Use of barbed threads in facial rejuvenation（4）
Uni-directional threads
Such threads are always placed in pairs. An equilateral triangle is marked in the temporal area, with its base parallel to the hair line, and the apex positioned more posterior. From the two corners of the line forming the base of the triangle, the uni-directional threads on their long needles are inserted, both parallel to each other, advancing at the same Sub-dermal depth and in a Sinuous manner, to points stopping just short of the smile lines [Figure 5].
The two threads in the temporal area are then brought out together from the third apical point, with the help of the curved cutting needle attached to the tail of the thread, this time taking a very deep sub-temporal fascia bite. At this exit point, they are tied together, and the knot buried under the skin, so as to ensure that it is not palpable.
The threads at the smile line are left about an inch long, taped and the patient sent over to the recovery room. Once the patient has overcome all effects of any anaesthesia, maybe even on the second day, she is called back to help in the actual lift. While she holds up the mirror and watches herself, the surgeon holds the end of the thread firmly down and pushes the skin of the cheek back over it, gradually deploying more and more barbs. This is done to a desired effect, to which the patient consents. Once both sides are done, both the patient as well as the surgeon agree to the extent of the lift as well as symmetry, etc. Only then are the free ends actually snipped close to the skin. The area from the temporal area down to the cheeks is taped, in an upward supporting style, to prevent the patient from over animating and undoing the effect of the thread lift. These tapes are preferably left in for about a week [Figure 6].
Figure 5a : Parallel markings for a pair of threads for jowl lift
Figure 5b : Zigzag manoeuvre to advance the barbed threads engaging maximum tissue（Picture courtesy Contour®）
Figure 6a : Deployment of the two threads by pulling the thread down and pushing the skin up, to the desired level
Figure 6b : Taping at the end of the procedure to prevent undoing of the lift till some fibrosis occurs
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