Silhouette Soft: making the new thread lift work for your patients

01 Apr 2014

Silhouette Soft is currently attracting a great deal of attention in the aesthetic world. Here, two surgeons discuss the importance of good patient selection and technique

The Silhouette thread lift was approved by the FDA in 2006, and is used by surgeons to lift the mid face and tackle early jowling in a minimally invasive way. It uses biocompatible but permanent polypropylene sutures and cones made of a bio resorbable L-Lacticle and Glycolide copolymer. These are anchored in the hairline via an incision in the temporal fascia under local anaesthetic, and sometimes under sedation. This procedure can only be performed by surgeons.

However, in October 2012 a new procedure, Silhouette Soft, was CE marked for use in the European market. This procedure is designed to lift the mid face, jawline, brows and even the nose, via two actions. It immediately lifts via the action of the threads, which become fixed by fibrosis, and then regenerates and volumises the face via a collagen stimulating effect. Silhouette Soft can be performed by cosmetic doctors and dentists and uses new, shorter (30cm) fully resorbable sutures made of polylactic acid (PLA), with eight bi-directional cones. There are four cones on each side of the suture, free floating between knots, and facing in opposite directions. These are also resorbable and made from lactic and glycolic acid. The PLA threads degrade into harmless lactic acid over a period of six to 24 months, and act as a collagen stimulator. The sutures, normally two to four on each side of the face, are inserted in the subcutaneous skin layer via an entry point in the middle of the suture pattern. Local anaesthesia is used only at the entry and exit points of the suture and, there is no need for a surgical incision or any stitches.


Surgeon Angelica Kavouni, who has experience of both Silhouette Lift and Silhouette Soft, says, “This procedure appeals to patients who do not want to have surgery, and don’t like the idea of any permanent substance being left in their faces. They also like that it is safe and subtle.” However, she adds that patient selection is key to the success of any thread lift technique. “You must be very careful,” she says. “Silhouette Soft is really not suitable for those who have significant loose skin. This usually means patients up to the age of 45, or 50 if they have good quality skin. It is also important to realise that in very thin-skinned patients the suture may be visible. A good way to check if a patient is suitable is to gently lift and push back the skin of the mid-face towards the ear using your fingers. The amount of skin bunching you get indicates the amount you will get post-procedure. Too much means the patient is not a good candidate. I do this with the patient holding the mirror and when I see a patient who really needs a surgical face lift, a useful tip is to ask them ‘What do you think will happen with this excess skin?’, and they normally agree that the treatment will not work for them.”


Cosmetic surgeon Rosalba Russo, when presenting a live demonstration of Silhouette Soft at this year’s IMCAS, agreed patients with too much sagging skin or excess facial fat are not suitable for the treatment. The eight-cone suture is the standard for treating the mid-face, however, Russo said the 16-cone suture, designed for the body, is good for mandibular rejuvenation. “Jowl definition is a very good indication for using this thread and can replace surgery if surgery is too aggressive or the patient does not want it,” she says.

Silhouette Soft may also be used to elevate the tail of the brow. Russo says this can be used even if Botox is not effective in this area. However, Ms Kavouni says that in her experience, “Eyebrows are difficult. They are so mobile that it is difficult to get a temporal lift. Patients who tend to pull their brows down can dislodge the thread before fibrosis occurs. In my opinion, botulinum toxin is required in order to fix the eyebrows for a period of time.” She says, “In my experience this treatment is most effective in the mid-face, cheeks and jowls. As the threads in Silhouette Soft are not anchored they cannot give as dramatic an instant lift as with the Silhouette Lift, but, particularly if used in combination with injectables and skin tightening treatments it can give impressive results. I personally use it with fillers, Fraxel and with Thermage.”

Post-treatment, patients will be able to see needle marks on their face, and there is, says Kavouni, “Always some degree of bunching up of the skin behind the insertion point for around three days, plus a small dimple where the suture is inserted.” However, most patients can apply make up to hide any bruises or needle marks and return to activities the following day. Russo said that 150,000 sutures have been used worldwide to date, with no reports of permanent or major complications. According to studies, improvement via fibrosis continues for five months after treatment and lasts up to two years. Future developments include developing threads and protocols for body and breast lifting.

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