Thread lifts emerged recently because many people would like a facelift, but can't afford it or don't want the long recovery time of the standard facelift. Thread lift is considered as a lesser, or preliminary procedure. Thread lifts cost less and require less downtime for many people. Some plastic surgeons promote the thread lift as a "lunchtime lift" or "weekend facelift." Usually thread lift can be performed in about one hour.

As we age, our facial support structure weakens, and we lose facial fat. The affected areas generally include the cheeks, the eyebrows and other areas around the eyes, the jowls and the neck. The result is a longer, older-looking face.

Younger people may experience cheek and brow ptosis (sagging caused by weakened muscles) as well. For these people especially, a thread lift may be a good alternative to the more invasive procedures necessary to correct problems in older people's faces.

Ideal candidates for thread lifts include people with minimal signs of aging who need just a small lift. Most people who undergo thread lifts are women between 35 and 45. They choose a thread lift because they have begun to see more prominence of the jaw, a relaxed (or minimally sagging) midfacial appearance or slight bags under the eyes or on the neck. Older people may undergo a thread lift during the more aggressive facelift procedure to provide additional support for the soft tissue area that was elevated in the facelift.

Other thread lift candidates include those who have had some relapse from a previous plastic surgery procedure such as a facelift or neck lift. Many physicians combine thread lifts with other procedures, such as chin lifts, neck lifts and brow lifts, for a customized approach to facial rejuvenation.

In a thread lift, barbed sutures (threads) are used to lift sagging eyebrows and eyelids, deep nasolabial folds (those furrows between your nose and the corners of your mouth) or aging neck tissues. Your surgeon would use a thin needle to insert the sutures under the facial tissues. The barbs on one end of the thread grab and lift the sagging skin, and the teeth on the other end anchor the skin to the underlying facial tissues. No incisions or stitches are required, and no scars are produced.

Two types of thread lift procedures are currently being performed in the United States: the Contour Threadlift and the FeatherLift or Aptos Thread lift. It's estimated that as many as 9,000 thread lifts have been performed nationwide with Contour Threads, which were approved by the U.S. Food and Drug Administration in September 2004, with current indications for elevation and fixation of midface, brow and neck. The Aptos Thread, which was developed overseas, received its premarket approval from the FDA in March 2005. The American Society of Plastic Surgeons reports that its members performed more than 5,000 thread lifts in 2006.

The main difference between the two is design. Contour Threads are unidirectional and fixed in the area of initial access, whereas Aptos Threads are bidirectional.

The Contour Thread material, clear polypropylene, has been used in other medical applications for many years. It has barbs along the thread that act as cogs to allow the surgeon to grasp, lift and suspend a relaxed facial area. The barbs open like an umbrella to form a support structure that lifts the sagging tissue. The Aptos thread has barbs on the entire length that are inserted under the skin to gather tissue to fill out and lift the cheeks and sagging skin.

Your surgeon may instruct you not to eat or drink after midnight before the thread lift. He or she may prescribe an antibiotic to take beforehand and tell you to cease taking certain other medications.

During the procedure, your surgeon will make small incisions in key locations and insert a threaded needle to lift the subcutaneous tissue and suspend the lift with the thread. The barbs on these threads will lock in place and encourage collagen formation upon insertion to lift very specific areas.

Several variations of the technique exist. In general, the "closed" technique involves molding the soft tissue over the suture in multiple location points until it catches in the appropriate location to provide the best result. During an "open" technique, the surgeon will use instruments under the skin to create a raw surface so that when the sutures are pulled up, the lift is more likely to remain in the appropriate position.

Other surgeons have developed a combination technique that uses sutures at multiple tissue levels to catch all the barbs and create a suspension that cannot be accomplished with a nonbarbed suture. Depending on your needs, the number of threads used can range from two to 20.

Thread lifts are often performed in an outpatient medical surgery center or hospital. Because the procedure is minimally invasive, general anesthesia is not required, so you can remain awake. One benefit is that the plastic surgeon can give you a mirror as the thread is pulled back, allowing you to give feedback. Usually an oral antianxiety medication, along with local anesthesia, is all that is required. Most people tolerate this well and avoid any "postanesthesia hangover."

Your surgeon will provide complete postoperative instructions that you must follow to reduce the risk of complications during recovery. These instructions may include an escort to drive you home and assist with daily activities for at least 24 hours, as well as diet restrictions (soft foods) for seven days. Pain can be managed with oral medications such as acetaminophen. Ibuprofen is avoided to limit bruising. Your surgeon may recommend elevating your head to reduce swelling for the first day.

The day following the procedure, you can resume nonstrenuous activities, and all normal activities can usually be resumed within seven days. You probably won't be comfortable in social situations for up to one week — three weeks for weddings, reunions and other formal occasions.

The thread lift is a relatively new procedure, and its techniques are still being developed. Results have varied greatly among patients, but continue to improve.

A significant risk of the thread lift procedure is that you may not notice any improvement. In this case, you would want to proceed with a traditional brow lift, facelift or neck lift for a noticeable improvement. Some thread lift patients with thin skin have reported that the sutures became visible under the skin shortly after the procedure. On the other hand, plastic surgeons with more experience say this represents poor techniques or patient selection.

You may experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.

Infection in the treatment area is an infrequent complication. If an infection develops, your surgeon will treat it with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible.

Contour threadlift is an innovative, minimally-invasive approach to tighten the underlying tissues of the face, offered by expert physicians at UW Health Transformations in Madison, Wisconsin.

A lift procedure performed with contour threads is a safe, conservative and effective one that offers subtle, natural-looking results. By gently shifting sagging tissues in an upward direction, this technique allows surgeons to produce a relaxed, fresh appearance while preserving and enhancing the natural contours of the face.

As an anti-aging alternative to cosmetic surgery, a threadlift is a minimally-invasive technique designed to give you a refreshed appearance through the use of fine surgical threads. Although a threadlift can raise droopy areas of the brow, cheeks, jowls, and neck, it will not produce the same dramatic results as a facelift or brow lift.

Length

30 Minutes

Side Effects

Possibility of minor bruising, swelling, and tenderness.

Recovery

Little to no downtime. Return to work: 2 to 3 days. Makeup can be applied soon after.

Risks

Rare possibility of skin irregularities, asymmetries, puckering, visibility of thread through the skin, threads poking through the skin, and infection.

Results

Immediate; although expected to last no more than 3 years before having the threads tightened or to add new ones.

Technology

Starting off the threadlift procedure, your surgeon will pass a hollow needle through the skin at a predetermined area, and then a barbed thread is inserted into the skin through the needle. The threads will grab onto the soft tissues once inserted; they help to provide a support structure that lifts and repositions the tissues. The needle is then removed, and your doctor will lift the droopy areas with smooth and barbed sutures and secure them down. Secondly, he or she will shape and sculpt the droopy areas by threading the barbed sutures beneath the skin close to the temple hairline into the subcutaneous tissues (although this may change if you are having droopy jowls or the neck lifted). To keep these sutures intact under the skin, they are textured with little “cogs” – similar to tiny fish hooks. The threads are then tightened to lift the face, positioned, and tugged into desired placement before being anchored and cut close to the skin.

Patient Status

Outpatient -

Anesthesia

Local

1. The Lunchtime Facelift

A thread lift is a relatively new cosmetic surgery procedure which is far less invasive and complicated than traditional facelifts. Because the process is quick in comparison, it is often referred to as the lunchtime facelift. During a thread lift, barbed threads are inserted into the skin under the tissues of the eyebrows, eyelids, neck and face. The barbs grab and lift drooping skin without the need for incisions and stitches, meaning a thread lift leaves no scars.

2. Candidates for Cosmetic Contouring

Thread lifts can be performed on their own or in conjunction with other plastic surgery procedures, but thread lifts along are not for everyone. Generally, thread lifts are for younger people who are only beginning to show signs of aging and only need slight lifting. Most thread lift candidates are between the ages of 35 and 45; however, threads are often used along with traditional facelift procedures as a means of adding extra support to the recently elevated tissues.

3. The Facelift You Can Watch

There are many advantages of thread lifts over traditional facelifts. Most procedures are performed in outpatient clinics as the process is fairly quick and non-invasive. Only local anesthetic is required, so you are able to remain awake during the procedure. This is advantageous for both you and your surgeon, as you can watch the lift being performed and give feedback to the doctor.

4. Recovery Realities

Recovery may be the most delicate part of your thread lift surgery, as it takes time for your connective tissue to adhere permanently to the threads. Pain, swelling and bruising is generally minimal and controllable with over-the-counter medications. It is most likely that your doctor will recommend soft foods for at least 7 days to prevent excessive movement of the facial tissue. Additionally, you will be required to refrain from strenuous activities, laughing, smiling and even yawning as these large facial expressions can stress the threads.

5. No Cosmetic Surgery is Risk-Free

While most post-surgery complications are rare, like any form of surgery, thread lifts carry a few risks that you should consider. Occasionally, people with thin skin have commented that the threads become visible beneath the skin; however, a good surgeon should be able to detect this possibility before the procedure is performed. Occasionally threads may come loose or migrate, in which another lift will be required to correct the sutures. Finally, as in all surgical procedures, there is a risk of infection.

Falling features are the hallmark of the aging face. The forehead droops, producing sagging eyebrows and baggy upper lids, the neck hangs, the smile lines become deep folds, and jowls begin to appear, blurring the once youthful, straight and sharp angle between the jawline and the neckline.

Until just recently, the only treatments that were available to deal with these problems were surgical procedures that were aggessive, expensive and required prolonged downtimes. These included a variety of facelift and browlifting procedures; ablative laser resurfacing surgery, deep chemical peels, and dermabrasion. All this changed, however, In the late 1990s with the introduction of a technique known as the threadlift, sometimes referred to as the featherlift, stringlift or looplift.

At present, Contour Threads™ (Surgical Specialties Corp., PA) is the only FDA-approved material for threadlifting in the United States. These ultrathin, clear threads are made of polypropylene (a plastic, non-absorbable material) that through many decades of use in heart surgery and in a wide variety of other surgical procedures has proven sturdy, safe and nonallergenic. The major difference between traditional sutures and Contour Threads is that a portion of the latter has been roughened to create very tiny, sharp barbs (cogs, bristles) that are capable of catching on to the tissue through which they are passed, allowing it to be pulled and repositioned as desired. The threads act like an "invisible bra of the skin." In most cases, the same degree of cosmetic improvement that can be achieved by pulling the loose skin back with the fingers can be reproduced by inserting the threads under the skin and drawing back in the same direction.

The ideal candidate for a Contour Threadlift is a person between the ages of forty and sixty-five who is in good general health and has healthy skin that is neither too loose, too thin, nor too overweight. I have personally performed the procedure on people as old as 75 and as young as 32 with excellent results. As with any cosmetic procedure, smoking makes for impaired healing, so smokers are poor candidates unless they agree to stop for several weeks before and after the lift.

The areas most amenable to treatment are lowered eyebrows and eyelid skin, pronounced smile line folds, deeply folded marionette lines, bulging or outpouched skin along the jaw line ("inverted camel humps)," jowls on the sides of mouth ("chipmunk pouches"), and looseness of the skin of the neck ("turkey necks").

Pre-procedure instructions include the avoidance of aspirin or aspirin-containing products for two weeks beforehand; avoidance of non-steroidal antiinflammatory agents (NSAIDs), such as ibuprofen and naprosyn for seven days prior; and abstinence from alcohol for at least twenty-four hours before. Since smoking is known to impede normal wound healing and may adversely affect the outcome of any cosmetic procedure, it should be stopped for at least two weeks before and three weeks after. Hair should be dyed and shampooed the night before, since hair washing is not permitted for at least three days afterward and coloring not for six weeks.

The procedure itself is simple and performed right in the doctor's office. The first step, which requires the patient's active input, is to determine the directions (or vectors) of pull necessary for eliminating the jowls and drooping. A map of these lines is drawn on the brow, face, jawline, and neck with a surgical marker. Next, the entire length of each vector is anesthetized with local anesthesia (usually lidocaine with a small amount of epinephrine to constrict the regional blood vessels and diminish bruising).

A long, very narrow needle is then inserted through a tiny puncture at the hairline and threaded in a zig-zag fashion underneath the skin along each of the mapped lines as the overlying skin is pulled taught over the advancing needle. The exit points are the jowls and folds that need the correction.

Once all the threads are positioned, the patient sits upright and the doctor contours and massages each one into place and then snips off any excess flush with the skin. The cosmetic results are immediate.

Strips of flesh-colored paper tape, which are removed in three to five days, are applied over the vector lines. They are placed more to remind patients that they must treat their skin gingerly like a china doll for the next few days. During the first week, the use of an inflatable travel pillow for sleeping is advisable in order to minimize inadvertent pressure on the treated areas.

A full-face procedure usually takes about an hour and a neck, jowl or brow lift alone, each about twenty minutes. The total number of threads needed depends upon the number of sites requiring lifting.

Post-procedure discomfort is unusual, and usually handled by two extra strength acetaminophen tablets (Tylenol™). Some bruising and slight swelling are common, but easily coverable with makeup. Applying ice can be helpful for reducing the swelling and any soreness. Doctors sometimes prescribe arnica capsules to limit bruising and oral antibiotics to reduce any chance of infection from the puncture wounds.

Complications of threadlifting are uncommon. Puckering of the overlying skin sometimes is visible, but this can be easily managed with massage. Sometimes a tiny end of the thread may work its way out of the exit site. This is simply trimmed off flush with the skin.

Immediately after the procedure, the skin is typically, smooth, tight and unjowled at the exit sites, but may be lax and corrugated ("bunched") closer to the hairline entry points. This is not permanent and is no reason for concern. In the course of the next seven to fourteen days, the skin undergoes a process called "tissue creep" in which the bunched areas gradually slide forward, smoothing themselves out along the lengths of the underlying threads.

Because the threads are most vulnerable to slipping or dislodging during the first few days, heavy exercise should be avoided for about two weeks, or preferably three weeks afterward. It's not so much that the physical exertion itself is harmful. It's rather that most exercises cause people to grimace, and it is these facial motions that may negatively impact on the results. Touching, rubbing or otherwise manipulating the sites must also be avoided.

Although some physicians charge according to the number of threads used, the vast majority do so according to the number of regions treated. The average fee for a Contour thread browlift and necklift are $2500 each. Faces generally run $4000 for both the jawline and cheek pad areas when done simultaneously or $2500 each, if done separately.

The advantages of stringlifting over surigical lifting are clear: no need for general anesthesia, minimal overall risk, little chance of scarring, negligible downtime, quick recovery, results that are immediate, and significantly lower cost. Benefits generally last between three to five years, which is not much different than the duration afforded by aggressive surgical techniques. In addition, the degree of improvement that can be anticipated may be as much as 60 percent of what might be obtained from aggressive surgery, which is quite impressive given all the other benefits.

Finally, lifting procedures of any kind, whether surgical facelifts or threadlifts, are for dealing with drooping, sagging and jowling. They are not intended for treating lines, wrinkles, folds and furrows. Indirectly, wrinkles and furrows may be temporarily improved to varying degrees by lifting, but since they tend to be located toward the center of the face, the degree of pulling that would be necessary to smooth them out sufficiently can result in a face that looks stretched overly thin and skeleton-like--the kind of Kabuki-like face seen in the early days of facelifting surgery (a time when there were no other treatments available for wrinkle problems). Today, when Botox and soft-tissue fillers of all types are available, we rely upon these agents to take care of the lines and folds.

Threadlifts represent an exciting, minimally-invasive breakthrough in cosmetic dermasurgery, and for eliminating jowls and sagging, they are rapidly gaining popularity the way Botox did a decade ago for treating lines and wrinkles.

The Thread Lift face lift elevates and lifts sagging facial tissue back to a more youthful position without any cutting. The forehead, midface (cheeks and jowls), and neck can be individually or simultaneously treated using the thread lifting technique.

As the skin begins to age, it loses it's structure, elasticity, and underlying support. As a result, it begins to sag. The geometric outline of the face changes from an upside down triangle to a rectangle, and sagging, deep folds, wrinkles, and creases become apparent. The Thread Lift face lift technique shifts sagging tissue in an upward direction to restore the natural shape and contours of the youthful face producing a more relaxed and refreshed appearance.

Contour Threads work by gently hooking the tissue to be lifted. They are inserted as an outpatient under local anesthesia, and the tissue to be lifted is pulled taught. The amount of lifting is exaggerated immediately after the procedure and settles over time. There may also be bruising afterward. Because of the exaggerated appearance of the lift and bruising immediately afterward, patients may feel self conscious about their appearance for 1 - 3 weeks afterward depending on the amount of lifting performed.

The cost of the Contour Thread Lift face lift varies depending on the number of areas treated. Patients interested in learning more about the Thread Lift face lift may make an appointment for a consultation

The threadlift suspends the soft tissue differently

The argument really is about what are effective ways to move "soft" tissue from one spot to another. When I was trained, I was instructed that suspension sutures "don't work." I was taught to lift and separate tissues widely so when I redraped them in the desired way there would be minimal tension. After redraping and stretching of the tissues to eliminate wrinkles there would be some excess skin and fat tissue to remove. In this way you reshaped the face and got rid of "excess tissue" which caused some areas of skin and fat to "hang". Trying to reposition that hanging tissue with "suspension sutures" would not work.

More recently, surgeons tried suspension sutures again, but with a difference. Instead of using a regular suture, surgeons now used sutures with multiple barbs so each of the barbs "catches" the tissue.

The threadlift uses special sutures

The principle behind the sutures is sound. With a regular suture, the suture "catches" the tissue at one spot, then that spot is pulled in the direction you want. All the tension is at that spot. Suppose you have a suture that has 6 pounds holding power. You suture it to tissue that has 3 pounds holding power. Since the pull of the suture(6 pds) at that spot is greater than the strength of the tissue itself(3pds), the suture will tear through the tissue. Now suppose the suture catches the tissue at three different spots. The strength of the pull is now divided along the three different spots. Now the pull at each of the three spots is weaker(2pds vs 3pds) and the likelihood of tearing through the tissue is minimised.

The thread lift suture has multiple little barbs or minihooks so that the suture "catches" the tissue at multiple points. This way the strength of the pull is never enough to tear through the tissue. Better yet, instead of pulling only at one or two spots, you pull along the entire path of the suture. This can potentially improve your ability to shape the tissues over a larger area.

Schedule for an appointment by calling or emailing us and one of our Botox specialist will discuss with you the treatment process. This free consultation will help you learn more about how Botox works and also the cost and the necessary preparations you will need for your Botox treatment. Just imagine how you would look with less wrinkles and a youthful face!

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Frequently Asked Questions

• How does a contour threadlift work?

Contour threadlifts are for patients who seek to restore the youthful contour of the face and eyes after aging and gravity have caused slight drooping of the face and brow.

Your plastic surgeon will reposition sagging cheeks, lift sagging eyebrows or readjust asymmetry in the brows or face using a barbed "thread" or suture. The thread is strategically inserted along fatty areas of the facial skin where barbs are anchored to drooping tissue.

In the final step of a contour threadlift, threads are pulled upward to lift and restore youthful tissue location. New collagen will form around each thread to maintain the effect for up to four years. This simple procedure takes less than an hour, is performed under local anesthesia, and leaves minimal scarring.

Temporary side effects of contour threadlift may include mild swelling, bruising or headache. Recovery time is about one week.

• Are there other options available to me?
  
  Other rejuvenation techniques that produce similar results as contour threadlifts include chemical peels, injectible dermal fillers, laser resurfacing and liposuction of the neck. Your contour threadlift may also be performed in conjunction with any of these procedures. It is not, however, intended to replace full surgical face lifts.

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