Threads vs. traditional lifting

January 1, 2007

National report - A Contour Threads (Surgical Specialties) lift offers a simple, safe, effective and cheaper alternative in face lifting procedures with minimal downtime, as compared with the traditional facelift, one expert tells Dermatology Times.

"The Food and Drug Administration (FDA)-approved Contour Threads is made of clear polypropylene and has tiny barb-like teeth placed in a helical fashion, increasing the tensile strength. This will decrease the risk of cheese wiring and cutting through the skin. Once the thread is tightened, it effectively pulls up sagging skin and facial jowls. Compared to a traditional facelift, the thread implant is considered a minimally invasive procedure and can be implanted in the dermis and subcutis at the level of the brow, jowls and neck with very satisfying aesthetic results," says David J. Goldberg, M.D., clinical professor of dermatology at New York's Mount Sinai School of Medicine and director of Skin Laser & Surgery Specialists of New York and New Jersey.

Identifying ideal patient

Prospective patients will usually be opposed to more invasive surgery and those that opt for the thread procedure should have realistic expectations. Patients must understand that, in general, a thread procedure can achieve up to 50 percent the improvement seen with a traditional facelift.

Evolution of Threads

The earliest Contour Threads required both a deployment and fixation port.

Usually, two to three deployment ports (two threads) shared a fixation port posteriorly. Newer threads are simpler. When Dr. Goldberg performs this procedure, he enters the skin at 90 degrees and moves the needle in a sinusoidal placement pattern. For optimal results, he advises surgeons to stay in the subcutaneous tissue, avoid dermal indentation and stay above the facial muscles. Depending on the location of the procedure, Dr. Goldberg either fixates the thread on the galea aponeurosis, in the deep temporal fascia or in the mastoid and cervical fascia.

"The procedure is simple, clean and quick. It usually takes less than 60 to 90 minutes to complete, depending on the number of threads used. Up to two weeks post-operatively though, patients must be very careful not to manipulate their facial expressions in a downward fashion. This means they should raise their brow by either smiling or extending the neck before touching their pillow. For optimal results, patients should avoid straining, drinking from drinking straws and keep to a soft diet," Dr. Goldberg explains.

He says the thread procedure is contraindicated in patients who have unrealistic expectations or are in poor health, as well as patients taking coumadin/heparin. Those patients taking aspirin must refrain from taking it for several days before the procedure. Also, patients who are excessively fat or thin (ideally a 1 inch to 3 inch pull), and those with diffuse deep facial wrinkles should be discouraged from having a thread facial lift.

Preventing complications

Preoperatively, Dr. Goldberg likes to give his patients a mild oral sedative, analgesic and prophylactic antibiotics.

Though complications are rare, they can still arise. Early complications include dimpling/skin bunching, ecchymosis, hematoma, suture failure, visible palpable sutures and nerve injury. Late complications include asymmetry, scarring, infection, extrusion or chronic pain.

Dr. Goldberg says he follows his patients one to seven days following the procedure. At this time, a recontouring can still be performed, if necessary.