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When Faces Need Just a Little Lift

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The demand for quick, “lunchtime” cosmetic procedures continues unabated; The American Society of Plastic Surgeons reported almost seven million minimally invasive procedures in 2004, a 43 percent rise over 2003. An F.D.A.- approved thread lift is one of the very latest developments.

July 13, 2005 -- Plastic surgery patient K.H. in Atlanta, Georgia, has an idea of what the future holds. And she’s not real sure she is looking forward to it.

“I’m 41 but believe in doing some cosmetic surgery now before I turn 60 and need a full surgical facelift,” says K.H. who asked that her identity be withheld. When a friend showed up with a tightened face done via a short procedure known as a Contour Thread Lift, K.H. was impressed and looked at her own face a little more critically in her mirror. She decided the droopy corners of her mouth could be lifted a bit along with the removal of a few wrinkles.

“The thread lift took an hour at the surgeon’s office and created some real subtle changes in my face,” she says. “Afterwards, I looked more refreshed and rested.”

K.H.’s surgeon, Marcia Byrd, M.D. in Roswell, Georgia, is more forthcoming, exclaiming: “I believe the procedure is the wave of the future for non-surgical facial rejuvenation.”

The lift K.H. enjoyed is actually the latest development in a long line of implantable, specially designed surgical threads used to lift sagging skin on the face, forehead, brows and neck. Experts say the operation is not for everybody nor is it intended to replace full surgical facelifts wherein sagging skin, along with some underlying muscle, is trimmed, stretched tighter and stitched back into place.

Moreover, surgical threads may only provide that more youthful look for anywhere from six months to five years, depending on the patient’s skin. But more people consider a quick procedure with virtually no recovery time a welcome trade-off for going back to the surgeon for more work when the youthful look fades.

Jeffrey M. Nelson, M.D., F.A.C.S., a plastic surgeon in Tucson, Arizona, started offering Contour Thread Lifts in October, 2004.

“Patients really like having a procedure done in the office with only minimal anesthesia,” Dr. Nelson says. “Recovery is faster than a surgical facelift because the outer layers of skin are not disconnected from their blood supply like in a full facelift. That scenario means more swelling and bruising.”

Various types of surgical threads that lift fleshy skin have been used about eight years, mostly in Europe and South America. Any surgeon could take some sutures, thread them through muscles just under the skin and tighten things up. But sutures alone cut through flesh and do no lifting.

Eventually, plastic surgeons in France, Russia and China developed a type of thread with small feathers, then cogs and now barbs – the version approved for use in the U.S. -- which provides more support for sagging skin. The barbs become fixated in their surrounding tissues and act more-or-less like opening an umbrella under the skin. Once the barbs are in position, the excess skin relaxes and shrinks in two to six weeks, thereby creating the new lifted look.

“Barbs on the Contour threads redistribute the forces of gravity along the entire length of the suture so there is less force pulling down at any one point,” says Dr. Verne Weisberg, M.D., F.A.C.S., a plastic surgeon in Portland, Maine.

The heavy lifting happens when the surgeon, using a thick, hollow needle, puts a thread into the fat layer just under the skin, starting near the cheekbone, (if the task at hand is to lessen the nasolabial folds, those thick, facial creases that run from the corner of the nose to the corner of the mouth.) The top end of the thread is then tied to deeper, firmer internal structures in the face. The other end of the thread travels under the skin about four inches. When the surgeon withdraws the needle, the barbs on the sutures deposit themselves in the droopy part of the face. The physician then gently tugs on the thread which pulls the loose flesh up, closer to where it once sat in the patient’s youth, and ties it down. The technique can be used to lift sagging cheeks, eyebrows and to create a better balance for eyebrows that may be asymmetrical.

Adds John Grossman, M.D. a board-certified plastic surgeon with offices in Denver and Los Angeles: “A thread lift patient can actually watch the procedure being done and even participate. He or she can say to the surgeon, ‘I want a little more pull here, a little less there.’”

Of course, all this new technology comes with a caveat or two.

“Patients must limit their facial activities after a thread lift,” says Dr. Weisberg. “Opening your mouth wide and being expressive with your face are not good ideas.”

Consequently, doctors’ orders usually include foregoing hilarious movies, skipping favorite stand-up comics and stifling the urge to do some marathon phone yakking. You would also not want to get in a wrestling match or even sleep on your side for fear of rubbing your cheeks – and the threads -- the wrong way.

After the thread lift, your face grows collagen, a natural substance found in the body, around the barbs, providing still more support for the lifted tissues. Common side effects of the procedure include some swelling, bruising or headache. However, surgical makeup allows most patients to be presentable the day after the procedure.

Possible risks of a thread lift include the threads popping out of the skin, infection and rejection. According to the company that makes the threads, a little less than one percent of cases have complications which are usually well managed by the surgeon.

Cautions Michael C. Bruck, M.D., a board-certified plastic surgeon at the Juva Skin and Laser Center in New York City: “ What concerns me are the practitioners from other fields like Ob/Gyn and other non-surgeons who are taking courses on how to use thread lifts. If I were a patient, I would look for a board-certified surgeon who had many years experience working with facial tissues.”

So, at least for facial rejuvenations, the old saw about “a stitch in time” can now be changed to “a thread in time.”

Medically Reviewed by Michele D. Koo, M.D., F.A.C.S.:
www.cosmeticsurgery.com/find/cosmetic-surgeons/Missouri/r~144/dr~info/


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