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Malar Reshaping Technique with Barbed Threads: for 3-Dimensional Aging in Asian Faces

According to Malar reshaping technique using bidirectional barb thread suspension procedure for 3-dimensional aging in Asian faces by Kwun Cheung Hau, MBChB, MRCP, FHKCP, FHKAM, DCH, and Suyog Jain, MD (2021) Aging is a natural process that causes skin texture changes, facial volume loss, and altered 3-dimensional topography of the underlying tissues. And 3-dimensional facial rejuvenation seems to be an effective, safe, and minimally invasive office-based procedure to achieve immediate and long-term effects.

Absorbable barbed sutures used in the malar reshaping technique can result in satisfactory aesthetic enhancement of 3-dimensional aging, including sagginess, jowling, central facial heaviness, and tissue descent in female and male Asian patients.

Plastic surgery has evolved in a less invasive direction. Many procedures and techniques for face-lifts have been investigated to avoid invasive surgery while retaining improved results. Thread-Lifting is as a minimally invasive procedure with minimised scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Thread technique for face-lifting is therefore becoming increasingly popular with both doctors and patients.

Three-dimensional perspective to facial aging

To assess the signs of aging, the face is divided into three parts (upper, middle, and lower part), among which the mid-face is of high importance in terms of aesthetic approach. The mid-face includes the eyes, nose, lips, and cheek bones and therefore requires a 3-dimensional perspective of assessment of aging signs with the aim to restore a youthful 3-dimensional facial topography.

This 3-dimensional approach aims to relax facial expression muscles, correct skin folds, replace lost volume, and treat the contours of the face, such as the temple, zygoma, mandible, nose, and chin.

There is a reduction/loss of facial fullness as a sign of aging. Left face in the image attached above is a young face in which facial fullness masks subcutaneous fat deposits. As aging occurs, there is a progressive loss of facial fullness, and subcutaneous fat deposits and underlying soft tissue and skeletal structures become more prominent (center and right face).

In comparison with other nonsurgical methods of face rejuvenation, the 3-dimensional aging signs can be relieved using a thread lift. It is the fourth most used procedure globally. The thread helps to lift the skin and has a long-lasting effect. Threads can be barbed or smooth, and the barbed sutures can be unidirectional or bidirectional. Based on the types, there are various designs used in aesthetic procedures, such as free-floating, bidirectional barbed sutures, unidirectional barbed sutures, anchored, and bidirectional double-threaded sutures

Barbed threads: A focus on bidirectional threads

Bidirectional barbed threads are mainly used to lift the cheek area. They can facilitate improved mechanical action in the two opposite directions between the barbs due to antagonistic traction. Moreover, their interaction with tissues or the biostimulation of tissues can also play a positive role in attaining satisfactory aesthetic results.

Numerous designs and modifications have been deployed to obtain the thread of choice. The major difference between bidirectional and unidirectional barbed threads is that the bidirectional threads have no anchoring points whereas unidirectional threads are anchored at a higher level fixation point.

Barbed suspension threads can be an alternative option to surgery because the thread procedure is safe, minimally invasive, and an office-based technique. Barbed suspension threading is associated with lower risks and involves less down time.

Although threads are considered a safe choice for superficial fat repositioning, this procedure often needs to be accompanied by other procedures for volume restoration. Moreover, in cases possessing a high fat volume or when superficial muscular aponeurotic system (SMAS) quality is impaired due to aging, repositioning with suspension threads may have limited effects.

Malar Reshaping Technique

The main objective in malar augmentation is to create an ideal facial profile and restore facial harmony that suits individual needs and ethnicity. Strong and prominent check bones are often part of a beautiful and well-balanced face. They help highlight the midface, promote a youthful appearance and aesthetically appealing.

Malar reshaping involves elevation of the midface and helps in facial rejuvenation to obtain a youthful and beautiful facial appearance without affecting the individual's personal features.

The barbs distribution is bidirectional and convergent. The threads interact with the tissues with a dual effect, mechanical and histological. The mechanical action of the thread is responsible for the immediate lift of the tissue and is done by symmetrically aligning both the halves of the thread that should be of the same entity.

The mechanical property of bidirectional convergent threads is an advantage over unidirectional barbed threads. It does not require anchorage points on the major parts of the facial region. Once placed in the subcutaneous tissue, these threads can continue to sustain their action on the tissues. Additionally, these threads exhibit a histological effect by ensuring the tissue traction and compactness


Ethnicity plays an important role in the aesthetics because physical characteristics vary. However, loss of volume while aging is experienced by all, independent of ethnicity.

These absorbable barbed sutures can be a good alternative to more invasive procedures. The plugs on the surface of the wires allow for the combination with other nonsurgical rejuvenation procedures, such as botulinum toxin, or substances with a transient and volumizing filler effect, chemical peelers, photorejuvenation with a pulsed light, and lip filling.

Operations with these threads do not require general anesthesia and take approximately 20 to 40 minutes to complete. The technique does not cause bleeding or pain, either during or after the operation, and does not produce scars that are visible on the skin. In addition, the operations does not require a postoperational recovery period. Moreover, the malar reshaping technique can result in satisfactory aesthetic enhancement of 3-dimensional aging signs, including sagging, heavy, or chubby large face of Asian patients.


Malar reshaping technique using bidirectional barb thread suspension procedure for 3-dimensional aging in Asian faces by Kwun Cheung Hau, MBChB, MRCP, FHKCP, FHKAM, DCH, and Suyog Jain, MD (2021)

Complication After PDO Threads Lift by Seung Ki Ahn MD and Hwan Jun Choi MD PHD (2019)

Malar Augmentation by Elegant Plastic Surgery Centre (2022)


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

Korean Advanced Non-Surgical Face Lifting Hand-On Master Classes/Mini Fellowship happening globally:

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