Facial Rejuvenation: 6 Steps of Eyebrow Thread-Lifting
The gaze significantly influences a youthful appearance, especially in women. The eyebrows play a crucial role as they frame the eyes, and maintaining an optimal distance between them contributes to a more open and pleasant gaze, making one appear younger. As a person ages, the tissues are affected, leading to sagging in the upper lid and brow (ptosis). The continuous growth and remodeling of facial bones over time also cause changes in the orbital region. Depending on the position of the eyebrows on the face, the gaze can convey different impressions.
To improve the aesthetic appearance and create a more youthful gaze, the restoration of brow anatomy involves repositioning ptotic tissues in their correct position. Various strategies exist for reshaping the eyebrows, ranging from more invasive approaches like surgery to less invasive ones, which are suitable for milder cases of ptosis.
The current trend focuses on achieving high-quality results with minimal invasiveness, reduced risk, and quicker recovery. In this context, the use of barbed threads for brow lifting is gaining popularity. This minimally invasive technique utilizes resorbable threads and has shown excellent aesthetic outcomes, particularly in patients with mild-to-moderate ptosis or no ptosis at all.
In this blog, we will discuss the step-by-step technique for eyebrow thread-lifting, and the outcome of eyebrow lifting using barbed threads.
Eyebrow Thread Lifting Technique
The technique is suitable for patients with mild or moderate ptosis of the brow tail or those without ptosis. The procedure is relatively short, taking around 20 to 30 minutes, and is performed under local anesthesia. Patients are recommended to undergo botulin toxin injections two weeks before the procedure to relax the frontal muscles and enhance the lifting effect of the thread. The costs are reasonably low, covering one thread per eyebrow and pre-treatment with botulin toxin.
To begin, two lines are drawn from a single point, one leading to the brow tail and the other to the arch, creating an inverted V shape. Local anesthetic (carbocaine with adrenaline 1:200,000) is then injected to both numb the area and induce vasoconstriction, reducing the risk of hematoma formation. Hydrodissection is also performed with the anesthetic to facilitate better separation of the tissues.
The first needle is inserted at the hairline (IN1), in a supraperiosteal plane to minimize complications.
See below the figure for the first step, which is the marking of the insertion points and insertion of the 1st needle with attached thread at IN1. (Taken from Santorelli et al, 2022)
It continues along the drawn line until reaching OUT1 (brow arch).
See below the figure for the second step, which is the guiding of the 1st needle from point IN1 to exit at the brow arch at OUT1. (Taken from Santorelli et al, 2022)
After approximately 10 minutes, the area turns white due to the injected adrenaline, indicating that it is ready for the thread insertion. For this, we use Definisse Double Needle Threads (RELIFE, Menarini Group), which are barbed bidirectional, convergent 12-cm threads made of poly (L-lactide-co-ε-caprolactone). Each thread has a non-barbed 1-cm part in the middle and a 10-cm straight triangular needle at each end.
See below the figure for the third step, where the exiting thread is cut off at the desired length. (Taken from Santorelli et al, 2022)
Then, the other end of the thread is inserted with the needle at IN1 and follows the second line until reaching the brow tail (OUT2).
See below the figure for the fourth step to the sixth step, where the 2nd needle with attached thread is inserted at IN1, before being guided from IN1 to exit at the brow tail (OUT2), and cut off at the desired length.(Taken from Santorelli et al, 2022)
Once the needles are removed, gentle massage eliminates the drawn lines and opens the barbs, which then anchor to the overlying tissues and the brow tail. While holding the thread in place, the brow tail is positioned as desired, ensuring symmetry between the brows. Any excess thread is removed, and two sterile stripes are placed in an anti-gravitational direction, which are later removed after two days. Postoperative care includes a course of prescribed antibiotics for six days.
Discussion of Outcomes
Brow ptosis, a complex and inevitable occurrence, can be caused by various factors such as orbital bone resorption, orbicular muscle hypertrophy, and tissue sagging over time. The severity of brow ptosis depends on the combination of these factors. To restore eyebrow position, several approaches are available, and the choice of treatment should be based on patient preferences and characteristics.
Fillers can be used to reintegrate resorbed bone, and high G prime fillers are recommended for optimal results. Botulinum toxin may help with decentralizing hyperkinetic orbitals. However, if a patient experiences saggy eyebrows, thread lifting should be considered the gold-standard treatment. For those who have previously tried fillers and botulinum toxin without satisfactory results and wish to avoid surgery, brow lifting with barbed threads is an excellent option. The minimally invasive nature and absence of complications make thread lifting a preferred choice for easily repositioning the brow arch and tail.
See below the figure to see the preoperative photograph of a 46-year old woman who underwent eyebrow thread lifting (left) and postoperative photograph, six months after the procedure (right). (Taken from Santorelli et al, 2022)
Eyebrow thread lifting is a highly effective and safe procedure for patients with mild-to-moderate brow ptosis. The treatment successfully repositions sagging tissues over the lid in patients with moderate ptosis, leading to excellent esthetic outcomes.
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