Complications of Thread Lift and How to Manage: Thread Protrusion, Infection, Dimpling and Bruising
The art of thread lifting has dramatically evolved since its introduction, and over the years, it has been revered as one the safest and most effective modalities for anti-ageing and facial rejuvenation. While the advancements in technology and techniques have significantly improved the reputation of thread lift, as with any procedure, it is not without its own set of complications. What is important to a practitioner however, is not to be overly concerned with the complications, but rather, how they can be prevented and managed.
Thread Protrusion
One of the most common complaints from patients is the protrusion of threads post surgery. There are many factors to the protrusion of threads, and one of the most common reason is employing the wrong technique - regardless during entry or when placing the threads.
Another reason for thread protrusion may be due to thread loss or breakage. It is therefore essential when placing threads that when the thread is cut, the end will tuck back into the skin – protrusion of a thread through the skin is an infection and granuloma risk and may cause distress to the patient.
In the case of monofilament, if there is a protruding thread, the end should not be cut as with barbs and cogs, but grasped firmly and removed. It’s easy and cheap to remove a mono threads thus eliminating the risk of granuloma if the thread is placed too superficially.
Barbed and cogged threads can only be removed with difficulty, if at all. If the end of a thread is left in a superficial plane then there is increased likelihood of granuloma formation.
Typically, thread breakage occurs during tightening of the PDO cogs and barbs as during placement the thread is protected by the needle or cannula. In some cases, the thread may not be protected by the inserting tool so tissues must be carefully manipulated in order to avoid breakage during insertion and tightening, thus, preventing protrusion.
Infection
Reported infection rates post-thread insertions are extremely low. Regardless of thread types, all threads should be placed using an aseptic technique to reduce the risk of infection, which, practically speaking, translates as use of betadine or chlorhexidine preparation, use of a sterile field such as surgical drapes for cogs and barbs and use of a sterile dressing pack and gloves.
Although rare, it is not uncommon for a painful lump to develop after a thread lift procedure. This may be caused by the thread buckling or curling under the skin. One way to treat this is to perform a subcision treatment which releases the thread from the skin and allow it to unwind, while the other is to make a small stab incision to remove the thread completely and replace it at a later time. There is always a small possibility of infection particularly if the lump is warm, red or fluctuant.
Lastly, incorrect placement of threads may also lead to localised infection. Overall, infection complications are few and far between, often easily managed by the removal of threads or by oral medication.
Dimpling
Dimpling in the skin can occur post thread lift procedures, however, they usually resolve on their own - but if threads are placed incorrectly, dimpling can cause disfigurement.
In addition, if the depth of the advancing thread is much more superficial or not uniform, a depression will occurred at a portion located closely to the skin, and which can cause dimple or irregular contour.
Furthermore, remarkable dimples must be managed by manual reduction and during which, it may sometimes affect the effect of thread lift as the thread must be completely removed address the dimple completely.
If dimpling does not resolve by itself, a practitioner may sometimes be required to place fillers in the dimple to solve the problem while at the same time allowing the threads gradually dissolve over time.
Bruising
Although the chances of bruising due to thread lift procedure is minimal, there still have been reported cases of patients who experienced bruising post procedure. Bruising can be caused by bleeding due to damage to the dermal plexus by needle or sharp cannula. In some cases, blood vessels may be damaged at entry, or en route cannula insertion.
Depending on the true of threads and technique, the cause of bruising may differ. For example, when a procedure is performed with a needle-type thread of sharp cannula, the dermal plexus may be damaged without bleeding, and may lead to bruising.
Bleeding at entry point can occur when a sharp needle or cannula is used for insertion. This usually happens around the hairline or the temporal area. Palpation of the pulse of the after and careful design planning can help prevent overlapping entry points and vessels.
Bleeding caused by en route cannula insertion is often caused vy damage to large blood vessels or branches rather than the dermal plexus. If not treated, it may lead to the development off hematoma. The risk of hematoma developing is higher if insertion is performed with a sharp needle instead of a blunt cannula. Even with the use of a blunt cannula, a practitioner should still take caution when performing the procedure as the cannula may still damage the tissue, causing bleeding in areas where tissues are dense - thus leading to bruising.
To prevent bruising, it is recommended to insert the threads into the subcutaneous layer rather than the dermis or hypodermic, but most importantly, insertion of threads should be done with the use of a blunt cannula rather than a sharp needle/cannula.
Lastly, it is important to place the threads in the correct layer of the skin to prevent bleeding and bruising. The subcutaneous layer where blood vessels are sparely distributed is a recommended later for insertion while taking note to not approach too closely to the SMAS layer where one would likely damage the large blood vessels.
Managing Complications of Thread Lift
Thread-lifting is a minimally invasive procedure with limited scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Using absorbable thread as such PDO, PLLA and PCL, it is a relatively simple procedure; although complications may occur, they are usually easily treated and managed. Despite so, it is important that a practitioner understand the science behind the cause of complication, and an understanding of anatomy, material and technique is imperative.
Today, thread lift is known to be one of the safest and most effective non-surgical procedures available. Compared to the standard incisional surgery for facial rejuvenation, the number of patients actively seeking thread lift procedure have increased Although there have been several reports on acute or delayed complications post-procedure, they are often than not associated with using non-absorbable thread type, and complications related to using absorbable thread type are few and far between.
Studies have shown that the common complications of thread lift procedures are easily managed and often reversible if a practitioner is equipped with the right skills, knowledge and technique.
Hope you have enjoyed the article! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!
References:
The Art and Science of Thread Lifting (Springer, 2019)
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