satisfaction: 69.6% excellent; 7.5% good; Fair 2.9%	Not recorded
De Carolis et al.,³⁷37 De Carolis V, Gonzalez M. Neck rejuvenation with mastoid-spanning barbed tensor threads (MST operation). Aesthet Plast Surg. 2014;38:491-500.	Polypropylene developed by the authors	67	13.4% of thread visibility at movements; 1.5% hematoma; 1.5% facial paralysis	18 months	No objective elevation measurement	First signs of neck flaccidity or oblique cervical-mentonian angle
Han et al.,³⁸38 Han SE, Go JY, Pyon JK, Oh KS. A Prospective evaluation of outcomes for midface rejuvenation with mesh suspension thread: "REEBORN lift". J Cosmet Dermatol. 2016;15:254-9.	Reeborn	18	5.5% minimum irregularity; 5.5% palpable suture	12 months	Significant reduction of wrinkles according to Fitzpatrick's Modified Wrinkle Scales and Marionette Line grade 6 months: p < 0.0001 12 months: p < 0.0003 100% patient satisfaction	Moderate to severe wrinkles and visible marionette lines

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mails:fayezbjr@gmail.com fayez@unb.br (F. Bahmad Jr.).

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Facial thread lifting with suture suspension☆ ☆ Please cite this article as: Tavares JP, Oliveira CA, Torres RP, Bahmad Jr. F. Facial thread lifting with suture suspension. Braz J Otorhinolaryngol. 2017;83:712-9.

Abstract

Introduction:

Objective:

Methods:

Result:

Conclusion:

Facial thread lifting with suture suspension^☆ ☆ Please cite this article as: Tavares JP, Oliveira CA, Torres RP, Bahmad Jr. F. Facial thread lifting with suture suspension. Braz J Otorhinolaryngol. 2017;83:712-9.