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What’s Important?

  1. Suspension sutures combat the aging process by anchoring the soft tissue to the periosteum.

  2. In contrast to traditional cosmetic surgery, thread lifts carry the advantages of decreased downtime and cost, lack of a need for general anesthesia, and less procedural invasiveness.

  3. Conversely, thread lifting results are thought to have less dramatic results that are temporary.

What’s New?

  1. Thread lifting has gained in popularity with the advent of other minimally invasive techniques.

  2. The development of absorbable barbed sutures has accelerated the popularity of this technique, as opposed to non-absorbable sutures, which have had a higher complication rate in the past.

What’s Coming?

  1. Absorbable suture materials, such as polydioxanone and poly-L-lactic acid, are favored due to their properties of collagen stimulation, although the long-term effects from the placement of threads composed of these materials are unknown.

  2. Threads composed of poly-L-lactic acid in combination with other suture materials with collagen stimulation properties are continuing to be developed, as the popularity of thread lifting further grows.



Although surgical facelifts have long been considered the gold standard for facial rejuvenation, the development of and interest in minimally invasive techniques have grown dramatically. Surgical lifting of the superficial musculoaponeurotic system (SMAS) along with general anesthesia is a highly invasive procedure carrying numerous potential perioperative complications in addition to prolonged postprocedural downtime and scarring.1 As our understanding of the mechanism behind the aging process and the mechanical anatomic vectors involved—particularly loosening of the SMAS—continues to advance, less invasive procedures have been developed and become increasingly popular. Although noninvasive neurotoxins, injectable fillers, radiofrequency, and ablative resurfacing tools play a significant role in facial rejuvenation, they do not address the need to lift the laxity of the underlying ptotic tissues.2 Recently introduced minimally invasive procedures include quick-recovery and limited-incision face-lifting, micro-focused ultrasound with high-resolution ultrasound visualization (MFU-V), in addition to barbed-suture lifting. The advantages these techniques purport to carry include a shorter downtime, lack of need for general anesthesia, faster procedure time, and fewer complications, which bestow increased convenience for both the patient and physician.3

Injectable fillers, skin resurfacing, and MFU-V play a major role in minimally invasive facial rejuvenation; however, fillers can result in unnatural contours, and resurfacing and MFU-V may not always sufficiently address the degree of tissue ptosis present.4 Suture suspension, also referred to as thread lifting, was first pioneered by Sulamanidze et al. in the 1990s5 and has gained popularity among dermatologists, plastic surgeons, and other cosmetic surgery practitioners. Although thread lifting initially employed conventional polypropylene, polyglactin, and polytetrafluoroethylene sutures, long-term efficacy was poor.6 Thread lifts with barbed sutures were then introduced, known as anti-ptosis (Aptos) threads, along with the development of absorbable threads.7 Other variations have since been developed including Xtosis,8 Isse Endo Progressive Face Lift Sutures, Silhouette sutures, and Contour Threads (Table 29-1...

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