Dr Sarah Tonks explains the process of thread lifting, selecting patients, and the risks and complications involved
Age-related changes in the facial skeleton, musculature, connective tissues, fat and skin manifest with universally-recognised patterns. Advancing laxity in the soft tissues leads to a ptotic brow, jowl formation, nasolabial fold prominence and malar flattening. The appearance is further compromised by hyperpigmentated and wrinkled skin.1
A variety of procedures are available to rejuvenate the ageing face. The most commonly used options in the non-surgical aesthetics clinic are botulinum toxin, dermal fillers and chemical peeling.2 Non-surgical procedures have become popular in recent years as they allow for a faster turnaround time and can be performed outside the theatre environment, making them convenient for patients and practitioners alike. According to the review of the regulations of cosmetic interventions by the Department of Health in 2013, the value of UK cosmetic procedures was worth £2.3bn in 2010 and is estimated to rise to £3.6bn in 2015.3
It is important to distinguish the difference between threads that are used for skin rejuvenation and threads that are used for lifting ptotic skin
Thread procedures often result in more downtime than that experienced when using injectables alone. For monofilament threads, the number of needle insertions necessary will inevitably result in bruising. For cogs and barbs, the entry point of the cannula or needle can be 16G, resulting in a visible entry area, and there can be irregularity of the skin over the thread tract for a couple of days. Patients differ with the amount of downtime they can tolerate, and what they perceive as downtime. Some patients will happily accept bruising and puckering for a number of days as being part of the procedure, whilst others will suffer a lack of confidence about their appearance if there are any visible signs of a procedure having taken place immediately after the treatment. Before discussing the possibility of using threads, it is important to know where your patient falls on this spectrum. Patient management post-thread procedure can be difficult if they do not fully grasp the risks of bruising, swelling and puckering following treatment. Unlike hyaluronic acid dermal fillers, the procedure cannot be easily reversed. It is important that all the possible complications and expected side effects are discussed, and the patient is given adequate time to weigh-up the information before deciding to go ahead. This is not a procedure suitable for consultation and treatment on the same day. It is essential that the patient is able to tolerate the procedure. Pain thresholds and acceptance of treatment varies widely from person to person. As threads are more invasive than injectables, it is important that the patient is able to tolerate a modicum of discomfort during the procedure. The sensation of having the barbed and cogged threads tightened can be uncomfortable, and for some a distressing experience.
Realistic expectations are obviously essential. From my experience, the maximum amount of lift that can be achieved using barbs and cogged threads is around 1cm. If the patient has more to lift than this, then it may not be appropriate. If the patient does not want or cannot have surgery, a staged approach may be appropriate – using multiple threads in conjunction with other treatment modalities, which will result in an improvement but a compromised treatment outcome in comparison with a surgical outcome. Threads for lifting do not work well on those with excessively lax skin, a large body habitus, thick skin and those with unrealistic expectations. Conversely, monofilament threads can be used to promote collagen stimulation in those with lax and crepey skin to promote skin tightening and texture improvement.14
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