Use of barbed threads in facial rejuvenation（5）
Recovery
Proper postoperative instructions must be given to reduce the risk of complications during recovery.
These instructions include：
1、Limited activities should be done for at least 24 hours.
2、Diet restrictions should be followed e.g. soft foods for seven days.
3、Pain can be managed with oral medications such as Acetaminophen.
4、Ibuprofen is avoided to limit bruising.
5、Though asepsis is strictly adhered to, it is preferable to give Antibiotics for a period of five days as this is, after all, an insertion of a foreign body.
6、Recommend elevating the head on the first day to reduce swelling.
7、The day following the procedure, the patient can resume non-strenuous activities, and all normal activities can usually be resumed within seven days.
8、Social situations are to be avoided for up to one week - three weeks for weddings, reunions and other formal occasions.
Postoperative care
1、Swelling and Bruising can be prevented by ice packs.
2、Movements are strictly restricted by taping the face, especially the area that has been operated. This is best advised for about a week.
3、Sleeping on the sides with the face against the pillow, can undo the effect of the procedure. Hence the patient is advised to sleep on the back for a week. Avoid excessive mouth opening and massage of any kind for three weeks.
Risks and complications and their management [4]
1、The thread lift is a relatively new procedure, and its techniques are still being developed. Results have varied greatly among patients, but continue to improve.
2、A significant risk of the thread lift procedure is that one may not notice any improvement.
3、Asymmetry is a very bothersome consequence. One has to carry out the procedure with great precision, from noticing pre-procedure asymmetries, to perfectly balanced markings, to ensuring the symmetry with the patient's consent before cutting off the ends of the thread.
4、Some thread lift patients with thin skin have reported that the sutures became visible under the skin shortly after the procedure. Rippling can persist for long. The surgeons need to be aware of this problem, and have to be careful while inserting the thread so as to keep it at the optimum depth. This does require some experience, and hence there is a learning curve for this.
5、Some patients experience a lack of sensitivity or numbness in the treated area, which usually subsides within weeks of the procedure.
6、Infection in the treatment area is an infrequent complication. If an infection develops, treat it with antibiotics. Rarely, an infection may require surgical drainage. Scar tissue formation is also possible. The knot of the thread in the scalp can cause formation of granulation tissue, bleed and be palpable. Sometimes, Hair roots are pushed in deep, leading to hair sinuses and inclusion cysts.
7、Some surgeons have noted rare Migration or even total Extrusion of the sutures, causing an unbalanced facial appearance. With this, or if the thread breaks, a simple reinsertion solves the problem. If a very large bore cannula has been used to place bi-directional threads, then the track created is also very large-sized, and this can lead to an early extrusion of the thread [Figure 7].
Some clinical cases of Thread Lift [Figure 8].
Figure 7a: Hair sinus at site of entry Figure
7b: Hair root entangled within the knot of the thread Figure
7c: Unilateral puckering of skin requiring correction Figure
7d: Rippling caused by too superficial placement of thread Figure
7e: Crusting at the site of entry of thread Figure
7f: Infection causing extrusion of threads Figure
7g: Before Thread Lift Figure
7h: An extreme grade of rippling immediately following thread lift. The author had to undo the procdure
Figure 8: (a) Sagging cheeks (b) After Cheek Lift with two Bi-directional threads each side
Figure 8: (c) Before profile improvement, (d) Besides rhinoplasty and chin augmentation, this girl was given a minimal, subtle cheek lift with threads only
Figure 8: (e) Sagging cheeks and jowls (f) Cheek Lift and Jowls Lift by two pairs of Contour Threads. each side (Other procedures done were lip augmentation/ chin augmentation and blepharoplasty)
Figure 8: (g) Sagging Cheeks (h) Ogee curve created with Cheek Lift by Threads
Figure 8: (i) Before Lift (j) After Thread lift, producing high cheek bone effect and reducing smile lines
References
1、Khazanchi R, Aggarwal A, Johar M. Anatomy of ageing face. Indian J Plast Surg 2007;40:223-9.
2、Wu WT. Barbed sutures in facial rejuvenation. Aesthet Surg J 2004;24:582-7.
3、DeLorenzi C. Barbed sutures: Rationale and technique. Aesthet Surg J 2006;26:223-9.
4、Paul MD. Complications of barbed sutures. Aesthet Plast Surg 2008;32:149.
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