The search for non-surgical or minimally invasive techniques for facial rejuvenation has been ongoing for decades. Some patients understandably want to avoid facelift surgery for reasons of recovery, cost and the invasive nature of the surgery. The use of the Threadlift procedure using barbed sutures to lift up sagging cheeks and jowls as a far less invasive facial rejuvenation procedure was introduced over fifteen years ago. The procedure had a lot of initial enthusiasm but waned after a few years of clinical results that showed lack of sustained results and thread-related issues.
While the initial Threadlift barbed sutures were eventually removed from clinical use, the promise of the procedure led to further innovations in the barbed suture material and techniques. It is a concept that remains appealing and, as a result, numerous manufacturers have developed newer types of barbed sutures for the same basic concept of suture facelifting.
In the February 2018 issue of the Aesthetic Surgery Journal, an article was published entitled ‘Effectiveness, Longevity, and Complications of Facelift by Barbed Suture Insertion’. In this retrospective clinical study the authors evaluated the results of 160 consecutive patients who underwent a facelifting procedure using barbed polydioxanone (PDO) threads. Their technique for malar lifting and improvement of the depth of the nasolabial folds by the placement of two or three PDO threads (23 gauge) per side. For the treatment of jowling and mandibular lines two or four PDO threads (21 gauge) were placed per side.Their results showed that the immediate and one month after surgery results had good improvement in facial sagging. But by six months the improvement had noticeably declined and disappeared by one year after the procedure.
Complications were not uncommon and occurred in one-third of the patients. (34%) Technical placement issues occurred in 11% of the patients with a too superficial thread position. Pertinent medical issues were persistent redness (9%), infection (6%), skin dimpling (6%) and temporary facial stiffness. (1%)
This study showed that, while the aesthetic effects of barbed threads showed an immediate improvement in age-related facial sagging, those effects were short-lived. In addition considering that the rate of complications was not insignificant, the use of PDO threads in facial rejuvenation is recommended for patients who can not undergo more traditional forms of facelift surgery.
The experience with more recent PDO threads is very similar to what was experienced with the original barbed suture thread lifts. There is really not a lot of difference in the clinical outcomes nor should it be expected to be. Pulling up sagging facial tissues with resorbable sutures should not be expected to have a sustained result as no tissues are removed or tightened. And like all implanted devices that are placed in the superficial subcutaneous tissues, the type of complications seen would be expected.
But that being said there still is a role for suture facelifting procedures in the properly selected patient. The best innovation with the use of PDO threads is that they are reservable so the risk of foreign-body reactions is eliminated after their facial lifting benefits have disappeared.
Dr. Barry Eppley
Indianapolis, Indiana