There are currently two fully absorbable suture materials FDA approved for use in the US for minimally invasive thread lifting techniques – PLLA/PLGA and polydioxanone (PDO). Having fully absorbable sutures and cones is a big paradigm shift, as the predecessors, bidirectional barbed permanent sutures, were fraught with complications. Complications from bidirectional barbed permanent sutures included loss of efficacy, palpability, secondary procedures, provisional plastic surgery, infection, extrusion, and delayed inflammatory reactions.
Aging is incredibly complex and as such oftentimes requires a multimodal treatment approach. Weakening tissue, bone resorption, fat loss, and redistribution are all of paramount significance. A thread lift is a type of procedure whereby a temporary and now fully absorbable suture is placed into freely mobile tissue to catch and lift the dermis in one direction and to affix the skin and soft tissue in an elevated position. Thread lifting produces a subtle yet visible lift in the skin and over time helps to thicken the dermis through neocollagenesis.
Since 2015, two fully absorbable suture materials have been FDA approved for use in the US for thread lifts. They are Silhouette InstaLift (18% PLGA and 82% PLLA monofilament with bidirectional cones) and polydioxanone (PDO). Polydioxanone (PDO) threads are comprised of a colorless, crystalline, biodegradable, synthetic polymer composed of the polyester poly p-dioxanone. Silhouette InstaLift uses a cone and knot design which provides immediate lift and support. Seven to eight Silhouette InstaLift sutures are the equivalent of 1vial of Sculptra. PDO threads come in a variety of shapes, sizes and specifications. Silhouette InstaLift sutures are administered via needles and PDO threads are administered via needles and or cannulas.
In animal models, PLGA and PLLA have been shown to stimulate production of types I and III collagen. Similarly, animal studies have supported the benefit of PDO in antiaging due to increased dermal thickness and fibrous tissue contracture. Silhouette InstaLift threads are used primarily for lifting the face and neck including the cheek and jawline. PDO threads are for lifting the face and neck, cheek and jawline and more specific areas of the face such as the lips, nose, and eyebrows. In addition, PDO thread lifts are indicated for skin rejuvenation on the face and neck as well as off the face including knees, arms, chest and abdomen.
In 2017, expert consensus on absorbable advanced suspension technology suggests the benefits are for patients who have moderate facial aging and require treatment beyond the use of injectable products only. An ideal candidate is someone with facial laxity correctable by lifting and contouring along a straight line vector and with adequate dermal thickness to prevent palpability of the suture.
Thread lifting is a good option for someone who may not be a good surgical candidate or in whom surgical scars may be more difficult to hide with short hair. Caution is advised in patients with a history of autoimmune disease, allergies to foreign bodies, active systemic or localized infections, or patients on blood thinners. A less than ideal candidate for a thread lift is a patient with heavy jowling, severe skin laxity, or excess weight of the face. Bearing in mind a surgical facelift is still considered the gold standard to address age related changes.
What does the science show us about the safety and efficacy of thread lifts? Unfortunately to date there are no randomized control trials and limited data or evidence for thread lifts. However, of the limited data available there have been no adverse events reported and favorable patient satisfaction ratings, >70%, even for up to 1 year. Most common side effects were swelling, redness, and bruising. A few patients experienced skin dimpling, suture breakage and palpability, extrusion, migration, expulsion, asymmetry, infection, and hematoma. Beyond just the benefit of lifting and repositioning subtle changes were also seen in skin quality and texture.
In summary, thread lifts may be a safe and effective option for someone in need of minimally invasive lifting of sagging skin on the face and or all over skin rejuvenation of the face, neck or body. Of the limited data available there was a good safety profile and no adverse events reported. Patient satisfaction was favorable and continued for up to 1 year.
Our goal is for you to have the best possible outcomes, and to enjoy the benefits of nonsurgical thread lifts. We would enjoy working with you to help you look and feel your best.
If you are interested in nonsurgical thread lifts or would like to learn more, please contact Hamilton Facial Plastic Surgery in Greenwood 317-969-8472 or Carmel 317-682-0803 today to schedule your consultation.
Mcclean, M. E., Boen, M., Alhaddad, M., Hoss, E., Kollipara, R., & Butterwick, K. (2019). Suture Lifting: A Review of the Literature and Our Experiences. Dermatologic Surgery, 46(8), 1068-1077. doi:10.1097/dss.0000000000002297