Threadlift – "One Hour Facelift?"

Reviewed by Scott R. Miller, MD, FACS

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Thread lifts emerged because many people — perhaps you — would like a facelift, but can't afford it or don't want the long recovery time of the standard facelift. Thread lifts have decreased in popularity, but in proper hands they can still be a useful tool. It is perhaps better considered as a lesser, or preliminary procedure. Thread lifts cost less and require less downtime for many people. Some plastic surgeons promote the thread lift as a "lunchtime lift" or "weekend facelift." Usually it can be performed in about one hour.

Who Should Consider a Thread Lift?

As we age, our facial support structure weakens, and we lose facial fat. The affected areas generally include the cheeks, the eyebrows and other areas around the eyes, the jowls and the neck. The result is a longer, older-looking face.

Younger people may experience cheek and brow ptosis (sagging caused by weakened muscles) as well. For these people especially, a thread lift may be a good alternative to the more invasive procedures necessary to correct problems in older people's faces.

Ideal candidates for thread lifts include people with minimal signs of aging who need just a small lift. Most people who undergo thread lifts are women between 35 and 45. They choose a thread lift because they have begun to see more prominence of the jaw, a relaxed (or minimally sagging) midfacial appearance or slight bags under the eyes or on the neck. Older people may undergo a thread lift during the more aggressive facelift procedure to provide additional support for the soft tissue area that was elevated in the facelift.

Other thread lift candidates include those who have had some relapse from a previous plastic surgery procedure such as a facelift or neck lift. Many physicians combine thread lifts with other procedures, such as chin lifts, neck lifts and brow lifts, for a customized approach to facial rejuvenation.

To be an ideal thread lift candidate, you should understand and accept the possibility of the risks and complications outlined below.

Thread Lift Basics

In a thread lift, barbed sutures (threads) are used to lift sagging eyebrows and eyelids, deep nasolabial folds (those furrows between your nose and the corners of your mouth) or aging neck tissues. Your surgeon would use a thin needle to insert the sutures under the facial tissues. The barbs on one end of the thread grab and lift the sagging skin, and the teeth on the other end anchor the skin to the underlying facial tissues. No incisions or stitches are required, and no scars are produced. Additionally, barbed sutures can be used as an adjunct to a more traditional facelift.

Two types of thread lift procedures are currently being performed in the United States: the Contour Threadlift and the FeatherLift or Aptos Thread lift. It's estimated that as many as 9,000 thread lifts have been performed nationwide with Contour Threads, which were approved by the Food and Drug Administration in September 2004, with current indications for elevation and fixation of midface, brow and neck. The Aptos Thread, which was developed overseas, received its premarket approval from the FDA in March 2005. The American Society of Plastic Surgeons reports that its members performed more than 5,000 thread lifts in 2006. (The group no longer tracks statistics on thread lifts.)

The main difference between the two is design. Contour Threads are unidirectional and fixed in the area of initial access, whereas Aptos Threads are bidirectional.

The Contour Thread material, clear polypropylene, has been used in other medical applications for many years. It has barbs along the thread that act as cogs to allow the surgeon to grasp, lift and suspend a relaxed facial area. The barbs open like an umbrella to form a support structure that lifts the sagging tissue. The Aptos thread has barbs on the entire length that are inserted under the skin to gather tissue to fill out and lift the cheeks and sagging skin.

The Thread Lift Procedure

Your surgeon may instruct you not to eat or drink after midnight before the thread lift. He or she may prescribe an antibiotic to take beforehand and tell you to cease taking certain other medications.

During the procedure, your surgeon will make small incisions in key locations and insert a threaded needle to lift the subcutaneous tissue and suspend the lift with the thread. The barbs on these threads will lock in place and encourage collagen formation upon insertion to lift very specific areas.

Several variations of the technique exist. In general, the "closed" technique involves molding the soft tissue over the suture in multiple location points until it catches in the appropriate location to provide the best result. During an "open" technique, the surgeon will use instruments under the skin to create a raw surface so that when the sutures are pulled up, the lift is more likely to remain in the appropriate position.

Other surgeons have developed a combination technique that uses sutures at multiple tissue levels to catch all the barbs and create a suspension that cannot be accomplished with a nonbarbed suture. Depending on your needs, the number of threads used can range from two to 20.

Thread lifts are often performed in an outpatient medical surgery center or hospital. Because the procedure is minimally invasive, general anesthesia is not required, so you can remain awake. One benefit is that the plastic surgeon can give you a mirror as the thread is pulled back, allowing you to give feedback. Usually an oral antianxiety medication, along with local anesthesia, is all that is required. Most people tolerate this well and avoid any "postanesthesia hangover."

Thread Lift Recovery

Your surgeon will provide complete postoperative instructions that you must follow to reduce the risk of complications during recovery. These instructions may include an escort to drive you home and assist with daily activities for at least 24 hours, as well as diet restrictions (soft foods) for seven days. Pain can be managed with oral medications such as acetaminophen. Ibuprofen is avoided to limit bruising. Your surgeon may recommend elevating your head to reduce swelling for the first day.

The day following the procedure, you can resume nonstrenuous activities, and all normal activities can usually be resumed within seven days. You probably won't be comfortable in social situations for up to one week — three weeks for weddings, reunions and other formal occasions.

Risks and Complications

The thread lift is still a relatively new procedure, and its techniques are still being developed. Results have varied greatly among patients, but continue to improve.

A significant risk of the thread lift procedure is that you may not notice any improvement. In this case, you would want to proceed with a traditional brow lift, facelift or neck lift for a noticeable improvement. Some thread lift patients with thin skin have reported that the sutures became visible under the skin shortly after the procedure. On the other hand, plastic surgeons with more experience say this represents poor techniques or patient selection.

You may experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.

Infection in the treatment area is an infrequent complication. If an infection develops, your surgeon will treat it with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible.

Some surgeons have noted rare migration of the sutures, causing an unbalanced facial appearance. With this, or if the thread may break, a simple reinsertion solves the problem.

Some surgeons are reluctant to perform the thread lift until they can evaluate results after one or two years. If the results look good and are deemed sustainable and safe after that time, they would elect to perform it. Clinical studies on various aspects of the Contour Threadlift are under way at three universities in the United States.

Selecting the Right Thread Lift Surgeon

Board-certified plastic surgeons typically have the most extensive knowledge about thread lifts. Your surgeon should be able to advise you as to the best treatment approach and the expected result. It is important to remember that each case is individual.

You should follow these steps when choosing a thread lift surgeon:

  • Check out the plastic surgeon. Review credentials, education, training, the type of board certification held and the number of times that the surgeon has performed thread lifts.
  • View before-and-after photos of the surgeon's thread lift patients, to help set reasonable expectations for your results.
  • Bring a photo of the result you would like to see. The surgeon can help determine if this is a reasonable outcome that you can expect from a thread lift.
  • Inquire about the type of equipment used, where the procedure will be performed and the nature of the treatment plan.
  • Ask about the specific technique that is recommended for your situation. Techniques may vary among surgeons and patients.
  • Review the preoperative and postoperative instruction list the surgeon provides.

Thread Lift Cost

Thread lifts can cost from $1,500 to $4,500. These costs vary based on the extent of the procedure, areas treated and the expertise of your surgeon. The American Society of Plastic Surgeons reported that in 2006 the national average physician fee for thread lifts was $2,443. The organization no longer tallies information on thread lift costs.

Because thread lifts (like most cosmetic procedures) are elective, most insurance carriers will not cover the cost. Some surgeons offer direct payment plans to their patients. Others work with a financial group that provides loans and other payment plans. Independent financial institutions also provide ways to handle these expenses.