Ben Tracy, MD Founder Monroe MedSpa Rochester, NY
Anil Rajani, MD Founder RajaniMD Portland, OR
Faisal Darwiche, NP Owner Panacea MedSpa Newport Beach, CA
Dina BenDavid, DNP Clinical Director
Yael Halaas, MD, FACS Facial Plastic Surgeon Scarsdale, NY
Today’s growing demand for minimally invasive aesthetic rejuvenation procedures is shining a light on the latest updates and advancements in thread lifts. Delivering instant lifting and natural looking results, thread lifts are transforming the industry. Furthermore, new technology has allowed practitioners to discover innovative ways of using them alone and in combination with other cosmetic rejuvenation treatments, which has led to the return of thread lifts as a viable aesthetic treatment option.
Thread lifts have evolved exponentially since their early days in the late 1990s. The previous iterations of permanent threads proved to be difficult to work with and techniques were often one- directional, which resulted in an unnatural, two-dimensional appearance. But the latest advancements have created new standards in thread technology, leading to the development of completely dissolvable and stronger threads.
Practitioners are finding it possible to treat facial aging with threads where other nonsurgical treatments cannot. Ben Tracy, MD, founder of Monroe MedSpa in Rochester, N.Y., uses threads for lifting and tightening. “In my practice, I have found that where threads really shine is in the lower third of the face. This is a notoriously difficult area to correct with injectables,” he pointed out. “By utilizing threads, I am able to re-drape subcutaneous tissue so that my patients are able to get a more defined jawline and decrease in marionette heaviness.”
Similarly, Anil Rajani, MD, who specializes in minimally invasive aesthetic medicine in Portland, Ore., has found a way to work with skin that was once considered too lax for thread lifting. “Sometimes if a patient needs more lift, we use molded threads,” he advised. “People can use Polydioxanone (PDO), or Polycaprilactone (PCL); however in my experience, PDO offers a great balance of longevity of the thread and the patient’s own collagen.”
Dr. Rajani is also a lecturer and trainer. His PDO thread tour is helping practitioners in the U.S. navigate the adjustments required in thread insertion and in man- aging potential complications. “In terms of new threading products, molded threads have now been introduced in the U.S.,” he shared. “Our goal is to help advanced practitioners who are already using barbed threads adjust and adapt to these molded threads.”
Faisal Darwiche, NP, owner of Panacea MedSpa in Newport Beach, Calif., prefers MINT molded threads (HansBiomed). “These threads have cogs or barbs that actually are molded with the thread, compared to other threads that have their barbs cut into the thread. This molding technology gives the thread a higher tensile strength, making it stronger and less likely to break once inserted under the skin,” he explained. He also likes the helical 360° design, which allows the cogs to adhere to the tissue from all sides for a better grip and a better lift.
In January of 2020, PDO Max, headquartered in Syracuse, N.Y., announced that it received 510(k) clearance from the FDA for its brand of PDO absorbable threads, which are made of a sterile, biodegradable, monofilament synthetic composed polymer. They have also added molded threads to their arsenal, providing physicians the ability to deliver more effective nonsurgical facial aesthetic solutions.
Dina BenDavid, DNP, clinical director at Divine MedSpa in Burlington, N.C., solely uses a blend of various PDO Max thread types, gauges and lengths in her practice. “I exclusively use PDO Max threads, as I have found their tensile strength and product quality to be superior,” she stated. “And, the company has recently launched some new exciting threads to accommodate new trends and a market void. Among these include a double cyclone thread for a more popped lip flip and a multi-thread for filling deeper depressions without the need for filler.”
Diverging from the foremost PDO or PCL technology, InstaliftTM, which was recently acquired by Suneva Medical, Inc. (Santa Barbara, Calif.), uses micro-suspension technology to lift and volumize the mid-face. According to Yael Halaas, MD, FACS, a key difference is the composition and design of the threads. “These sutures and cones are made from polylactic-coglycolic acid (PLGA), a polymer that is frequently used in sutures and absorbed into the body while also stimulating the production of collagen,” she elaborated. “They have adjustable bidirectional cones that lift the subcutaneous tissue and hold them in place rather than non-adjustable barbs.”
Updated product technology enables aesthetic practitioners to expand their armament of facial rejuvenation treatment options, while thread lift treatments, in combination with other therapies, offer the greatest range and customization for their patient’s individual needs. “Combining procedures really gives that wow effect because it is not just reapproximating tissue and lifting, but also filling hollows and creating volume, which no doubt provides some type of a lifting effect,” Dr. Rajani noted.
According to Dr. Rajani, each practitioner eventually develops and refines their personal technique for PDO threads. “We use the threads in combination with treatments like Sculptra, fillers and neuromodulators to help alter the muscular movements and hypertrophy of the muscles in the face to create contours and angles that are consistent with a more youthful look.”
Dr. Tracy agreed, “The best results come when I combine injectables such as HA dermal fillers with thread lifting. I typically use dermal fillers first to recreate the youthful structure that is lost with aging and then I use PDO threads to address the laxity in the superficial tissues.”
Mr. Darwiche has also found creative ways to combine thread lifts with other treatments. “I always advocate for combination therapies to achieve the best outcomes,” he shared. He frequently combines threads with multiple treatment modalities which are individualized to the patient’s situation and desired outcomes. But he also finds that combination treatments can address complex skin conditions.
“When a patient has moderate to severe skin laxity, or their skin is very thin, I like to start with radiofrequency skin tightening to help build some collagen before per- forming a thread lift, usually four weeks prior to the procedure.” Mr. Darwiche explained.
“Injectables are a great addition to threads,” he continued. “I usually inject the same day as the thread procedure or wait one week depending on the degree of swelling following thread lifting.”
Mr. Darwiche has advice that he encourages everyone to incorporate. “One thing I always make sure to do is lift before you fill.” He went on to clarify, “I believe we should first lift the skin to the desired location before we inject dermal fillers, this way the injection is more precise and we can address volume deficiencies more accurately with the ‘new’ location of the skin and the hollowness we plan to fill.”
Thread lifting in the past provided only short-lived results, even while threads were not dissolvable. Results were inconsistent with possible asymmetry, puck- ering or rippling. If the procedure was not performed with great accuracy or skill, patients might experience visible bumps, scarring and infection.
Current thread technology has enabled innovative techniques, offering advanced designs devised to address both lifting and repositioning of the skin to reshape the face. Consequently, this has allowed aesthetic practitioners to create their own artistic and unique ways to address each patient’s individual needs and deliver improved results and satisfaction. Today’s minimally invasive threads are composed of the same material that has been used in cardiovascular surgery for years, leading to more predictable out- comes. And users report that downtime is minimal and effects are immediate.
In Dr. Rajani’s experience, newer technologies require new techniques. “I think the new larger, molded threads have a little more pull and a little more longevity,” he elaborated. “Now, we tend to move the tissue over the thread versus moving the cannula through the tissue while pushing it. Some people use another technique, which is to insert the cannula into the patient and then insert the thread through the cannula, so in effect the cannula becomes a ported opening. Then the desired type of thread can be used, and once the thread is anchored the cannula is removed, leaving the thread in place.”
Through his training, Dr. Rajani finds that thread lifts inspire practitioners to create their own personalized vectors and innovative techniques. “I usually do about four threads per side and that would include one along the jawline, so a total of eight threads for a single procedure,” Dr. Rajani explained. “I reevaluate at six to eight weeks after the procedure and fine tune from there. Some people are going to need the exact procedure with eight threads repeated, others may need something in between depending on their satisfaction level and tolerance for the procedure, but I find that provides a great result with minimal downtime and patient satisfaction.”
Mr. Darwiche takes advantage of new technology and has his own creative uses for thread lifting. “There is a ‘new look’ in high demand today, and it has been given a few different names such as ‘Cat Eyes’ or ‘Fox Eyes.’ This look is achieved by lifting the outer edge of the brows, and shaping the brow to almost a straight line pointing upwards. With threads, you not only can get the best eyebrow lift, but you can also design and shape the brows in many different ways that were previously not possible.”
Dr. Tracy has perfected a treatment for those who need more of a lift than is usually achieved with threading. “I created a new technique I call a suspended thread lift. This new type of lift utilizes specially placed ‘suspension’ threads that I then latch onto with ‘lifting’ threads to create more tension when reapproximating sub-cutaneous tissue. Patients have benefited tremendously from this technique, as it gives a more dramatic lift than traditional thread lift procedures.”
Incorporating Today’s Thread Lift Solution
For some, thread lifts are creating a paradigm shift in aesthetic rejuvenation. While a thread lift cannot replace a facelift, with little to no downtime and requiring only local anesthesia, patients can experience a nearly instant lift without the higher cost of surgical options.
As with any treatment, providers agree that thread lift outcomes should not be overpromised, and discussion with the patient and expectations management is important.
Thread lifts are ideal for patients who have mild to moderate laxity and good skin tone, and the skin should not be too thick or thin. These patients will enjoy a refreshed and natural look, especially when used in combination with other skin rejuvenation treatments.
Dr. BenDavid had some final advice, “There is no ‘one size fits all’ when it comes to thread lifts.It is essential to carefully assess each patient’s face to identify optimal thread placement. Additionally, I tend to couple placement of smooth threads with barbed (lifting) threads, as the smooth threads help build a collagen scaffold around the barbed threads, therefore enhancing the overall results and longevity.”
According to Mr. Darwiche, the main benefits of thread lifting are the immediate results we can achieve with minimal to no downtime, no pain and no serious complications. “The results we can achieve with threads are far more superior than those obtained from devices such as ultrasound and radiofrequency. I believe that thread lifting will give you the absolute best nonsurgical face and neck lift results,” he expressed.