As with most reboots, thread lifts are haunted by disappointments past. The early 2000s version—“permanent polypropylene threads with coarse barbs laid in a way that was not physiologically sound,” explains Chicago plastic surgeon Julius Few, MD—was riddled with flaws, from visible bunching that lasted weeks and potential skin perforations years later to asymmetric breaking of the threads and lack of efficacy. “I was practicing when the original threads came out, but I never used them because I felt they were poorly conceived,” says Dr. Few, who is now the country’s top user of the Silhouette InstaLift, a next-gen dissolvable device comprising polyglycolide/l-lactide threads studded with tissue-gripping cones intended to temporarily hoist the midface. (Rival brands like Nova Threads and MINT make similar products from polydioxanone, a safe biocompatible material that’s long been used in Asia).
The Debate Over Efficacy
Dr. Few, who is also an investigator and consultant for Silhouette, makes a point of referring to the minimally invasive procedure by its official name—“absorbable suture suspension”—rather than the colloquial “thread lift,” a term he says they’re trying to get away from. Ghostbusting in action.
Silhouette, he believes, is “really something different.” In more than 1,000 cases, he’s never seen an infection; a thread snap or extrude; “or any folding or bunching of the skin that lasted more than overnight and wasn’t truly minor in nature—barely visible.” The fact that Silhouette is completely reabsorbed by the body after nine to 12 months makes it less risky. As the threads dissolve, they stimulate the body to make more of its own collagen for a lift that lasts between two and three years, according to Dr. Few’s most recent data—which, by the way, is something else that distinguishes Silhouette from threads of old: “Where we are now, data speaks,” he says. “In the past, it was all hype, no studies.”
The greatest danger with these modern threads, warns Dr. Few, is pushing the envelope. The ideal candidate (usually in her 30s or 40s) has relatively good facial volume and skin quality with mild-to- moderate sagging—“meaning the central part of the face is just beginning to droop, making the eyelids look tired and the cheeks look older, and the jawline is starting to get a bit irregular and form a jowl,” he says. “In those cases, I can get a complete correction that makes surgery temporarily unnecessary. It’s super predictable and there’s little downtime” (a few days of swelling and bruising). For people in their late 50s and 60s, results can be hit-or-miss, and oftentimes “a classic facelift is going to reset the clock in a more dramatic way and last longer,” he notes, rendering patients refreshed for a good 10 years or more. Surgery may also be a better bet for those whose necks have aged beyond their years.
“The majority of patients who’ve done this once want to do it again, and that’s a strong endorsement,” he says. But not ringing enough to sway every surgeon. “I think it’s a placebo,” says Corona Del Mar, CA plastic surgeon Val Lambros, MD. “I don’t think the operation works, and there’s an anatomic reason for that: The face is held onto the bone by lots of tiny ligaments, which in aggregate are very strong, but individually, are quite weak,” he explains. It’s these ligaments that the threads and cones aim to snag and anchor onto. “They’re not catching something with a lot of strength to it, and once you start pursing your lips and smiling, the threads can release from the ligaments.”
Indeed, some thread lift studies show improvements lasting less than six months, but there are many different brands and styles of threads, and not all are created equal. Dr. Few contends his “scientific conclusions [on Silhouette specifically] are supported by extensive research published in multiple peer-reviewed journals.” For best results, find a board-certified dermatologist or plastic surgeon with significant thread-lifting experience.
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