Use of barbed threads in facial rejuvenation（3）
Candidates for Thread lift
Right candidates
Ideal candidates for thread lifts include people with Minimal signs of ageing who need just a small lift. Usually, these are women between 35 and 45. The threads are indicated because these patients have begun to see more prominence of the jaw, a relaxed or minimally sagging mid-facial appearance or slight bags under the eyes or on the neck.
Older people may be advised to undergo a thread lift during the more aggressive facelift procedure to provide additional support for the soft tissue area that was elevated in the facelift.
Other thread lift candidates include those who have had some relapse from a previous procedure such as a facelift or neck lift.
Ideal patients are also those who understand and accept the possibility of the risks and complications outlined below, who understand the limitations of these threads, have realistic expectations and who are prepared to follow the post-operative regimen.
Poor candidates
Those patients who have excessively sagging skin at an advanced age will show a very limited improvement.
Those patients who are obese, or have very heavy, rugged skin too will show no improvement.
All other contraindications of implants, etc. also hold good here, like Multiple skin allergic reactions or infections, Dandruff, Hair lice, Immunologically compromising diseases like cancer/ HIV etc., Systemic diseases like diabetes, tuberculosis, etc.
Surgical procedure
Bi-directional threads
A classical example of their use is to lift the cheeks.
The anaesthesia chosen differs depending upon the patient, the surgeon and any associated procedures. When several other procedures are being done simultaneously, one can choose a general anaesthesia. When a lunch time thread lift alone has been planned, only a local anaesthetic can be infiltrated along the expected track. At most other times, if the patient is willing for a longer day care stay, twilight IV sedation with local anaesthetic is given. The last is the author's most preferred method.
A spinal needle is inserted under appropriate anaesthesia from the pre-tragal area, in a curved direction to a point below the cheek, and then up again towards a point stopping just short of the smile line. As this needle is advanced, it is actually progressed in a Sinuous manner, moving the needle tip from side to side. Also, the depth of the needle is at all times maintained At the same Sub-dermal level, gliding just Above the Fat layer.
A similar needle is passed about one to one and a half centimetres above this line. Through the two needles, the bi-directional threads are inserted, making sure the thread and its barbs do not get 'caught' and do not damage.
Once the thread has been passed through, it is positioned such that the centre of the thread gets placed in the centre of the track. Once done, the needle is slowly withdrawn. The tissue can be 'gathered' over the thread, and once the desired effect has been reached, the long ends of the thread are then cut off [Figure 4].
Figure 4a : Defining the lowermost cheek point
Figure 4b : Marking the cheek curve
Figure 4c : Ensuring bilaterally symmetrical markings
Figure 4d : Inserting the spinal needle along the curve
Figure 4e : Thread firmly fixed, now does not budge on traction in either direction
Figure 4f : Thread snipped close to the skin
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