Early 2001 saw Tom and Nicole, J.Lo and P. Diddy, and Hollywood’s infatuation with the thread lift. The latter was the most literal of breakups: one A-lister’s thread snapped on the red carpet under the eagle eye of Joan Rivers (if you believe the rumors to be true), while a high-profile agent suffered a thread malfunction while yelling at his assistant.
Dubbed a quick fix for hoisting up cheeks and jowls without the need for a surgical facelift—“threads,” aka sutures, are inserted into the skin via a needle—the original thread lifts quickly fell out of favor with the rest of the country in 2002 when the barbed polypropylene threads often resulted in facial distortion and asymmetries. Some even broke under the skin, causing infections, or protruded through thinning skin in aging patients. “Early threads were made of the same material used to string a tennis racket,” says Chicago plastic surgeon Julius Few, MD. “They were very unforgiving, very firm and could easily irritate the tissue.”
In 2015, Silhouette InstaLift spearheaded the shift from permanent, polypropylene threads to dissolvable, poly-l-lactic acid (PLLA) sutures, and doctors loved the modification. Brands such as Nova Threads and MINT have also introduced similar versions made of polydioxanone (PDO), a material that’s been widely used for thread lifting in Asia for years.
These modern thread lifts—many experts are moving away from the term “thread lift” and toward “absorbable suture suspension” to shake the stigma associated with old-school methods—also provide more than just a lifting benefit. “With Silhouette InstaLift specifically, because the sutures are largely composed of PLLA—the same material used in the dermal filler Sculptra Aesthetic—a bio-stimulatory effect occurs in the skin with the production of both Type 1 and 3 collagen,” Washington, D.C. dermatologist Tina Alster, MD says. “This collagen increase leads to a volumizing effect that continues for up to two years, enhancing the quality of the skin in the long run.” Dr. Few, who has performed more than 1,000 thread lifts, says that based on the patient questionnaires submitted in his 100 case studies, all patients felt as though their appearance continued to improve over time.
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“The best candidate is someone in their 30s, 40s or early 50s with mild-to-moderate sagging,” says New York plastic surgeon Z. Paul Lorenc, MD. “For patients in their mid-50s and older, we can still see some good results, but they’re much less predictable.” Downtime is generally minimal with little swelling and/or bruising, and Dr. Few says many of his patients have gone to big events 24 hours later where no one noticed, although he notes this may not be the case for everyone.
Although all of the experts interviewed for this story agree that a surgical facelift is still the gold standard for lifting and shaping the facial tissues into a more youthful position long-term, Eugene, OR plastic surgeon Mark Jewell, MD says thread lifts can offer a temporary fix for those with mild skin laxity. “When we’re doing a facelift, we’re working to pull the deeper layers of muscle and fat up with the skin, which thread lifts don’t do, so the lifting effect isn’t nearly as profound.” La Jolla, CA plastic surgeon Robert Singer, MD agrees, adding that some patients who have minimal laxity may benefit from suture lifts, but only short- term. “Those with significant skin laxity, loss of elasticity or sun damage won’t experience a positive effect and are generally best-suited for a facelift,” he says. “Patients need to be educated on the differences between the two procedures so that they don’t have false expectations.”
For patients who are deemed candidates for both, cost is generally a deciding factor. The cost of a thread lift varies considerably by region in the U.S.—the doctor’s expertise plays a role, too—but expect to spend $3,500 on average. A traditional facelift rings in at around $12,000, depending on the surgeon and technique used, but it can last up to 10 years. So all things considered, repeat thread lifts every two years for a decade could set you back about $17,500, but whether or not patients will do that remains undetermined, as the procedure is still so new.
While Silhouette InstaLift is only currently FDA-approved for lifting the cheeks—in Europe, it’s also approved for the lower face, neck and brow—many plastic surgeons and dermatologists have been experimenting with it, and other types of sutures, elsewhere on the body. “It’s still highly investigational and new techniques, products and applications are still in development, but the future looks promising,” says Dr. Few.
Two of the most popular below-the-face requests include the area under the chin, which can be tightened with the suture technology, and the neck, which can be lifted. Drs. Lorenc and Few have published their findings on the effect of sutures used in these areas, and say they have a high degree of patient satisfaction, but treating the neck is definitely more involved and the results aren’t as predictable as they are on the face. “We’re still working out the applications for this area, but what we know so far is that there seems to be an absolute need to help support the jawline first and then the neck. When the two areas are done together, the results are much more consistent and patients are happier.”
Doctors are also testing the use of threads to lift lax breasts and buttocks, as well as skin above the knees and on the upper arms. Dr. Alster has seen successful skin tightening on the arms and knees, but says there’s not enough clinical work for her to make a full endorsement. Additionally, the consensus among top docs is that the current sutures on the market in the U.S. are not suitable for a butt lift. “Years ago, I was part of an investigation that studied the biomechanics of facial lifting and how much force it took to pull the jowls up. It was about six pounds of force, which isn’t a ton, but that was just for the lower face,” says Dr. Jewell. “The buttocks are much heavier, so they would require many times that, and I don’t believe current thread technologies have enough lift capacity to hold them up, let alone for an extended period of time.” Dr. Singer adds that using sutures in this way “has never been shown in a valid scientific study to produce reasonable or long-term results,” aside from the appearance of a lift increase due to initial swelling, which eventually wears off.
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Some surgeons, like Drs. Singer and Jewell, argue that this same reasoning applies to the breast tissue, especially larger breasts. However, a new type of suture technology called Refine is set to debut in the U.S. later this year under the Silhouette umbrella, and claims to offer an effective solution. “Instead of being made of PLLA like InstaLift, they’re more durable—and permanent—medical-grade polyester sutures that have been used in surgery for decades, so we see great potential in their ability to lift the breast tissue,” says Montclair, NJ plastic surgeon Barry DiBernardo, MD, one of the lead investigators for Refine who has already used it in more than 75 cases. “There is a huge demand for nonsurgical lifting on the body, and the breasts in particular, which tend to deflate and/or sag as a result of pregnancy, breastfeeding, weight fluctuations and age.”
At launch, Dr. DiBernardo says Refine will be used surgically—the sutures will enhance a breast lift by “creating and maintaining fullness in the upper breast” using standard incisions. Often, breast implants are combined with a lift to create the same upper fullness; Refine would offer another option. However, researchers predict that eventually the sutures will be inserted under local anesthesia, like a thread lift, providing a minimal-incision breast lift. “There has been a lot of hype behind ‘minimal incision’ and ‘scarless’ breast lifts, but none have proven successful in published studies,” says Dr.Singer, noting that clinical trials for Refine are still in their infancy and more data is needed to verify its efficacy.
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Patient selection will play a crucial role in the procedure— as an adjunct to a surgical breast lift, Refine will benefit a larger, heavier breast, as it will provide secondary support. As a stand-alone treatment, smaller breasts may have the advantage, as there will be less weight for the sutures to bear, but testing is still underway.
“Proper technique is paramount when using these sutures in order to achieve the appropriate breast shape. There will be a learning curve for doctors,” Dr. DiBernardo says. “Current research is also being conducted to show that the sutures are not visible to interfere with test results.”
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