Falling features are the hallmark of the aging face. The forehead droops, producing sagging eyebrows and baggy upper lids, the neck hangs, the smile lines become deep folds, and jowls begin to appear, blurring the once youthful, straight and sharp angle between the jawline and the neckline.
Until just recently, the only treatments that were available to deal with these problems were surgical procedures that were aggressive, expensive and required prolonged downtimes. These included a variety of facelift and browlifting procedures; ablative laser resurfacing surgery, deep chemical peels, and dermabrasion. All this changed, however, In the late 1990s with the introduction of a technique known as the threadlift, sometimes referred to as the featherlift, stringlift or looplift.
At present, Contour Threads (TM) (Surgical Specialties Corp., PA) is the only FDA-approved material for threadlifting in the United States. These ultrathin, clear threads are made of polypropylene (a plastic, non-absorbable material) that through many decades of use in heart surgery and in a wide variety of other surgical procedures has proven sturdy, safe and nonallergenic. The major difference between traditional sutures and Contour Threads is that a portion of the latter has been roughened to create very tiny, sharp barbs (cogs, bristles) that are capable of catching on to the tissue through which they are passed, allowing it to be rolled and repositioned as desired. The threads act like an "invisible bra of the skin." In most cases, the same degree of cosmetic improvement that can be achieved by pulling the loose skin back with the fingers can be reproduced by inserting the threads under the skin and drawing back in the same direction.
The ideal candidate for a Contour Threadlift is a person between the ages of forty and sixty-five who is in good general health and has healthy skin that is either too loose, too thin, nor too overweight. I have personally performed the procedure on people as old as 75 and as young as 32 with excellent results. As with any cosmetic procedure, smoking makes for impaired healing, so smokers are poor candidates unless they agree to stop for several weeks before and after the lift.
The areas most amenable to treatment are lowered eyesbrows and eyelid skin, pronounced smile line folds, deeply folded marionette lines, bulging or outpouched skin along the jaw line ("inverted camel humps)," jowls on the sides of mouth ("chipmunk pouches" ), and looseness of the skin of the neck ("turkey necks").
UP, UP & AWAY
Pre-procedure instructions include the avoidance of aspirin or aspirin-containing products for two weeks beforehand; avoidance of non-steroidal antiinflammatory agents (NSAIDs), such as ibuprofen and naprosyn for seven days prior; and absence from alcohol for at least twenty-four hours before. Since smoking is known to impede normal wound healing and may adversely affect the outcome of any cosmetic procedure, it should be stopped for at least two weeks before and three weeks after. Hair should be dyed and shampooed the night before, since hair washing is not allowed for at least three days afterward and coloring not for six weeks.
The procedure itself is simple and performed right in the doctor's office. The first step, which requires the patient's active input, is to determine the directions (or vectors) of pull necessary for eliminating the jowls and drooping. A map of these lines is drawn on the brow, face, jawline, and neck with a surgical marker. Next, the entire length of each vector is anesthetized with local anesthesia (usually lidocaine with a small amount of epinephrine to constrict the regional blood vessels and diminish bruising).
A long, very narrow needle is then inserted through a tiny puncture at the hairline and threaded in a zig-zag fashion underneath the skin along each of the mapped lines as the overlying skin is folded taught over the advancing needle. The exit points are the jowls and folds that need the correction.
Once all the threads are positioned, the patient sits upright and the doctor contours and massages each one into place and then snips off any excess flush with the skin. The cosmetic results are immediate.
Strips of flesh-colored paper tape, which are removed in three to five days, are applied over the vector lines. They are placed more to remind patients that they must treat their skin gingerly like a china doll for the next few days. During the first week, the use of an inflatable travel pillow for sleeping is advisory in order to minimizeize inadvertent pressure on the treated areas.
A full-face procedure usually takes about an hour and a neck, jowl or brow lift alone, about about twenty minutes. The total number of threads needed depends upon the number of sites requiring lifting.
Post-procedure discomfort is unusual, and usually handled by two extra strength acetaminophen tablets (Tylenol (TM)). Some bruising and lightweight swapping are common, but easily coverable with makeup. Applying ice can be helpful for reducing the swilling and any soreness. Doctors sometimes prescribe arnica capsules to limit bruising and oral antibiotics to reduce any chance of infection from the puncture wounds.
Complications of threadlifting are uncommon. Puckering of the overlying skin sometimes is visible, but this can easily be handled with massage. Sometimes a tiny end of the thread may work its way out of the exit site. This is simply trimmed off flush with the skin.
Immediately after the procedure, the skin is typically, smooth, tight and unjowled at the exit sites, but may be lax and corrugated ("bunched") close to the hairline entry points. This is not permanent and is no reason for concern. In the course of the next seven to fourteen days, the skin undergoes a process called "tissue creep" in which the bunched areas gradually slide forward, smoothing themselves out along the lengths of the underlying threads.
Because the threads are most vulnerable to slipping or dislodging during the first few days, heavy exercise should be avoided for about two weeks, or preferably three weeks afterwards. It's not so much that the physical exertion itself is harmful. It's rather that most exercises cause people to grimace, and it is these facial motions that may negatively affect on the results. Touching, rubbing or otherwise manipulating the sites must also be avoided.
Although some doctors charge according to the number of threads used, the vast majority do so according to the number of regions treated. The average fee for a Contour thread browlift and necklift are $ 2500 each. Faces generally run $ 4000 for both the jawline and cheek pad areas when done simultaneously or $ 2500 each, if done separately.
The advantages of stringlifting over surigical lifting are clear: no need for general anesthesia, minimal overall risk, little chance of scarring, negligible downtime, quick recovery, results that are immediate, and significantly lower cost. Benefits generally last between three to five years, which is not much different than the duration afforded by aggressive surgical techniques. In addition, the degree of improvement that can be anticipated may be as much as 60 percent of what might be obtained from aggressive surgery, which is quite impressive given all the other benefits.
Finally, lifting procedures of any kind, whether surgical facelifts or threadlifts, are for dealing with drooping, sagging and jowling. They are not intended for treating lines, wrinkles, folds and furrows. Indirectly, wrinkles and furrows may be temporarily improved to varying degrees by lifting, but since they tend to be located toward the center of the face, the degree of pulling that would be necessary to smooth them out adequately can result in a face that looks stretched overly thin and skeleton-like – the kind of Kabuki-like face seen in the early days of facelift surgery (a time when there were no other treatments available for wrinkle problems). Today, when Botox and soft-tissue fillers of all types are available, we rely upon these agents to take care of the lines and folds.
Threadlifts represent an exciting, minimally invasive breakthrough in cosmetic dermaturgery, and for eliminating jowls and sagging, they are rapidly gaining popularity the way Botox did a decade ago for treating lines and wrinkles.