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The History and Principles of Thread Lifting

Minimally invasive facial rejuvenation procedures have recently grown in popularity around the world. According to the plastic surgery statistics of the US from 1997 to 2008, the number of surgical cosmetic procedures increased by 180% whereas that of nonsurgical cosmetic procedures increased by over 750%.

Nonsurgical aesthetic procedures are expected to increase in popularity in the future. More patients prefer non-invasive methods as they offer satisfactory and natural outcomes with shorter downtime, lower risk and better affordability.

Among the minimally invasive procedures, thread lifting using no or minimal incision and various cog or similar thread are becoming very popular. However, there is paucity of clinical data regarding this method.

In Korea, many types of threads are being used in lifting procedures such as E-Z lift, Misko, Misju, Mesh Lift, Blus Rose Lift and Omega Lift, etc. Recently, manufacturers are introducing a new thread every 2-3 months, adding to already numerous choices available. This also shows that the demand for thread lift is very high.

In the past, a cogged, absorbable thread was produced by 100% manual labor. Therefore, the cogs did not line up at a consistent angle, causing earlier absorption. The thread shaft also broke and lost efficacy or the thread became exposed. These days, cogged threads are produced by molding technology with consistent strength and alignment cogs.

History of Thread Lifting

In the 1990s, Sulamanidze of Total Charm Plastic Surgery in Moscow first developed anti-ageing thread lift using barbed suture. In 1990, he also developed the ‘Non-Surgical Face Lift’ technique, later ‘Aptos Thread’ became widely used for facial thread lift, followed by various thread lift procedures such as waffles thread lifting, waptos suture lifting, issue unidirectional barbed threads and silhouette thread lifting, etc.

In 2002, Sulamanidze et al, reported a variation on the aptos thread lift using bidirectional small barbed 2-0 polypropylene thread. Sulamanidze’s wrinkle removing procedure inserts specially processed barbed thread in the subcutaneous fat layer or SMAS, where the barbs pull the skin tissues in the opposite direction of the wrinkle to smooth out lines.

The thread used is 2.0mm polypropylene with very little risk of tissue response. Cogs, dents or microhooks on the thread shaft pull and fix the sagging skin away from the pull of the wrinkle. About 4-6 weeks after the procedure, fibrous tissues for around the cogs, strengthening the support and wrinkles smoothing effect.

Occasional side effects of aptos thread lift include asymmetry, hematoma, edema, and pain etc. most of which are mild and transient. However, as the thread is non-absorbable, removing the thread is difficult and may cause long-term discomfort. To complement these shortcomings, absorbable PDO thread was developed in 2011 and has been used in lifting procedures.

Absorbable suture material such as PDO is referred as it has longer half and lower tissue response compared to monofilament threads such as aptos thread, catgut or Polyflycolic acid (Dexon) thread. In the early days, the monofilament PDO thread used in nonsurgical face lifts improved the skin tome and elasticity to greater satisfaction of patients.

Later, barbed PDO thread was developed to maximize the lifting effect and threads of various thicknesses have been introduced. Thicknesses ranging from 1-0, 2-0, 3-0, and 4-0, etc, have become available as well as twisted or twin threads made from twisting two or more monofilament threads have been developed to provide better tensile strength and efficacy .