Thanks to user-friendly innovations, thread lifting provides an answer for hard-to-treat jowling and neck laxity (off-label). However, experts say the learning curve can be steep, especially for inexperienced practitioners. And, unfortunately, some providers overestimate the capability of threads.
Thread lifting enjoys great popularity internationally, spurred by the ease of newer unidirectional threads, said Farhan Taghizadeh, M.D., a facial plastic surgeon in Scottsdale and Phoenix, Ariz. “It offers an effect very similar to structural injectable fillers, and the same longevity.”
And, like injectable treatments, Dr. Taghizadeh emphasized, threads work best in conjunction with other minimally invasive therapies.
Suneel Chilukuri, M.D., a dermatologist based in Houston, Texas, agreed. “When you utilize your pathophysiology knowledge to use technology in combination, you can achieve that wow factor,” he stated.
According to Dr. Taghizadeh, the key to success is setting reasonable expectations. “Threads are another tool to offer patients. But like anything else in aesthetics, the mistake that is often made is that people use that one tool for everything. And this is happening with thread lifting,” he said.
Practitioners initially overused permanent threads, he continued. “This resulted in physicians like me spending a lot of time pulling threads out of patients’ faces.”
While new-generation threads are absorbable and easier to set than their predecessors, Dr. Taghizadeh pointed out that thread lifts alone cannot satisfy patients with significant wrinkles or neck laxity.
In Dr. Chilukuri’s opinion, the Silhouette InstaLift poly-L-lactic acid (PLLA) threads from Sinclair Pharma provide the best, longest-lasting lift. “We are seeing great results, not just with lifting of the skin, but with skin texture, which improves over the course of a year.”
Dr. Chilukuri uses Silhouette InstaLift for patients in their 40s to 70s who have jowling or neck laxity that resists fillers.
“We need to redrape that skin, to give it something to rest on,” he explained.
Polydioxanone (PDO) threads work well for fine lines and texture, Dr. Chilukuri noted. “But in my experience with them, I have not seen as much of a lift.”
Nevertheless, Silhouette InstaLift and smooth PDO threads are fairly easy to use, Dr. Chilukuri added.
“If you are a good injector, it is not hard to learn them,” Dr. Taghizadeh added.
However, Dr. Chilukuri said that learning to place barbed threads may be easier for those who trained in a surgical or core aesthetic residency (dermatology, plastic surgery, facial plastic surgery or oculoplastic surgery).
“With barbed (PDO) threads, in inexperienced hands, I see more complications,” Dr. Chilukuri shared. “Often these threads are improperly placed, leading to unnatural dynamic motion, granulomas and arterial disruptions. In addition, the tensile strength is not as strong as using the cones with the PLLA thread, and patients may be disappointed as expectations are not met.”
Inexperienced practitioners often do not appreciate the appropriate depth for placing threads, Dr. Chilukuri expressed. “But with proper training, understanding of anatomy and realizing the importance of combination therapy, threads are a great benefit for patients.”
In Dr. Taghizadeh’s opinion, thread lifting remains an up-and-coming technology; more shapes, designs and products will become available with time. “And there will be more courses and opportunities to learn about them. The data on them are not perfect, but certainly reasonable. Like everything else, sometimes the first design isn’t what makes the technology great. But the second and third iterations take you over the top.”
Dr. Chilukuri is or has been a speaker, researcher or advisory board member for Sinclair.