In recent years, there has been a movement in cosmetic surgery toward less invasive, shorter recovery treatment options. For many, the desire for cosmetic improvement must be balanced against concerns about recovery time, expense, and risk. This has spurred an increased popularity of in-office procedures, such as Botox®, injectable fillers, and laser skin resurfacing. But even certain surgical procedures have emerged which are less invasive variations of more extensive operations.
One example of this phenomenon is the thread or suture lift. The procedure basically involves suspension of the soft tissue at one area of the face through threads or sutures placed under the skin and anchored to a point above. These procedures are typically performed in the office under local anesthesia and require very little down-time. The regions that may be addressed include excess or hanging soft tissue of the neck, jowls, midface, and forehead.
After the sites to be treated are numbed with a local anesthetic injection, the procedure starts with the placement of several small (1-2 mm) incisions through the skin in the area onto which the stitches are to be anchored. For example, if the midface and cheek are to be elevated (to reduce naso-labial folds, aka laugh lines), the anchor point would likely be the strong connective tissue under the skin in temple area just in front of the ear. The incisions would be placed behind the hair-line so that they are hidden.
Next, a suture or thread is passed with a long needle under the skin surface from one of the anchor site incisions, down to the area which is intended to be elevated. The needle and suture then exit through the skin at the area needing elevation. For the midface/cheek, the suture would exit at a point just above the nasolabial fold. The needle and suture is then passed back through the same exit hole and directed back toward the original entry incision, but in a slightly different pathway. This allows for the suture to “catch” some of the soft tissue in its loop. The needle is then passed beneath the connective tissue at the anchor point and the 2 loose ends of suture are firmly tied together, thus cinching the loop of suture and pulling the targeted soft tissue up.
Usually several suture loops as described above will be used to lift a site, each just next each other. This allows for more of a uniform elevation of tissue. If a very specific area is to be elevated, a single suture loop may be used. For example, when the goal is to elevate only the outer corner of the eyebrow, a single loop may be used.
Several different types of suture have been designed for thread or suture lifting procedures. Permanent sutures or threads made from material such as nylon or Gore-Tex® can be used. More recently, there have been more long-lasting absorbable sutures available for these procedures. Other sutures come with tiny barbs etched along the length of the suture, allowing for the sutures to “grab” the soft tissue better.
Because these procedures tend to be smaller, less-invasive interventions, they overall lead to less severe complications. There is minimal risk of significant blood loss or nerve injury, for example. Swelling is more limited given that the surface of the skin is not elevated from the deeper tissue as in standard lifting operations. The main problems resulting from these procedures are cosmetic in nature. If the suture catches the skin too close to the surface, undesired dimpling or puckering of the skin can ensue. There can be the risk of the skin being pulled upward in an irregular manner rather than as uniform sheet of skin. In other words, the skin at the area in contact with suture lifts up more than skin not in direct contact, potentially creating a “pleated” appearance to the surface.
The main disadvantage of these procedures is their limitation in creating a large change and their limited duration of effect. Because the lift is dependent solely on the pull of the suture, the lifted tissue will eventually sag again as the suture reabsorbs in the body. Even if permanent sutures are used, the suture will gradually erode through the soft tissue (“cheese-string effect”) as it must bear the weight of the soft tissue. Traditional surgery does use sutures as well for suspension and fixation, but because the soft tissue is widely elevated from the deeper tissue, the skin heals and attaches into the improved position.
Overall, the role of suture or thread lifting procedures should be limited to minor deformities in areas of the face in which mild sagging of skin or soft tissue is present. Patients should understand that the duration of treatment is likely to be less than a year and should be given alternatives for traditional surgery.
Thread-lift for facial rejuvenation: assessment of long-term results. Abraham RF, DeFatta RJ, Williams EF 3rd. Arch Facial Plast Surg. 2009 May-Jun;11(3):178-83.