The Non-Surgical Face-Lift
Newsday, February 7, 2006
Doctors See Pros and Cons of Threadlift Procedure
by Debbie Geiger, special to Newsday
(Copyright Newsday Inc., 2006)
Jacqueline Mullen of Manhattan said she needed a change.
"At my age, you start having little sags here and there," said the 49-year-old professional musician.
A full face-lift was out of her financial reach. So when her physician told her about a new procedure called a threadlift that is minimally invasive, less expensive and could be done in the doctor's office in about an hour, she decided to give it a try.
"There is definitely a difference in terms of lifting up the skin under the chin and a little around the eyes," said Mullen, who underwent the procedure in May. "It made me look more rested and maybe five years younger."
In September 2004, the Food and Drug Administration approved the use of threads to lift sagging eyebrows, reposition sagging cheeks and lift drooping skin on the lower face and neck.
The threads, which are inserted under the skin through a small incision, are lined with tiny, teeth-like barbs that grasp onto and lift the soft tissue.
"You maintain tension on the thread by pulling on the thread that comes out," explained Dr. Frederick Lukash, a plastic surgeon in Manhasset who has been performing the procedure for about six months. "You slide the skin up the threads and they hook onto the micro barbs."
Once the desired effect is achieved, the threads are cut and tied in place under the skin in the deeper tissues.
"It's a very clever procedure," said Dr. Michelle Copeland, a plastic surgeon in Manhattan. "The skin bunches up at first, but then it adapts and shrinks. Within an hour, you're going to look better."
"It's 95 percent improved," said Karen Geller, 63, of Oyster Bay who underwent a threadlift on her neck in December. "There was no swelling, no bruising, and I went back to work a few days later."
Mullen walked home from her physician's office after the procedure and was at her child's birthday party in two days. "I was fine. It was no big deal."
Guests on the Oprah Winfrey and "Today" shows have heralded the procedure's quick results, calling it a "lunchtime lift." Copeland has touted its virtues on television shows such as "The View" and "The Insider" and in People magazine.
But some doctors say they aren't impressed.
"In the 'before' and 'after' photos that I've evaluated, I haven't been impressed with the post-operative results so far," said Dr. Lyle Leipziger, chief of plastic surgery at North Shore University Hospital in Manhasset.
Leipziger said the threadlift technology is "really in its infancy. I think it needs a lot more investigation. I've spoken to colleagues and read some early anecdotal reports that there can be complications."
That's true. Depending on how they're placed, threads can become visible through the skin, break or pop out of the skin altogether. Infection is a risk because an incision is made and a foreign body is being inserted. And, even though a local anesthetic is administered, the procedure can be uncomfortable and sometimes cause swelling.
What also troubles Leipziger is how long the results will last.
"The early suspicions are that it won't last that long."
According to Surgical Specialties, the company that makes the FDA-approved Contour Threads, the results can last up to five years.
Copeland is more cautious, saying she expects the results to last a few years. Other doctors say their experience isn't so promising.
Cautions and costs
"The majority of people who are doing this are not seeing the longevity that's being touted," said Dr. C.B. Boswell, a plastic surgeon in St. Louis. "We started doing them over a year ago, and the biggest issue we've run into is that it doesn't last. It's more likely to last for two to three months."
To ensure that it lasts longer, Boswell says, more threads can be used, but that ups the price. "The physician charge per thread is about $100. The patient charge is between $250 and $350 per thread, depending on where you live. You could use up to 32 threads to do the whole face. You're looking at about $10,000. I haven't done a threadlift on a patient in six months now because it's just not cost-effective."
Lukash says that in time, prices will change to reflect the actual proven results. "You're going to find that some areas work great and others don't work so well. In my practice so far, it works great on the neck and the brow because the distance the threads have to travel from the point of origin to the point of insertion is short."
He also thinks it will be useful in "'touch-up' surgery. If you've done a full surgical procedure and you have an area that you're not totally satisfied with, you may be able to pass a thread or two, pick up that area and make the person happy." Lukash said he doesn't think it will work well for the cheek and mid-face. "It's a big area with a lot of gravitational forces on it over time."
Lukash says big problems can arise if patients go to physicians who aren't familiar with facial anatomy. Leipziger agrees. "Anyone with a medical license can pay to take a weekend course in this procedure."
"They see it as a money-maker," Copeland said. "They think because it's not surgical, that you don't need a surgical background. There is an art and science to being able to do it, and to be able to get a good and safe result. When people are doing it who don't have the surgical skills, it's possible to have complications." That's why she recommends that people see a board-certified plastic surgeon.
Copeland also says potential patients should have realistic expectations. "People who don't want surgery are candidates. People may do it to see how they look, then eventually may have a face-lift."
That's an important distinction, Lukash said. "This is not a panacea for facial aging. It's not a quick trip to the doctor to replace standard facial plastic surgery. It's not a replacement face-lift. It's a compromise. It's better than nothing. You have to appreciate that you won't have the same result, but you'll have some improvement."
INSERTING THE THREAD
A thin needle attached to a Contour Thread—essentially a suture with tiny barbs—is commonly inserted into the temple. The needle and thread are guided under the skin and out near the mouth. The thread then is anchored at the temple, and the needle is cut off. This is repeated with several sutures.
LIFTING THE FACE
The surgeon firmly grasps the loose thread at the end near the mouth and gently pushes the facial skin upward. The thread's barbs hold the skin in place, preserving the lifting effect.