Barbed vs Non-barbed Threads in Facial Rejuvenation

Thread-lifting, also known as suture suspension, stands as a pivotal technique within the realm of facial rejuvenation, offering a swift, secure, and minimally invasive option that presents itself as a viable alternative to traditional facelift procedures. The genesis of this method traces back to 1951 when barbed sutures initially surfaced in the context of tendon reconstruction, subsequently gaining prominence for their utility in surgical wound closure. Notably, in the 1980s, Sulamanidze pioneered the application of barbed threads for noninvasive aesthetic interventions. Over the ensuing two decades, this technique has garnered global acclaim owing to its abbreviated recovery period and immediate cosmetic enhancements.

Emerging research delineates two primary mechanisms by which barbed threads facilitate enduring rejuvenation effects. Firstly, these threads engage with the surrounding soft tissue, leveraging their barbs to anchor and elevate, thereby redistributing tension to the dermis and skin, consequently sculpting facial contours. Secondly, as the threads gradually metabolize and disintegrate within the localized milieu, they incite the synthesis of collagen and elastic fibers, furnishing sustained structural support, thus perpetuating tissue suspension over a semipermanent timeframe.

Nevertheless, the efficacy of thread-lifting is subject to variances attributable to patient-specific idiosyncrasies and clinician expertise, rendering objective product evaluation challenging. The proliferation of thread brands and their attendant commercial marketing strategies has precipitated a surge in thread utilization for lifting procedures, each product presenting distinctive attributes.

With respect to material composition, polypropylene (PP) emerged as the inaugural substance employed for facial sutures, characterized by its nonabsorbable nature, necessitating over a year for complete degradation. Conversely, recent advancements have seen the integration of absorbable materials such as polycaprolactone (PCL), polylactic acid (PLA), polyglycolic acid (PGA), and polydioxanone (PDO), each offering unique properties.

This blog aims to provide a comprehensive analysis of facial thread-lifting, focusing particularly on the comparison of barbed and non-barbed threads, and the considerations surrounding thread material selection and design.

Barbed Threads

Source: Rhinoplasty with Barbed Threads (2018)

Barbed threads represent a crucial component of facial thread-lifting procedures, providing a mechanism for soft tissue manipulation and immediate suspension effects. These threads feature tiny barbs along their length, which anchor into the surrounding tissue upon insertion, enabling the manipulation of sagging or lax skin to achieve a lifted appearance. The unique design of barbed threads allows for enhanced tissue engagement, facilitating the redistribution of tension and the reshaping of facial contours.

In clinical practice, barbed threads are typically utilized in patients with mild to moderate facial sagging or laxity who desire subtle improvements in facial contours without undergoing invasive surgery. These threads are particularly suitable for individuals seeking a quick and minimally invasive solution to address signs of aging, such as drooping cheeks, jowls, or brows. However, it is essential for clinicians to carefully assess each patient's unique anatomical features and aesthetic goals to determine the suitability of barbed threads and tailor the treatment approach accordingly.

Advantages

Provide an immediate lifting effect, allowing patients to experience visible improvements in facial sagging or drooping shortly after the procedure. This immediate gratification can enhance patient satisfaction and confidence in the treatment outcomes.
The minimally invasive nature of thread-lifting procedures, facilitated by barbed threads, reduces the risk of complications and shortens recovery times compared to traditional surgical interventions.
Gradual degradation of barbed threads stimulates a local tissue response, promoting the formation of fibrous structures that contribute to sustained lifting effects over time.

Disadvantages

Variations in thread material, design, and mechanical properties can significantly impact treatment outcomes and patient satisfaction. Therefore, the result will not be the same for every patients.
Similarly, the design of barbs and their anchoring ability must be carefully considered as it might cause damage or discomfort to the patient. Choosing the wrong design may influence the longevity of lifting effects and cause the incidence of adverse reactions.

Mechanism of Action

The mechanism of action of barbed threads revolves around their unique design, characterized by tiny barbs strategically placed along their length. These barbs serve a crucial function in thread-lifting procedures, anchoring into the surrounding tissue upon insertion and enabling the manipulation of sagging or lax skin to achieve a lifted appearance. The efficacy of barbed threads depends largely on the design of these barbs, which must strike a delicate balance between optimal anchoring ability and minimal tissue trauma.

Types of Barbed Threads

Two primary designs of barbs have been employed in thread-lifting procedures: Cut and Press-molded.

Cut barbs Cut barbs are formed by cutting tiny grooves into the surface of the thread, creating protrusions that engage with the surrounding tissue.
Press-molded barbs Press-molded barbs, on the other hand, are integrally formed on the thread body through molding methods, resulting in more uniform and consistent barb shapes.

Press-molded barbs have demonstrated superior mechanical strength in some studies, offering enhanced durability and reliability during tissue manipulation. This increased strength can result in more secure anchoring and lifting effects, particularly in areas of high tension or mobility. However, variations in thread diameter and barb design necessitate careful consideration of mechanical properties, including elasticity and modulus, to ensure optimal lifting effects and minimize foreign body sensations.

Conversely, cut barbs may offer greater flexibility and adaptability to individual tissue characteristics, allowing for more precise and tailored lifting effects. However, the efficacy of cut barbs may be influenced by factors such as thread diameter and barb depth, which can impact tissue engagement and anchoring ability. Clinicians must carefully evaluate these factors when selecting barbed threads for thread-lifting procedures, taking into account the unique anatomical features and aesthetic goals of each patient.

Non-barbed Threads

Source: Idea Pharmaceutical (2024)

Non-barbed threads represent another facet of thread-lifting techniques, offering an alternative approach to facial rejuvenation without the use of barbs. Unlike barbed threads, which feature tiny barbs along their length to anchor into the surrounding tissue, non-barbed threads rely on smooth surfaces for tissue engagement and lifting effects. These threads are typically composed of absorbable materials such as polydioxanone (PDO) or polylactic acid (PLLA), which gradually degrade over time, stimulating collagen production and promoting tissue tightening.

Non-barbed threads are utilized in facial rejuvenation procedures to address mild to moderate signs of aging, such as facial sagging, fine lines, and wrinkles, without the need for invasive surgery. They are particularly suitable for patients seeking subtle improvements in facial contours and skin laxity, as well as those who prefer a minimally invasive approach with shorter downtime and fewer risks compared to traditional facelift procedures.

Advantages

Versatility and adaptability to various facial regions and aesthetic concerns. These threads can be strategically placed to target specific areas of concern, such as the cheeks, jawline, or brows, allowing for customized treatment approaches tailored to each patient's unique anatomical features and aesthetic goals.
Non-barbed threads offer immediate lifting effects and gradual collagen stimulation, resulting in natural-looking rejuvenation and long-lasting results.
Non-barbed threads are associated with minimal discomfort and downtime, making them an attractive option for patients with busy lifestyles or those who prefer non-surgical alternatives to traditional facelift procedures.
The absorbable nature of these threads also eliminates the need for thread removal, further streamlining the treatment process and enhancing patient convenience.

Disadvantages

The efficacy of these threads may be influenced by many factors such as thread material, diameter, and placement technique. Therefore, the results may vary for every patient.
Additionally, while non-barbed threads offer immediate lifting effects, the gradual degradation of absorbable materials may result in a gradual loss of lift over time, necessitating maintenance treatments to sustain results.

Mechanism of Action

Non-barbed threads, integral to the realm of facial rejuvenation, embody a distinct approach to tissue manipulation and lifting effects devoid of barbed structures. Their mechanism of action revolves around their smooth surface architecture, facilitating tissue engagement and promoting collagen stimulation for enhanced skin tightening and rejuvenation. Composed primarily of absorbable materials like polydioxanone (PDO) or polylactic acid (PLLA), non-barbed threads gradually degrade within the tissue environment, inducing a localized biological response that fosters collagen synthesis and tissue remodeling.

The efficacy of non-barbed threads hinges on their ability to induce controlled trauma within the dermal layers, triggering a cascade of cellular events that culminate in tissue tightening and rejuvenation. Upon insertion, these threads create micro-traumas, prompting fibroblasts to proliferate and deposit new collagen fibers. Over time, as the threads degrade, the newly synthesized collagen matrix strengthens, leading to sustained lifting effects and improved skin elasticity.

Types of Non-barbed Threads

Non-barbed threads encompass a diverse array of types, each distinguished by its composition, structure, and mode of action, catering to various patient needs and aesthetic goals in facial rejuvenation procedures.

Polydioxanone (PDO) Threads PDO threads constitute one of the most commonly utilized types of non-barbed threads in facial rejuvenation. Composed of a biocompatible synthetic polymer, polydioxanone, these threads boast excellent tissue compatibility and predictable degradation kinetics. PDO threads are available in various configurations, including mono, screw, and cog designs, offering clinicians versatility in addressing different facial regions and concerns. Mono threads feature a smooth surface and are ideal for promoting collagen synthesis and skin tightening. Screw threads, characterized by their helical pattern, provide enhanced tissue engagement and lifting effects. Cog threads, equipped with tiny barbs or cogs along their length, offer superior anchoring and mechanical tension for targeted tissue repositioning.
Polylactic Acid (PLLA) Threads PLLA threads represent another prevalent type of non-barbed threads renowned for their longevity and durability. Derived from a biodegradable polymer, polylactic acid, these threads stimulate collagen production and tissue remodeling, resulting in sustained lifting effects and improved skin firmness over time. PLLA threads are available in various configurations, including mono, screw, and cog designs, offering clinicians flexibility in addressing different aesthetic concerns and treatment areas. These threads provide a robust scaffold for collagen deposition, promoting natural tissue regeneration and rejuvenation.
Caprolactone Threads Caprolactone threads are composed of a biocompatible synthetic polymer, caprolactone, known for its flexibility and tissue compatibility. These threads promote collagen synthesis and tissue tightening, resulting in natural-looking rejuvenation and enhanced facial contours. Caprolactone threads are available in mono, screw, and cog designs, offering clinicians versatility in addressing different facial regions and aesthetic concerns.

Choosing Between Barbed and Non-barbed Threads

Both types of threads offer distinct advantages and considerations, making them suitable for different indications and patient profiles. When deciding between barbed threads and non-barbed threads, several factors must be considered, including the severity of facial laxity, patient preferences, and the desired treatment outcomes.

Barbed threads are particularly well-suited for patients with mild to moderate facial laxity or sagging who desire immediate lifting effects and minimal downtime. Barbed threads offer a quick and minimally invasive solution to address signs of aging, such as drooping cheeks, jowls, or brows, without the need for traditional surgical interventions. Additionally, barbed threads may be preferred in patients with thicker skin or more substantial soft tissue laxity, where a greater degree of mechanical tension is required to achieve optimal lifting effects.

Non-barbed threads are particularly suitable for patients seeking subtle improvements in facial contours and skin laxity, as well as those who prefer a minimally invasive approach with shorter downtime and fewer risks compared to traditional facelift procedures. Additionally, non-barbed threads may be preferred in patients with thinner skin or more delicate facial features, where a gentler approach to tissue manipulation is desired.

In summary, the choice between barbed threads and non-barbed threads depends on various factors, including the severity of facial laxity, patient preferences, and the desired treatment outcomes. Both types of threads offer unique advantages and considerations, and clinicians must carefully assess each patient's individual needs to determine the most appropriate approach for facial rejuvenation.

Reference:

Comparison of different thread products for facial rejuvenation: Materials and barb designs (2023)

A comparison between barbed and nonbarbed absorbable suture for fascial closure in a porcine model (2012)

Thread-lift sutures: anatomy, technique, and review of current literature (2020)

Long-term efficacy of anchored barbed sutures in the face and neck (2008)

Idea Pharmaceutical (2024)

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