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Non-Surgical Face Lifting: 10 Factors For Thread Lifting Longevity

Thread lifting has evolved into one of the most sought-after minimally invasive aesthetic procedures, offering significant results for facial rejuvenation and contouring. While the immediate effects are impressive, achieving long-lasting outcomes is a nuanced art and science. In a study done by Hong et al. (2024), titled "What Are the Factors That Enable Thread Lifting to Last Longer?", the authors explore the key factors that influence thread lifting longevity. Understanding these factors is essential to optimize their techniques and deliver superior results.


In this article, we examine these key factors, how they affect outcomes, and how to maximize the lifespan of thread lifting procedures.



1. Patient Selection: Building the Foundation for Success




The ideal patient for thread lifting is someone with mild to moderate skin laxity. Younger patients in their 20s and 30s seeking contour refinement often experience longer-lasting results compared to older patients with significant tissue sagging. The skin's elasticity and the extent of collagen production are critical in determining how well the threads integrate with tissues.

Patients with overly thin or damaged skin, severe laxity, or unrealistic expectations may experience suboptimal results or faster degradation of effects. Conversely, younger skin tends to heal better and maintains collagen scaffolding for longer.


How to Maximize Longevity:

  • Conduct thorough assessments: Evaluate the patient's skin quality, elasticity, and degree of laxity. Look for mild to moderate sagging, as these cases respond best to thread lifting.

  • Set realistic expectations: Explain that thread lifting can subtly improve sagging but may not replace surgical lifting for more severe cases.

  • Combine treatments: In cases of significant laxity, consider complementary procedures such as dermal fillers, BTX, or even surgical interventions to enhance and extend the results.



2. Thread Material: Choosing the Right Tool for the Job


Threads are made from materials like PDO, PLLA, and PCL, each offering distinct characteristics. The thread material also determines tensile strength, elasticity, and collagen induction capacity, all of which influence how well the tissues remain lifted over time.

  • PDO Threads dissolve within 6–9 months but stimulate collagen that sustains results for up to a year.

  • PLLA Threads dissolve over 12–18 months and induce stronger collagen production, making them suitable for longer-lasting effects.

  • PCL Threads last the longest, with degradation periods of 18–24 months, offering extended lifting and biostimulation.


How to Maximize Longevity:

  • Tailor thread choice to patient needs: Use PDO for subtle lifts or younger patients with minimal sagging. PLLA and PCL are better suited for patients seeking more dramatic, longer-lasting results.

  • Combine materials: For multifaceted results, blend PDO for contour refinement with PLLA or PCL for structural support and extended lift.



3. Thread Design and Structure: Anchoring Strength Matters



The structural design of threads, including cogged or barbed configurations, directly affects tissue anchoring. Threads with multidirectional cogs or barbs provide better grip, ensuring stable lifting. Molding-type threads outperform cutting-type threads, as the latter may weaken at their notched areas, reducing tensile strength. Additionally, thread diameter and length play a role, with thicker and longer threads offering superior lifting for areas with significant laxity.


How to Maximize Longevity:

  • Opt for advanced cog designs: Multidirectional barbs or cogs ensure superior anchoring in areas like the midface or jawline.

  • Use molding-type threads: These retain their structural integrity better, reducing the risk of thread breakage or migration.

  • Match thread thickness and length to the target area: Choose thicker threads for larger, sagging regions and thinner threads for precision in smaller areas like the periorbital region.



4. Placement Depth: The Importance of Precision



Correct placement depth ensures threads engage the right tissue layers to lift and support facial structures. Threads placed too shallowly can result in surface irregularities, such as dimpling or visible threads, while threads placed too deep may fail to lift the desired tissue effectively. Misplacement also increases the likelihood of migration, which compromises both the lift and the patient’s satisfaction.


An additional consideration is thread engagement with the SMAS (superficial muscular aponeurotic system) layer. This connective tissue provides the most durable anchor point for threads, enabling them to maintain tension over time.


What to Do to Maximize Longevity:

  • Target the Right Depth: Insert threads into the subdermal or SMAS layer for optimal lift and tissue engagement. Placement in these layers allows threads to hold the lifted tissue securely while promoting collagen production around the threads.

  • Avoid Common Errors: Shallow placement risks thread visibility or palpability, while deep placement in fat layers may fail to create a lifting effect. Anatomical knowledge and precise techniques are essential.

  • Invest in Advanced Training: Utilize guided ultrasound or pre-marked anatomical landmarks to perfect depth accuracy. Advanced training courses focused on facial anatomy can significantly improve placement consistency.



5. Lifting Vectors: Aligning for Aesthetic and Longevity



The direction of thread insertion, or lifting vectors, plays a vital role in ensuring both immediate and long-term aesthetic results. Lifting along incorrect vectors may create uneven tension, leading to asymmetry, ineffective lifting, or premature relaxation of the threads. Proper vectors not only enhance lifting power but also ensure results align with natural facial movements, preventing a rigid or "pulled" look.


What to Do to Maximize Longevity:

  • Plan Individualized Vectors: Identify lifting directions based on the patient’s unique facial anatomy. For example, the cheek area typically benefits from oblique lifting vectors, while the neck and lower face require vertical vectors to counteract the effects of gravity.

  • Simulate Outcomes: Use manual lifting during the consultation to visualize the effects of different vectors. This allows practitioners to map the ideal insertion points and directions.

  • Follow Natural Contours: Align threads with the natural tension lines of the face (Langer’s lines) to distribute tension evenly and reduce stress on the skin.

  • Double-Vector Techniques: In areas with significant laxity, consider dual-vector lifts (e.g., combining horizontal and vertical lifts) for a stronger, more cohesive result.



6. Tension and Traction: Balancing Lift and Comfort



As discussed by Hong et al. (2024), applying too much tension can lead to discomfort, visible dimpling, and premature thread failure. Conversely, insufficient tension leads to an ineffective lift and a faster relaxation of the tissues. Properly balanced tension provides an optimal and lasting lift without overstretching the skin or compromising the threads.


What to Do to Maximize Longevity:

  • Apply Controlled Tension: Use enough force to engage and lift tissues securely, but avoid excessive pulling, which can overstress the skin. Adjust tension progressively during the procedure to achieve symmetrical results.

  • Avoid Overcorrection: Over-tightening may create unnatural contours and increase the risk of complications such as skin dimpling or thread protrusion.

  • Use Multi-Thread Techniques: For larger areas or areas with heavier sagging, use multiple threads with moderate tension instead of relying on one thread with excessive force. This distributes the load and enhances longevity.



7. Anchoring Techniques: Ensuring Stability


Anchoring threads to stable structures ensures they stay in place and maintain tension over time. Weak anchoring increases the risk of thread migration or loosening, which can compromise both aesthetic outcomes and patient satisfaction. Proper anchoring also enhances collagen stimulation, as stable threads provide consistent tension to the surrounding tissues.


What to Do to Maximize Longevity:

  • Secure to Robust Anchor Points: Use stable structures like the temporal fascia or periosteum for anchoring threads. These areas provide a firm foundation to hold the lifted tissues.

  • Double-Anchoring for High-Tension Areas: In regions with significant sagging or movement, such as the jawline, consider double-anchoring techniques to increase stability and longevity.

  • Refine Fixation Techniques: For barbed threads, ensure the cogs are fully engaged with the tissues. Use techniques such as a slight rotation of the cannula during insertion to improve anchoring.



8. Post-Procedure Care: Patient Compliance is Key


Neglecting post-procedure care can lead to complications such as thread displacement, dimpling, or uneven lifting. Proper care during the healing phase also enhances collagen stimulation and ensures the threads remain securely positioned.


What to Do to Maximize Longevity:

  • Advise Rest and Gentle Movements: Recommend avoiding vigorous activities, excessive facial expressions, or sleeping on the treated side for at least two weeks to prevent thread displacement.

  • Support Skin Health: Suggest a post-treatment skincare regimen that includes sunscreen, collagen-boosting products (e.g., peptides, retinoids), and hydration.

  • Schedule Follow-Ups: Regular post-procedure check-ins allow you to monitor healing progress, address patient concerns, and ensure optimal results.



9. Patient Lifestyle Factors: Protecting the Lift


A patient’s lifestyle has a significant impact on thread lifting results. External factors like smoking, sun exposure, and poor nutrition accelerate skin aging, undermining the benefits of the procedure.

What to Do to Maximize Longevity:

  • Encourage Healthy Habits: Educate patients on the importance of hydration, a balanced diet, and regular exercise in maintaining skin health.

  • Promote Sun Protection: Emphasize the use of sunscreen to protect against UV-induced collagen breakdown.

  • Discourage Smoking: Smoking impairs blood flow and collagen production, significantly reducing the longevity of thread lifting results.



10. Managing Complications: Proactive Measures


Complications such as thread migration, dimpling, or infection can shorten the lifespan of the lift and reduce patient satisfaction. Prompt and effective management ensures the lift remains intact.


What to Do to Maximize Longevity:

  • Prevent Issues: Use high-quality threads, maintain strict aseptic techniques, and follow proper insertion protocols.

  • Monitor for Early Signs: Identify and address complications early, such as minor dimpling or thread visibility, with non-invasive adjustments.

  • Intervene When Necessary: In severe cases, remove or replace threads and provide treatments like antibiotics or anti-inflammatory medications to manage infections or reactions.



Conclusion


Achieving long-lasting thread lifting results demands more than technical skill; it requires a deep understanding of the factors influencing longevity and the ability to tailor each procedure to the patient’s unique needs. By mastering these factors—patient selection, material science, placement, and post-care—medical professionals can ensure durable, aesthetically pleasing outcomes that enhance patient satisfaction.



Reference:

  1. Hong, G. -W., Hu, H., Park, S. -Y., Wan, J., & Yi, K. -H. (2024). What Are the Factors That Enable Thread Lifting to Last Longer? Cosmetics, 11(2), 42. https://doi.org/10.3390/cosmetics11020042

 


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