In the last decade, there has been increasing popularity of nonsurgical cosmetic procedures performed. This reflects the increasing demand for facial rejuvenation with quick recovery period, low risk, not too costly, and provides natural results. The commonest nonsurgical cosmetic procedures include cosmetic muscle relaxation using botulinum toxin and soft tissue augmentation with dermal fillers such as hyaluronic acid. In addition, there are also several tissue-tightening devices such as infrared ligh and radiofrequency to improve skin laxity by heating the deep dermis. However, none of these modalities address the sagging of deeper tissues of the face.
Thread facial rejuvenation techniques are good adjuvants to tissue-tightening machines and injection procedures for patients who would benefit from lifting of mild to moderate sagginess, but they do not replace surgical facelift procedures for those with more severe sagginess or excessive skin laxity. Volume changes are usually due to aging process and occur both in the underlying bone and the soft tissues. Small changes due to volume loss and bony resorption can be addressed using dermal fillers.
In the midface, the cheek fat pad descends gradually from its normal position over the cheek bone. Gravity facilitates this process by providing a downward vector for tissue that has lost elasticity and underlying structural support. As the fat falls away from the lid–cheek junction, the lower lid appears to lengthen and a hollow below the eye develops, also known as the tear trough deformity. The nose-lip fold deepens as the cheek fat pad adjacent to it drops. Further descent of the cheek fat pad accentuates the jowls and flattens the cheek above. Aging in the lower face and neck begins with accumulation of fat in the jowls and below chin area, skin laxity in the neck, and prominent 'turkey neck' bands. These changes results in a loss in definition of the jawline, a rectangular-shaped face, and an increase in the neck-chin angle.
The rationale for treatment using threads is to reverse the early signs of aging by lifting and suspending tissues that have begun to drop. By repositioning soft tissues in this way, not only are sagging tissues lifted, but volume is also restored in important areas, such as the midface. These techniques are not intended to correct more advanced signs of aging where significant skin laxity is present. Similarly, excessive fatty deposits in the face, below chin area, and neck are not improved with threads alone, particularly when the overlying skin is tight. These problems require more aggressive measures such as surgical facelift. The ideal candidate for a suture lift has mild sagginess of brow, outer eye angle, cheek fat pad, jowls, or neck. Even mild sagginess in these areas can produce a sad or sullen look and lifting by a few millimeters will give a more pleasing contour. Skin laxity should not be excessive and facial volume should be fair. If there is drastic skin laxity or the face is too thin, the threads may cause excessive bunching or irregularities. Patients should have realistic expectations and understand that thread facial rejuvenation techniques do not replace conventional surgical facelift.
