Threads make a comeback: New technologies emerge for minimally invasive facelifting


Several novel technologies are emerging for minimally invasive facelifting. According to one expert, the Aptos and now Cousin (elastic ligament knitting) threads lead the way in thread-lifting with a bidirectional cog system, ensuring longer-lasting cosmetic results.

Key Points

Paris - Lifting aging facial skin and tissues can be easily achieved using Aptos (KMI) threads, as these barbed threads represent an excellent alternative to existing invasive surgical procedures, resulting in less bruising, no scars and a much quicker recovery time.

"Modern lower-face rejuvenation has developed into an exquisite art. Lifting sagging skin can now be surgically achieved not only through traditional lifting procedures, but also with the use of novel technologies, such as the Aptos thread, achieving cosmetically superior as well as longer-lasting results," says Henry Delmar, M.D., a plastic surgeon at the Center for Aesthetic Surgery in Cap d'Antibes, France.

Dr. Delmar readily uses the Aptos thread in his patients when performing minimally invasive facelifts.

Malar region

Dr. Delmar says one area where the Aptos thread is particularly effective is the malar region, where the short 12 cm thread is used and can achieve dramatic results.

The Aptos thread anchors itself in the facial tissues, which are then gently lifted (not pulled) and suspended at their "new" anatomical position.

Once the thread is in position, collagen will grow around the barbed elastic ligament, providing a new and permanent support structure for the tissue.

The Aptos and Cousin (Cousin Biotech) threads are designed with bidirectional cogs - different from Contour (Surgical Specialties Corp.) threads, which use only uni-directional cogs - giving these threads more of a scaffolding for the neo-collagen to grow around, ultimately creating a sturdier foundation for the tissues beneath the skin.

"If the thread is placed too superficially, then there is the danger that the silhouette of the thread will be visible and/or palpable under the skin, and the tightening effects of the thread will be less than optimal," Dr. Delmar says.

Patient selection

According to Dr. Delmar, the Aptos and Cousin threads are most successful in females younger than 40 years of age with sagging tissues of the face and neck.

Optimal patient selection includes patients with a mild-to-moderate sagging of the soft tissues of the face, premature aging and sun damage, weakly pronounced aesthetic contours, and a flaccid, flat face.


Dr. Delmar says, on average, the lifting effect will usually last about two years. The procedure would then need to be repeated because of time and gravity.

According to Dr. Delmar, Aptos threads have less of a dramatic cosmetic result in the sagging tissues of the neck. Though the procedure is still done to lift the platysma, the effects are less durable.

Typical downtime in the neck region can be up to one week, whereas in the malar area, it is only two to three days.

According to Dr. Delmar, the shorter downtime in the malar region is mainly because of the decreased vasculature tissue here, which translates into less ecchymosis.

"Many cosmetic surgeons still like to use threads that need to be fixated at one end with a suture. I believe that this technique is too rigid.

"The novelty of the Aptos and Cousin threads are that the cogs fixate themselves in the tissue, without the requirement of a suture. This allows for more elasticity of the tissues, giving a much more natural look to the patient upon facial movement and mimicking, and less of a mask-like effect," Dr. Delmar says.

Over time, he says, a 5 percent to 10 percent retraction of the Cousin thread ensues, which additionally ensures its longer cosmetic effect.

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