Thread lifts have been popular in aesthetic clinics in Singapore for more than a decade ago.  It is minimally invasive, a lunch time non-surgical treatment with minimal down time and offers an alternative to face lift surgery with long recovery times and risks of complications for patients.  The first brand of face threads was invented by Dr Sulamanidze called APTOS.  Ever since then, there are many different types and brands of face threads in the aesthetic field.   Just which kind and brand of threads offer the most lifting results and why?  Is the procedure painful?  What kind of recovery can I expect?

What is a thread lift?

Thread lifts are minimally invasive treatments that can visibly lift and slim the face immediately without the risk of surgery and long recovery times for patients.  It involves inserting fine threads, typically biodegradable, at the areas of the face that needs lifting.  This is usually done with local anaesthesia and if done correctly, with minimal discomfort.

How does a thread lift work?

The fine threads are typically introduced into areas that need lifting or slimming via introducers also known as “cannulas”.  As the cannula is removed, the thread is deposited into the face tissue, usually the deep fat layer of the face.  These threads typically contain barbs or  tiny “hooks” that grasp on the surrounding tissue and the overlying skin so that when it is gently pulled, the sagging treatment area of the face is lifted.  Therefore such lifting threads have a physical lifting action.

Most of the threads for face thread lift used in aesthetic clinics in Singapore are biodegradable.  That means that it will be broken by the body over time and produces collagen stimulation in that area.    Therefore threads increases collagen production in the treatment areas and also have a skin rejuvenation effect.

What can threadlift do for patients?

Thread lift procedures can produce the following results for your face and body:

1. It can physically lift up the sagging areas of the face, like the brows, the jowls and smile lines.  It also has a skin lifting result.

2. It stimulates collagen production

3. It also have fat reduction and contraction effect (which is more pronounced if more threads are inserted)

4. It also has a skin whitening effect due to the growth factors released

5. As the skin is made tauter, the skin wrinkles are reduce

6. Nose threads at the nose bridge and nose tip has a nose augmentation effect.

Targeted areas for a thread lift

Thread Lift Procedure

Can non-surgical thread lift procedures produce facelift kind of results?  Thread lift treatments’ results and patient experience vary from the type of threads used, the thread material and also the skill of the physician performing it (the thread insertion techniques).  

Thread material

Let us explore the 3 commonest thread lift material in Singapore: PDO threads, PLLA threads and PCL threads.

PDO threads started in Korea more than a decade ago.  It is an ideal material for face threads – it is completely biodegradable, stimulates collagen production.  It’s shortfall is its short duration lasting only 4 – 6 months.  Therefore, pdo threads’ value as a lifting thread is limited but should be considered for collagen stimulation effects.

PLLA material is biodegradable and lasts 18 months.  A popular brand of PLLA threads is silhouette threads.  For a season silhouette threads is a popular thread of choice in an aesthetic clinic.  However, silhouette threads tend to be brittle  and may break with pressure.  So even though the thread material has a long lasting duration but the results do not last as long.

PCL material lasts the longest, lasting 24 months.  PCL also stimulates collagen production.  These qualities might make it an ideal thread for a more sustained facelift.  However PCL material is soft and pliable and may not be as strong as other material.  Perhaps the a mixture of PCL and PLLA might combine both strengths and produce a strong durable thread.

The newer generation of threads have hyaluronic acid infused within, which is release into the skin tissue when the threads are inserted.  This promises additional skin improvement of hydration and improvement in texture for patients.

Thread Types

Threads can divided into lifting or non-lifting threads (mainly for collage stimulation). 

Lifting Threads

Anchoring Threads are the first generation of face threads that are introduced into the market, the first generation of APTOS Threads is a good example.  Silhouette lift is also another good example of these kind of threads.

 

The insertion technique for anchoring threads typically involves a mini-surgical procedure – that involves an incision into the scalp at the anchor point (as seen above).  There at the anchor point the thread is stitched to an immovable point, either the fascia or the bone.  Then the full length of thread are introduced downwards towards the sagging areas of the face to lift it.

 

Here’s a simple diagram to explain the lift in simple terms:

Anchoring threads typically offer the strongest and most drastic facelift results.  However because of it’s complicated insertion technique, and the doctor need to be trained to perform this type of threads.

Suspension threads are similar to anchoring threads except that there is no necessity for an incision.  Suspension threads usually is of a double arm needle design like this:

Of course it is possible to have suspension threads inserted without the double needle arms, but the insertion techniques will be more complex and certain instruments will be needed for the insertion.

The red points represent the points in which the suspension threads are inserted and the blue points represent the points in which the threads exit. Suspension threads offer strong thread lifting results but demand a higher level of skill for the performing physician.

Floating threads do not have a fixation point or a suspension area to lift the facial tissues.  Instead, they work by “bunging” the skin tissue together, see the diagram below:

As illustrated above, floating threads do give a mild lift, but the lift is limited because of a lack of fixation and hence no strong suspension is formed. Migration (movement of the thread) is an issue which may result in the thread moving beyond the area we want them to.

 

However with the latest thread designs such as bi-directional or multi-directional cogs this migration is minimized. An example of floating threads are the Ultra V lift threads.

 

The skin lifting results are milder as compared to suspension threads.  Longevity of the results for PDO floating threads is limited as patients often express that the results diminishes after a few months. It is however easier for the doctors to insert as the insertion technique is simple.

Types of cogs design

All lifting threads, suspension or floating, will have cogs to grasp the tissue enabling the thread to lift it.  The cogs though have several designs and have underwent several rounds of improvement and evolution.

The first cog design that hit the aesthetic market have the cogs facing in just one direction which looks like this:

This are what we call mono-directional cogs threads.  The issue with this first generation of cogs threads is that migration of the threads is a big issue.  As you can see from the thread design above the thread is obstructed to move to the right but can easily move to the left.

 

Subsequently bi-directional threads are released to the market replacing mono-directional ones and they look like this:

Can you see the cogs face other in opposite directions? As a result the thread will face resistance in movement in either direction and hence reduces the chance of thread migration.  There is however still an inherent weakness in this thread design.  If the middle of the thread breaks, the thread can easily migrate in both directions:

Newer generation of threads is therefore of a “multi-directional” design with the cogs all facing in random different directions and therefore even if the thread is to break any point the chances of migration is very low.

4D or 3D cogs threads have cogs arranged 3 dimensionally or spirally around the threads so that they grasp the fat tissue in all dimension.  This gives an even stronger firmer grasp on the tissue.

 

The latest generation of lifting threads have shifted away from the traditional cog design to a ‘”punch “design(with various names like “concertina” or “n-fix like this:

Companies promoting this design allege that the tissue grasping power of these threads are stronger than the traditional cog design. 

Differences in procedure of producing cogs of thread 

Cut threads vs molded threads vs ultrasound molding.

Lastly we want the different ways the cogs of the threads were made and you will see the importance of it if you read on.

Conventionally to make cogs on the threads, they are cut so that the barbs are formed.  This is how it look at higher magnification:

It is a relatively easier manufacturing process to produce cut threads.  However cutting the threads inherently weakens it (imagine cutting a string at the side, that would weaken it against weight).  

Molded threads, on the other hand, the material is heated and pressed on a thread mold.  Very much like how when water is poured into an ice tray and subsequently frozen into the shapes of the mold.  Molded threads are stronger than cut threads.

The barbs of the cut threads also bend easily under pressure like this:

Therefore, molded thread’s cogs are stronger and unlikely to bend with pressure and therefore have a firmer grasp on the skin tissue.

Lastly the difference between cut and molded threads is the way the threads and their barbs are degraded over time.

The barbs on cut threads degrade much faster than molded threads (see above).  What that means is that in just a period of 2-3 months, the cut threads is degraded to almost a smooth mono-filament thread with no lifting power.  Many patients expressed that the lift initially seen is gone in 1-2 months.  That is of course disheartening to both the doctors and the patients.

The newest generation of molded threads are the ultrasound-molded threads.  Instead of heat, the threads are molded with ultrasound (which is a cold process).   They allege that this process will make stronger and better molded threads.

How much does Thread Lift in Singapore cost?

Face thread lifts in Singapore cost from $1500 onwards depending on the type of threads, the number of threads and of course the skill of the doctor performing it.

How does thread lift compare to HIFU or Ultherapy?

Threadlift offers the most distinct face lifting results compared to other non-invasive face lifting options such as HIFU or ultherapy.  However most patients are still more receptive to non-invasive treatment options.

FAQ

Are there any risks or side effects?

Are there any risks or side effects?

Threadlifts are safe minimally invasive procedure.  However depending the doctor’s skills, some side effects such as bruising, swelling and dimples can occur.  Previously when sharp needles are used, there was a risk of nerve injury if the thread was introduced unto the wrong place.  However, this risk has been minimised with the advent of slimmer more blunt non-cutting needles.

Is a thread lift painful?

Is a thread lift painful?

With the effective use of local anaesthesia, thread lift is a tolerable procedure.  However we advise some oral sedation and pain killers if patients have a low pain threshold.

What to expect after a thread lift?

What to expect after a thread lift?

The treated areas will feel tight after the procedure.  This feeling usually subside after 1-2 weeks.

How many years does a thread lift last?

How many years does a thread lift last?

PDO threads typically last 3-6 months.  PCL threads lasts up to 2 years.

How often can you do a thread lift?

How often can you do a thread lift?

We advise patients to consider another threadlift just months before the duration of the previous thread expire.

Is there downtime?

Is there downtime?

With the new generation of lifting suspension threads and their atraumatic needle, there is minimal down time and swelling.  Most patients are able to resume their normal activities immediately after the procedure.

What aftercare is required after a Thread lift procedure?

What aftercare is required after a Thread lift procedure?

We advise antiseptic cream to be applied on the small entry wounds until they heal in 2-3 days.  It is best to avoid high intensity exercises for 2 weeks. 

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