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A well known minimally invasive facial rejuvenation procedure is the thread lift. This term refers to a concept of lifting sagging facial tissues by placing special designed sutures that can grab onto the subcutaneous tissues to be pulled upward along the line of the suture placement. This occurs as a result of a tied knot of the suture at its location of initial placement. There are multiple suture placement locations located either above the ear in the temporal region or behind the ear in the retroauricular sulcus. Either or both placement locations can create a modest improvement in sagging cheeks and jawline tissues.

While many different types of sutures have been devised for these threadlift procedures they are require a knotted suture line at the placement incision. This leaves a larger amount of permanent suture material underneath the incisions than would normally occur from the more traditional non-threadlift sutures. As a result and with the ingrowth of scar tissue a mass effect can occur creating an external bulge. This may or may not be associated with some discomfort when palpated. In my experience this is more likely to occur in the temporal region due to the temporal muscle on which the fascial knot fixation is placed.

For symptomatic temporal thread lift sites excision of the knotted material is the definitive treatment. The actual knot is typically encased in scar so wide excision of the area should be done. This usually requires removing some temporal fascia which to ensure that all knotted material is removed.

This will alleviate both the bulge created by the suture knot but will alleviate any discomfort associated with it as well.  

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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