Improving Longevity of Non-Open Face Surgery via Mesh Thread

As a result of the unpredictability of the long-term findings, thread lifting remained a rather more controversial technique for a long time after it was first described in the early 20th century. Only a handful of studies discussed the patients' long-term follow-ups.There hasn't been a perfect thread that can exhibit long-lasting results up until this day.

There has been a long-term clinical study done by Dr. Kamol Wattanakrai, Dr. Nattawut Chiemchaisri, and Dr. Penpun Wattanakrai, that validates the Mesh Suspension Thread technique's ability to last longer in comparison to other techniques for facial rejuvenation. 29 patients underwent thread lifting procedures performed by the mentioned doctors at the Bangkok Skin-Plastic Surgery Center and Bhumibol Adulyadej Hospital using mesh suspension thread. Its results indicated that its capacity to last up to 2 years had positive contributions to the future research of this field.

Surgical Techniques used in the Study

They started with an incision that was made in the temporal area as planned and carried down to the deep temporal fascia. Then, wide blunt dissection over the deep temporal fascia was performed down to the anterior hairline. This dissection plane was under the superficial temporal vessels and their branches. At the hairline area, the dissection plane was changed to a more superficial plane to the subcutaneous tissue to avoid the frontal branch of the facial nerve.

A polypropylene mesh was placed over the deep temporal fascia at the temporal incision. The mesh was secured to the deep temporal fascia with 4–0 polyglactin sutures to enforce the strength of the deep temporal fascia for later suspension of the thread. The cannula with blunt trocar introducer was inserted through the temporal incision under the dissection plane. At the hairline area the trocar was shifted to a more superficial plane to avoid the frontal branch of the facial nerve.

After passing the facial nerve passage line, the trocar was introduced to a deeper plane to catch the SMAS plane. Then, at the medial parotid border the trocar was pointed slightly superficial in the deep subcutaneous tissue to avoid accidentally catching the distal facial nerve that lay underneath the SMAS. The trocar was then removed, and the mesh threads mounted on the needle tip were inserted one by one through the cannula that was held in place. A sharp needle was pushed through the distal end of the cannula through the skin at the proposed exit point.

The thread was removed from the carrying needle, and the needle was withdrawn while stabilizing the distal end of the thread in place. The thread was then pulled down freely inside the cannula after one or two barbs constituted a marker for the proper distance to the mesh to be seen. After ensuring the proper position of the mesh, the cannula was removed. The process was repeated for the remaining three threads on each side.

Discussion of Results

The authors discovered the mesh suspension thread technique in 2015. Because the ingrowth tissue should interlock with the mesh to create a long-lasting anchored unit, the concept of tissue ingrowth in the mesh offered a promising option for durability. The authors have divided the patients into 3 groups relative to their follow up periods.

The study's findings demonstrated that, in every instance, the mesh thread suspension could maintain a better result for more than six months (GAIS one to three by patients and the investigator). 14 cases (66.6%) went on for more than a year (Group 1 & Group 2). After two years, eight patients (38%) in group 1 still had the improved outcome. Additional monitoring should reveal more encouraging outcomes for group 1 (2 years and up). In other instances, we found that patients' GAIS ratings were greater than the investigator's.

The patients reported firmness of their faces and slight change in facial contour that might be difficult to detect by regular 2D photographs, especially in the oblique or lateral view. In the picture above, Patient 16's 2 years and 2 months post-op show clear evidence of improvement in AP view but less improvement in oblique view.

Any thread lifting technique typically results in palpable abnormalities and apparent problems or adverse effects. The cause of irregularities is a nonuniform movement and a too shallow insertion. Surgeons should be mindful of the visibility or palpability of the thread, especially at the mesh area, because the polypropylene mesh thread is a non-absorbable thread. To avoid any irregularities, surgeons must embed it deeply in the SMAS surface.

2 Main Scientific Bases that Explains the Longevity of the Result

1. A composite anchored unit made by integrating tissue with the mesh should endure longer than one that depends solely on the thread material, which could lose the attachment over time.

2. The lower face that required attention was situated close to the primary lifting point (mesh). As a result, it was easier to raise and hence had a lower probability of coming undone. The anchoring points on earlier iterations of the threads, which are either barbs or cones, are spaced evenly along the threads. The lower sections will have less of a lifting impact if the higher anchoring point captures face tissue. In order to overcome the distance to the target area, the lifting point that originates from a distance from the target point should require greater tension than the lower section. As a result, it will cause a quick loss of attachment. Additionally, facial skin stretches more quickly over time than skin raised close to a defect because it retains its suppleness and creates less stress.

Conclusion

Many patients today want less invasive, minimally invasive facial rejuvenation procedures. The expensive energy-based gadgets may result in some skin tightening, but the effect is still insufficient to match what we typically get from other types of facelifts. Plastic surgeons who want to make a noticeable impact in patients who are refusing open surgery should consider the thread lift procedure. However, the fundamental barrier to all thread lifting procedures continues to be its dubious durability. The findings of this study indicated that this less invasive method may have a 2-year durability. The idea of tissue ingrowth into the mesh and the creation of a long-lasting anchored unit should be investigated further by researchers in the future.

Improvements in the surface area to volume ratio are regarded as the most effective anti-aging techniques since aging is a phenomenon in which different tissues are weakened and collapse in diverse directions rather than just soft tissue or skin drooping due to gravity.

Reference

Mesh Suspension Thread for Facial Rejuvenation (2019)

Removal of Facial Soft Tissue Ptosis with Special Threads (2002)

Elevating the midface with barbed polypropylene sutures (2005)

Outcomes in thread lift for facial rejuvenation (2009)

Uncovering the benefits, indications & limitations of the thread lifting in our upcoming

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