Your Face on a String

Dr. Kenneth Sanders

How does this sound? Facial tissue repositioning with barbed sutures. Barbed – as in spiked! Not an inviting picture to someone considering a facelift. This describes PDO thread lifting: a cosmetic technique that lifts and tightens sagging skin tissues by inducing collagen production. Before I tell you why I no longer offer this facelift substitute, I’d like to tell you where it came from and how it works.

Dr. Gregory L. Ruff, a plastic surgeon in Chapel Hill, N.C., invented the thread lift in 1992. Searching for a way to raise the crushed cheek of a car-accident victim, he cut little notches into a few of his surgical sutures, threaded the sutures under her skin and used them as a sling to move her cheek back into position.

After using hand-notched sutures in several more reconstructive surgeries, Dr. Ruff decided they would also make a useful cosmetic tool. In 2004, he introduced Contour Threads, which are transparent sutures with one-directional barbs, designed to tighten sagging skin on the face and neck.

I was intrigued, so after some discussion I went to Dr. Ruff’s office for more instruction on this procedure. It seemed like a very good procedure so I decided to try some. The results were good initially but, in the end, did not last. In my opinion, this is because the “barbs” are not strong enough to hold up over time to the day-to-day stresses that our skin goes through. After a couple of years and removal of the sutures, they were eventually taken off the market.

Around the same time, in Moscow, Dr. Marlen Sulamanidze, a surgeon who was looking for a way to do face-lifts without making large incisions, developed Aptos threads, monofilament material called polypropylene to also pull tissue upward. Once inserted under the skin, these cogs will form a support structure for the production of collagen.

Overnight, the thread lift became the cosmetic surgery procedure du jour, appealing to people seeking subtle cosmetic changes that are quick and relatively inexpensive. But because the procedure was so new, doctors couldn’t predict how long results would last. Some doctors predicted that the best ones would last five years. But other doctors say they have seen cases in which the sutures do not hold patients’ flesh taut for more than a few weeks. Dr. Robert C. Silich, a plastic surgeon in Manhattan who has removed sutures from several patients operated on by other doctors claims, “One cough and a sneeze, and the thread lift is all over.”

The problem with the thread lift is this: living tissue expands to accommodate tension. This means that if you pull on skin it will grow and stretch out to eliminate that pull. It’s almost like “one foot forward, two feet back.” Use the thread to tighten, the tissue works against your results.

Whatever you want to call it, the Puppet Lift, the Purse String Lift and the Lunch Hour Lift – although you may not want to go back to work after this procedure, or the Aptos Lift. I cannot recommend this procedure for anyone and don’t personally know anyone performing it any longer.

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