INTRODUCTION
Facial aging is associated with gravitational redistribution of facial soft tissue. To date, rejuvenation has been achieved by repositioning soft tissue via invasive surgery. A more recent approach is thread lifting, a closed facial lifting technique in which threads are inserted and passed under the skin surface, pulled to lift the ptotic tissue, and anchored at the point of entry.1,2
Thread lifting, or suture suspension, has yielded variable results1,3 and progress in its application has been questioned.4 Nevertheless, suspension sutures have progressed from non-absorbable polypropylene5,6 to resorbable multianchor suspension sutures with knots,7 absorbable poly-L-lactic acid,8 polydioxanone (PDO),9,10 and from barbed threads5 to threads with cogs or cones4,11 specifically designed to hold tissue in place.
As important as thread and cannula design are for a successful lift, the technique of thread placement is also important. In general, thread placement publications fail to address the details of technique.12 The present work describes, in detail, a thread-based, face-lifting technique that has provided reproducible and predictable results for 200 to 300 patients.
Thread lifting, or suture suspension, has yielded variable results1,3 and progress in its application has been questioned.4 Nevertheless, suspension sutures have progressed from non-absorbable polypropylene5,6 to resorbable multianchor suspension sutures with knots,7 absorbable poly-L-lactic acid,8 polydioxanone (PDO),9,10 and from barbed threads5 to threads with cogs or cones4,11 specifically designed to hold tissue in place.
As important as thread and cannula design are for a successful lift, the technique of thread placement is also important. In general, thread placement publications fail to address the details of technique.12 The present work describes, in detail, a thread-based, face-lifting technique that has provided reproducible and predictable results for 200 to 300 patients.
MATERIALS AND METHODS
Patients
Adult patients with descended superficial fat pads are candidates for a new thread-based, face-lifting (TBFL) technique (BussoLyftâ„¢) regardless of age, skin thickness, and body weight. Thin patients with significant fat pad descent and skin laxity achieve the most dramatic results.
Thread Design
Volumetric PDO threads (50 mm mesh) and tissue-engaging PDO threads (60-mm harpoon and 100-mm harpoon) were purchased (Medyglobal America, Miami, FL) for use in three primary vectors (Figure 1). Knowledge of different parts of a thread and their distribution in a cannula (Figure 2) is essential for performance of the TBFL.
Adult patients with descended superficial fat pads are candidates for a new thread-based, face-lifting (TBFL) technique (BussoLyftâ„¢) regardless of age, skin thickness, and body weight. Thin patients with significant fat pad descent and skin laxity achieve the most dramatic results.
Thread Design
Volumetric PDO threads (50 mm mesh) and tissue-engaging PDO threads (60-mm harpoon and 100-mm harpoon) were purchased (Medyglobal America, Miami, FL) for use in three primary vectors (Figure 1). Knowledge of different parts of a thread and their distribution in a cannula (Figure 2) is essential for performance of the TBFL.
