Complications of Thread Lift and How to Manage II: Thread Migration, Bulging at Entry Point, Sunken Cheek and Temporary Paralysis of Facial Nerves

November 4, 2019

Thread lift was developed as a cosmetic procedure alternative to improve the face by giving patients a more youthful and attractive appearance. While the thread lift is increasingly popular in the world of plastic surgery, it can present complications.

 

The traditional face lift not only requires a hefty amount of time and money, but it can also be a traumatic experience for patients, with high risk and potential complications.

 

Side effects of a thread lift are few, especially compared to other face lift techniques. However, it is not uncommon for the treated area to be bruised and swollen, subsiding within a week or less. In some cases, the treated areas may also experience numbness.

 

Other complications present in thread lifts are migration of threads, bulging at entry point, sunken cheeks and more severe but rare cases, temporary paralysis of the face.

 

It is therefore imperative for a practitioner to understand the mechanics of thread lift techniques, and how to manage the different complications in the rare case, if it should occur.

 

Migration of Threads

 

The symptoms of migration of threads can occur several weeks after the procedure and in general can be caused but the use of threads without cog, incorrect cutting of bi-directional cog threads and breakage of threads.

 

often, patients complain that the threads have moved or that they feel like it is likely to come out. As additional migration can stimulate the skin at the end, it advisable to have the threads removed. 

 

In the case of migration due to the use of threads without cogs, it often occurs almost immediate and can be seen through right below the skin. Such cases usually occurs around the mouth area where facial expressions are more dynamic compared to the other areas. Sometimes, the migration can be observed through the thin skin of the jaw line.

 

Migration of threads may also cause thread protrusion in some areas. To avoid migration, it is important for a practitioner to to insert a cog thread in both directions sufficient for a more secure anchoring.

 

Furthermore,  when cutting cog threads must be preserved in bi-directionally for fixing. Failing to do so will it may cause the cog threads to become unidirectional, and thus increasing the risks of thread migration.

 

Thread migration may also be caused bu the breakage of threads due to long term storage. Although materials such as PLLA and PCL are used for thread lift procedures, the most commonly used material is PDO. The nature of PDO is such that it easily breaks if exposed to moisture in the air, and cannot restore its strength. Improper or long term storage may lead to bi-directional cog threads to become broken after insertion, causing it to lose its fixing ability, thus may migrate after insertion.

 

Bulging at Entry Point

 

The saying that less is more cannot be more true than aesthetic - if and when too many threads are inserted through a singular entry point, the many thread ends will gather and may form a bulge at entry points.

 

The area of occurrence is most common if an entry point is made at a level there who horizontal line of lateral acanthus and hairline meet, the likelihood of bulging increase due to zygomaticus muscle movement. 

 

Another likelihood of accordance is if the threads are not properly cut or if too many thick threads are inserted in a singular entry point. 

 

It is not always necessary to cut the threads again by incision if they do no protrude through the skin as absorbable threads should resolve without squeal afterwards.

 

To prevent bulging, it is important to check the movement of the skin based on the expression of the zygomatic muscle when designing an entry point. Just as importantly, a practitioner should ensure that the threads are appropriately cut.

 

Sunken Cheek

 

Sunken cheek is another complication of thread lift that is not common, but possible. To understand the cause and treat sunken cheek post procedure, it is important to understand the anatomy of the cheek. For example, the cheek is a structure consisting of the zygomatic cutaneous ligament and masseteric-cutaneous liagement, the location on the cheek and the angle of sagging also differ between individuals. 

 

In addition, it is also important that a practitioner understand that ethnicity plays an a significant role in aesthetics - for example, sunken cheek may be a desirable trait in Western culture but most Asian women would have a different beauty perception.

 

Age can also play part in sunken cheeks as it has been observed by some studies that older patients tend to have a more noticeable sunken cheek.

 

If the skin is pushed inferior-laterally with the hand, significant feature can be observed. When pushed up or downwards with the fingers, the skin is move in accordance with the direction. However, when the skin on sunken cheek is pushed superomedially, it moves in the same direction, but if it should move inferolaterally, it is likely that the skin is folded inwards. 

 

It is also important that a practitioner note that the cheek area has some fat and consists of ligament and fibrotic tissues, making it hard to pass during the procedure. In addition, once cog threads are placed, they often fixed and nearly at a stand-still, this may result in sinking even after the procedure.

 

To prevent sunken cheeks, a performing surgeon should always highlight and confirm any flaws such as asymmetry and/or sunken areas prior to the procedure. It is also important to explain and manage patients’ expectations prior to the procedure. 

 

Temporary Paralysis of Facial Nerves

 

Although it is unlikely for a cannula to damage the motor nerves which are located in the space between the SMAS and the muscle, if and when local anaesthetic agent is used for pain control, it is crucial that the performing practitioner ensure that the anaesthetic agent does not damage the motor nerves due to the diffusion of lidocaine. 

 

Temporary paralysis of the facial nerves while rare, is complication that would usually resolve by itself by the next day or over the next few days. To prevent such incident from occuring, it is therefore important for a practitioner to correctly mark and design the injection point for local anaesthesia                                                        

The Art of Thread Lift

 

Since its introduction, advancements in techniques and technology has launched the progress of thread lift forward by leaps and bounds. Today, it is considered to be one of the safest and most effective non-surgical procedure available. However, this does not mean that thread lift procedures are without risks nor are they complication-free; hence a practitioner must always be equipped with skills and knowledge to manage any complication in the off chance that any of the complications should occur.

 

 

 

 

 

 

 

References:

The Art and Science of Thread Lifting (Springer, 2019)

 

Learn How to Manage Thread Lift Complications at our upcoming Korean Non-Surgical Face Lifting Hands-On Master Classes!

 

IFAAS Hands-On Master Class 

Korean Non-Surgical Face Lifting -

Minimally Invasive Thread Lift & Combination Therapies​

November 9-10, 2019 | Johor Bahru, Malaysia

 

 

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IFAAS Hands-On Master Class 

Korean Non-Surgical Face Lifting -

Minimally Invasive Thread Lift & Combination Therapies​

November 16-17, 2019 | London, United Kingdom

 

 

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Korean Minimally-Invasive Facial Rejuvenation & Lifting 

March 26-27, 2019 | Seoul, South Korea

 

 

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