A New Perspective on Threadlifts

In my experience, the most common application of threads in aesthetic surgery was to “lift” as an antigravity device. We have applied these with good results to the midface, jowls, neck and forehead.

We have gravitated to using MINT threads as they are well made with a 360 degree helical pattern of press molded hooks on the thread which have given, in our experience, a secure and lasting grip on the lifted tissue.

I used to see the eventual dissolution of the PDO material as a disadvantage which, over time, would lead to a lessening of the antigravity effect of the lifting suture. This something we would explain to the patient so that they were aware that, in the future, we could either do another MINT threadlift or progress to a surgical facelift.

A new concept has emerged where this dissolution process is used to the patient’s benefit. Histological studies of the threads in tissue show that dissolution occurs due to a chronic inflammatory response which, eventually, leads to formation of strands of collagen. This collagen can be utilized as a support system which lasts far longer than the threads. More important is the fact that more PDO material results in more of this beneficial collagen network. This is “Biotensegrity” applied to the skin and subcutaneous tissue.

In fact, this concept has led to a change in practice. Instead of fanning out from one anchor point, threads are placed to form a criss- cross pattern to stimulate more collagen production. This sometimes requires multiple points of insertion and anchor points. Thicker gauge threads (USP 1) produce more collagen. In addition, individual threads are placed through specific fat pads to lift specific areas.  The new “Mono” smooth threads are placed superficially to stimulate the formation of a sheet of subdermal collagen allowing “en bloc” lifting. Finally, this can be supplemented by use of Mono Screw and Mono Twin Screw to add volume to depressed areas like the nasolabial fold and marionette lines.