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Two years’ outcome of thread lifting with absorbable barbed PDO threads:
Innovative score for objective and subjective assessment

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DOI: 10.1080/14764172.2017.1368562

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Two years’ outcome of thread lifting with

absorbable barbed PDO threads: Innovative score
for objective and subjective assessment

Dr. Yasser Helmy Ali

To cite this article: Dr. Yasser Helmy Ali (2017): Two years’ outcome of thread lifting with
absorbable barbed PDO threads: Innovative score for objective and subjective assessment, Journal
of Cosmetic and Laser Therapy, DOI: 10.1080/14764172.2017.1368562

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 JOURNAL OF COSMETIC AND LASER THERAPY
https://doi.org/10.1080/14764172.2017.1368562

Two years’ outcome of thread lifting with absorbable barbed PDO threads:
Innovative score for objective and subjective assessment
Dr. Yasser Helmy Ali
Plastic Surgery, Al-Azhar University, Cairo, Egypt

ABSTRACT ARTICLE HISTORY

Background: Thread-lifting rejuvenation procedures have evolved again, with the development of Received 2 April 2017
absorbable threads. Although they have gained popularity among plastic surgeons and dermatologists, Accepted 14 August 2017
very few articles have been written in literature about absorbable threads. This study aims to evaluate KEYWORDS
two years’ outcome of thread lifting using absorbable barbed threads for facial rejuvenation. Methods: Objective assesment;
Prospective comparative stud both objectively and subjectively and follow-up assessment for 24 months. satisfaction; thread lifting
Results: Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting
from 3–10 mm and high degree of patients’ satisfaction with less incidence rate of complications, about
4.8%. Augmented results are obtained when thread lifting is combined with other lifting and rejuvena-
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tion modalities. Conclusion: Significant facial rejuvenation is achieved by thread lifting and highly
augmented results are observed when they are combined with Botox, fillers, and/or platelet rich plasma
(PRP) rejuvenations.

Introduction Thread lifting gained popularity among patients as well as

physicians, as it is minimally invasive, quick procedure, and
Aging is inevitable and a progressive process, and face is
can be undertaken at an outpatient clinic.
the mirror of total body aging. Aging in face affects all
This study is designed to assess barbed thread lifting out-
facial layers (1), skin, subcutaneous fat, superficial muscular
comes alone and in combination with another methods of
aponeurotic system (SMAS), deep facia, the retaining liga-
facial rejuvenation with regard to complications, degree of
ments, neurofacial muscles activity, and even the facial
lifting, and patient satisfaction.
bony skeleton. Variable procedures for facial rejuvenation
have been innovated through surgical and nonsurgical tech-
niques, according to degree of tissue laxity, surgeon assess- Patient and methods
ment, and patient preference. The most common
Prospective comparative study was designed to include 63
nonsurgical tools for face rejuvenation are the dermal fil-
patients that were divided into 3 groups, each one comprising
lers, Botox, peeling, laser resurfacing, platelets rich plasm
21 patients. First group underwent facial rejuvenation by
(PRP), and lifting using threads. Thread lifting has long
thread lifting only with one procedure; second group was
history (2) and debate because of high record of complica-
managed by combined thread lifting once and were subjected
tions of non-absorbable threads recorded previously. It was
to other rejuvenation procedures which either use fillers,
approved in 2005 by the FDA (3) and lost approval years
Botox, or platelet rich plasma (PRP) every 6 months; and
later. With the introduction of absorbable threads, made of
third group was subjected to three facial rejuvenation proce-
polydioxanone (PDO), thread lifting has gained interest and
dures by fillers, Botox, and plasma fore once protocol till
popularity again among diverse manufacturing companies
6 months.
that produce many types with many techniques, either for
This study is designed to evaluate the following three
rejuvenation and/or skin lifting. Thread lifting is neither
components in each group; complications throughout the
alternative to surgery nor magic per se, but it could have
follow-up period, degree of skin lifting in millimeters using
good results for rejuvenation and skin lifting, especially
lifting score, and patient satisfaction throughout the follow-
when combined with another method of facial rejuvenation.
up. Follow-up was continued for 24 months.
Many histopathological studies indicated dermal and sub-
The following complications were evaluated in each group
cutaneous foreign body reaction after inserting the thread,
just after the procedure and throughout the follow-up period
in forms of lymphocytes infiltration, collagen deposition,
till 2 years: asymmetry, thread breakage, hypersensitivity,
and fibrosis (4–6). This fibrosis could explain the tightening
edema, hematoma, seroma, persistent rippling and puckering,
effect throughout contracture and remodeling and subse-
palpability, infection, granuloma, skin erosion, upper eyelid
quent skin tightening.
ptosis, nerve injury, sensory impairment.

CONTACT Dr. Yasser Helmy Ali dryasserhelmy@gmail.com Plastic Surgery, Al-Azhar University, Cairo, Egypt.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ijcl.
© 2017 Taylor & Francis Group, LLC
 2 Y. H. ALI

Innovated score was designed and named (HEL. SCORE),

Helmy score for objective assessment of the degree of skin
lifting. Score measure is the degree of skin lifting, from zero to
four, when zero means no lifting, one means minimal lifting
ranging from 1 to 2 mm, two means moderate lifting from 3
to 6 mm, three means considerable lifting of more than 6 mm
to 1 cm, and four means sensational skin lifting more than
1 cm. (Table 1A)
Objective assessment is carried out by measuring certain
lines drawn from fixed anatomical landmarks to certain
points at upper, mid, and lower face, at each step of follow-
up (Figure 1). These lines are to measure the degree of skin
re-draping after thread lifting. At the upper face, I measured
line drawn from end of eyebrow to the hair line. At mid face,
measured line, is a line drawn from the tragus to the midpoint
of nasolabial fold. At the lower face, measured line was drawn
from the tragus to the midpoint of marionette line. These
lines are measured by a ruler graduated in millimeters
(Figure 2)
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Table 1A. Helmy’s score for objective assessment of the degree of skin lifting.
Degree of skin lifting in mm Score Description
0 0 No lifting
1–2 1 Minimal
3–6 2 Moderate
˃6–10 3 Considerable
˃10 4 Sensational

Figure 2. Lines are measured by graduated ruler in millimeters.

Then clinical overall observation of the face is assessed

with regard to the height of lateral eye brows, nasolabial
angle, cheek mandibular groove, cheeks’ contouring, promi-
nence of jowls, marionette lines deepening, and overall jaw
line curvatures (Nephritis’ curvature).
Subjective assessment of patient satisfaction by (Hel. satis-
faction score). Score was designed by questionnaire also from
zero to four, when zero means dissatisfied, one means mini-
mal satisfaction, two means moderate satisfaction, three
means high satisfaction, and four equals to full satisfaction
(Table 1B).
Collected aesthetic outcome data were submitted for sta-
tistical analysis for the three groups using two-tailed t-test
with calculation of standard deviation and p value considera-
tion of significance at (p = .05)
Thread used in this study to lift facial skin laxity, exactly; to
elevate lateral eye brow, and to pull the crease over frontona-
sal angle, in upper face, to augment cheeks’ contour, recreate
the cheeks mandibular groove, and to shallow the nasolabial

Table 1B. Helmy’s score for subjective patient satisfaction.

Figure 1. Lines of measuring. Line 1 is drawn from end of eyebrow to the hair
line. Line 2 is drawn from the tragus to the midpoint of nasolabial fold. Line 3 is
drawn from the tragus to the midpoint of marionette line.
Score Description
0 Dissatisfied
1 Less satisfied
2 Moderate satisfied
3 Highly satisfied
4 Fully satisfied

folds, in midface and in lower face to eliminate the sagging of
jowls and marionette lines.
Threads description and technique
Threads used in this study were, Absorbable PDO, Barbed,
4D, 21 Gauge, 60 mm length for cheek lifting; 19 Gauge,
90 mm length or 18 Gauge, 100 mm length for jowls and
mandibular edge lifting, according to degree of skin sagging
and skin texture, and thickness, packed each thread separate,
inside blunt cannula and sterilized by EO gas.
Steps of technique:
(1) Outpatient procedure room was under aseptic con-
ditions and complete sterilization.
(2) Procedure was done under the influence of local
anesthesia infiltrated at site of entry and along the
proposed thread line, in multiple infiltration sites of
2–5 ml of mepivacaine HCL 2% mixed with levo-
nordefrin 1:20000 and 1.5–2 cm apart between each
site of injection.
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(3) Threads were introduced after skin puncture by
Trocar 18 Gauge, at hair line, then cannula containing
the thread is held perpendicular to the skin till it
passes through the dermis, then repositioned in par-
allel to the face to pass through the subcutaneous
plane superficial to facia continued from the SMAS
to be away from facial nerve by two layers, the SMAS
and superficial layer of superficial temporal fascia.
(4) Thread cannulation was stopped, 3 mm-6 mm
before any proposed crease e.g. the nasolabial crease,
marionette line. Surgeon or physician should take
care, because if the tip of the cannula, passes the
proposed crease, so cannula’s side hole opening will
be inside the crease, therefore thread will make
traction on the crease, and the result will deep it
more instead of its shallowing.
(5) Rolling the external part of the cannula by dominant
hand and applying gentle pressure over the skin to
anchor the barbed thread inside the tissues.
(6) Withdrawal of the cannula leaving thread inside the
track.
(7) Insertion of all other threads through the proposed
subcutaneous track on both sides of the face.
(8) Gentle traction force is applied bilaterally, on the
corresponding threads at each side, when patient is
lying down or in sitting position.
(9) Finally, cut the extra length with scissors forcing
against the opening, so that no excess parts of thread
could remain to avoid skin irritation.
(10) Put small piece of Steri-strips to reinforce skin punc-
ture closure and then give the patient post-proce-
dure instructions as following: avoid facial massage,
limit facial muscle overactivity for 24 hours, soft diet
in the first 3 days, sleeping on the back for first
weak, and prescribe analgesic or antiedematous
tablets only when required. No antibiotic was pre-
scribed for any patients.
Hyaluronic FDA approved fillers were used to fill the
temples, correct frontonasal angles, nasal dorsum, nasal sides
JOURNAL OF COSMETIC AND LASER THERAPY 3
irregularities, nasal tip definition, nasolabial angles, and in
lower face to fill the marionette line and the jaw line
depression.
FDA-approved botulinum toxins were used only to rejuve-
nate forehead creases in upper face, crew’s feet, and nasal
muscle overactivity in midface and Botox used to weak the
hypertrophied masseter muscle to define the mandibular angles.
PRP was applied by 5 sessions protocol at first year with 1
month apart and two sessions at the second year as
maintenance.
Study was conducted between October 2014 till January
2017 at the private practice among three countries. Full
patient history and examination were carried out before the
procedure. Informed consent for the study and photography
by same focal length, identical background with standard
views were obtained from each patient. From 63 cases seeking
facial rejuvenation, 55 were females aged between 35 and
50 years old with average age of 40, and 8 males aged from
45 to 55 years old. All patients were Baker I, II classified for
facial aging rhytidectomy, and number of threads used in each
side of the face was from 2–5.
Exclusion criteria were: bleeding disorders, chronic dis-
eases, immunologic or healing disorders, facial bone defects,
cases of facial nerve injury, hereditary facial atrophy, patients
underwent previous face lifting or facial surgery or submitted
before inclusion in the study for any other type of thread
lifting. Ethical Committee of Al-Azhar university was
approved for conducting this study.
Results
Two groups of the study underwent thread lifting, on total 42
subjects. It was performed alone for face lifting in group 1
containing 21 patients, and combined with another rejuvena-
tion procedure in group 2. In group 3, patients were sub-
mitted to triple facial rejuvenations by fillers, Botox, and
plasma in 21 cases.
Outcome complications in all groups of the study almost
near each other, resembling one case/21 in each group,
about 4.8%.
One case from 21 cases who were submitted for thread
lifting alone, was complicated by, thread breakage and loss of
it is potential anchoring. After long experience and practice of
the procedure, Author has an explanation for this technical
error; when he has missed the subcutaneous plane during
thread insertion and being superficial in dermis, then he
tried to re-direct in subcutaneous plane, so thread broken
and withdrawn out.
In group 2, subjected to thread lifting and another rejuve-
nation, palpability of the thread was reported in one case and
continued after 2 weeks up to 1 month with subcutaneous,
feeling pain and pricking of barbed thread, resembling about
4.8%. of the group.
In group 3, subjected to triple facial rejuvenations, one case
of injected filler to the nose was complicated by infection, and
superficial skin erosion, but fortunately it healed by epitheli-
zation with topical ointment.
No case in any group showed asymmetry, hypersensitivity,
hematoma, seroma, rippling and puckering, granuloma, upper
 4 Y. H. ALI

Incidence of complications in the study groups

25

20

15

10

0
Incidence Group1 Group2 Group3

Figure 3. Incidence of complications in the study groups.

eyelid ptosis, nerve injury, or sensory impairment, after the 6 months measure of skin lifting recorded 95.2% ˃6–10 mm
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procedure or throughout the follow-up period. (Figure 3) (score3) and 4.8 ˃ 10 mm (score4). At 1 year, lifting score was
Score for degree of skin lifting shows highest degree of 66.6% 3–6 mm (score2), 28.5% ˃6–10 mm (score3), and 4.8%
skin lifting, immediately, after 3, 6, 12, and 24 months ˃ 10 mm (score4). In second year’s follow-up, lifting score
follow-up, in group 2 when compared with other two was 71.5% 3–6 mm (score2), 23.8 % ˃6–10 mm (score3) and
groups. (Table 2) (Figure 4) 4.8 % has recorded ˃10 mm (score4).
In group 1, immediately after the procedure, it was 81 % In group 3, it was 100 %1–2 mm (score1) immediately after
˃6–10 mm (score3) and 19% ˃10 mm (score4). At 3 and the procedure. At 3 months, lifting score in group 3 was 24 %
6 months, lifting score in group 1 was 100% ˃6–10 mm 3–6 mm (score2) and 76% ˃6–10 mm (score3). At 6 months
(score 3). At 1 year, lifting score was 95%, 3–6 mm (score2) measure of skin lifting was recorded to be 100% “0” score
and 5% (score 3). In second year’s follow-up, lifting score was after the effect of Botox and filler subsided.
33.3% 3–6 mm (score2), 57% 1–2 mm (score1), and 9.5% has Score for degree of patient satisfaction, (Table 3) and
recorded 0 score. (Figure 5) are showing the highest degree of satisfaction, in
In group 2, it was 100 % ˃6–10 mm (score3) immediately group 2 when 100% of patients were immediatelysatisfied
after the procedure. At 3 months, lifting score in group 2 was after the procedure, this percentage showed 24% of the highly
76% 3–6 mm (score2) and 24% ˃10 mm (score4), while at satisfied upgraded to fully satisfied at 3 months, and 95%
continued to be highly satisfied at 6 months. After one year,
71.5% of the patients in group 2 were moderately satisfied,
Table 2. Lifting score results after thread lifting. 12.5% highly satisfied, and 12.5% continued to be fully satis-
Lifting score (Helmy’s score) Group 1 21 Group 2 21 Group 3 21 fied. After 2 years follow-up, 43% of the patients in group 2
Immediate were moderately satisfied, 43% highly satisfied, and 14% were
No lifting
1(1–2 mm) 21
fully satisfied.
2 (3–6 mm) In group 1, 81% of patients were immediately highly
3 (˃6–10 mm) 17 21 satisfied and 19% showed full satisfaction after the proce-
4 (˃1 cm) 4
At 3 months dure, then jumped statistically as it showed 100% of the
No lifting highly satisfaction at 3 and 6 months, then all patients
1(1–2 mm)
2 (3–6 mm) 5 declined to 100% moderate satisfaction after 1 year. After 2
3 (˃6–10 mm) 21 16 16 years of follow-up, 47.6% of the patients in group 1 were
4 (˃1 cm) 5 moderately satisfied, 38% less satisfied, and 12.3% had
At 6 months
No lifting 1 become dissatisfied.
1 (1–2 mm) In group 3, submitted for triple rejuvenations without
2 (3–6 mm) 21 20
3 (˃6–10 mm) threads, 100% showed immediately less satisfaction, and
4 (˃1 cm) after 3 months 71.5% showed high satisfaction, 19% moder-
At 1 year ate satisfaction, and 9.5% showed full satisfaction regarding
1 (1–2 mm)
2 (3–6 mm) 20 14 skin lifting, then satisfaction score declined to zero after
3 (˃6–10 mm) 1 6 6 months, when the effect of Botox and filler subsided.
4 (˃1 cm) 0 1
At 2 years However, there was overall satisfaction of patients with
0 no lifting 2 regard to the effect of PRP on skin texture, pigmentation,
1 (1–2 mm) 12
2 (3–6 mm) 7 15
and smoothing. Photography documentations for the clinical
3 (˃6–10 mm) 5 outcome were indicated in each figure caption (Figures
4 (˃1 cm) 1 6–11).
 JOURNAL OF COSMETIC AND LASER THERAPY 5

Figure 4. Lifting score results in the study groups.

Table 3. Patient satisfaction score results for thread lifting.

Satisfaction score (Helmy’s Group 1 21 Group 2 21 Group 3 21
innovated score with questionnaire about patient satisfaction,
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score) pt. pt. pt. and it did not omit the recording of incidence of
Immediate complications.
1 (Less satisfied) In this study, all over the 2 years, complications were
2 (Moderate satisfied) 21/21
3 (Highly satisfied) reported in 3 cases out of 63, when one case showed thread
4 (Fully satisfied) 17 21 breaking, one showed palpability in thread lifting groups, and
4 one showed infection in triple rejuvenation group. All compli-
At 3 months
1 (Less satisfied) cations are resembling 4.8%. but no incidence of asymmetry,
2 (Moderate satisfied) infection, edema, granuloma (11), seroma, and hematoma
3 (Highly satisfied)
4 (Fully satisfied) 21 16 4 (10,13) was observed. This may be explained as thread in this
5 15 study was inserted using blunt cannula and not a sharp needle.
2 No nerve damage, upper eyelid ptosis, persistent rippling and
At 6 months
1 (Less satisfied) puckering, skin erosion, sensory impairment or hypersensitiv-
2 (Moderate satisfied) ity or chronic pain (12) were reported similar to other studies.
3 (Highly satisfied) 21 20
4 (Fully satisfied) 0 1 In previous two studies conducted on thread-lifting tech-
At 1 year niques, one was carried out by Abraham (14) regarding use of
1 (Less satisfied)
2 (Moderate satisfied) 21 15
thread lifting combined with radiofrequency and micro-need-
3 (Highly satisfied) 3 ling for treatment of superficial rhytids, it showed improved
4 (Fully satisfied) 3 results, and one article was published by Sarah Tonks, titled
At 2 year
0 (Dissatisfied) 3 Understanding Thread Lifting (4) which concluded that thread
1 (Less satisfied) 8 lifting could be conjugated with other treatment modalities to
2 (Moderate satisfied) 10 9
3 (Highly satisfied) 0 9 augment the aesthetic outcome and best effects. Both studies
4 (Fully satisfied) 0 3 include our findings.
This study shows the highest significant outcome of thread
lifting and sustained results beyond 1 year and continues till 2
Discussion years, in both groups where threads were used. In the study
Worldwide concept about minimal or less invasive facial reju- group 2 where thread was combined with other modalities,
venations has gained high popularity among physicians and Botox, filler and plasma, 100 % of the group populations
clients who are seeking facial skin lifting and rejuvenation (4,7). immediately showed more than 6–10 mm skin lifting immedi-
Histopathological evidence of collagen stimulation and fibrosis ately after the procedure. At 3 months, skin lifting in group 2,
(4) formation has been studied and confirmed; however, not was 3–6 mm in 76% of patients and sensational skin lifting
many reports about histology for long time follow-up are pre- more than 1 cm in 24% the group. While at 6 months of
sent. Collagen is formed around the thread and its cogs or barbs measuring skin lifting has recorded 95.2% showing consider-
and induces more effect (8,9). able ˃6–10 mm lifting of the skin and 4.8 showed sensational
Studies (10,11) conducted before and published by many lifting ˃1 cm. At 1 year, measuring of skin lifting, recorded
authors (10,12) have focused on methods and complications 66.6% showed 3–6 mm, 28.5 showed ˃6–10 mm, considerable
mainly (13), and it was recommended by some authors like lifting and 4.8 showed sensational lifting more than 1 cm.
Shimizu Yuki and Kane Terase (4) from Japan, to undertake At 2 year, measuring of skin lifting, recorded 71.5% showed
long-term observations and assessments. 3–6 mm, 23.8% showed ˃6–10 mm, considerable lifting and
This study included long-term follow-up till 2 years after 4.8% showed sensational lifting more than 1 cm. No case
thread insertion, and has evaluated lifting degrees by showed minimal lifting 1–2 mm or zero lifting in this group.
 6 Y. H. ALI

Satisfaction score after thread lifting in the study groups

25

20

15

10

Group1 Group2 Group3

Figure 5. Satisfaction score after thread lifting in the study groups.

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Figure 6A. 50 years old female patient submitted for barbed thread lifting only Figure 7A. 55 years old male patient submitted for barbed thread lifting alone.
with considerable skin lifting about 10mm and immediate high patient satisfac- Pre-thread lifting photo lateral view.
tion. Pre-thread photo frontal view.

Figure 7B. 3 months’ post-thread lifting lateral view. Considerable lifting about
Figure 6B. Immediate post-thread lifting results front view. 9 mm with high patient satisfaction.
 JOURNAL OF COSMETIC AND LASER THERAPY 7

Figure 8A. 55 years old female patient submitted for barbed thread lifting and Figure 9B. 3 months’ Post- thread lifting front view.
PRP rejuvenation. Pre-thread lifting photo front view.
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Figure 9C. 6 months’ Post-thread lifting and immediate after re-filler and re-
Figure 8B. 6 months’ post-thread lifting front view. Considerable lifting about 8 Botox. front view.
mm with high patient satisfaction.

Figure 9A. 42 years old female patient submitted for barbed thread lifting, Figure 9D. 1 year post-thread lifting lateral view. Sensational lifting more than
which has augmented by fillers and Botox. 10 mm with high patient satisfaction.
 8 Y. H. ALI

Figure 10A. 52 years old female patient submitted for barbed thread lifting with Figure 11B. Post 2 years thread lifting front view.
filler and PRP rejuvenations. Pre-thread lifting photo frontal view.
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Figure 10B. 2 years post-thread lifting front view. Moderate skin lifting about 4
mm with moderate patient satisfaction at 2 years. Figure 11C. Pre-thread lifting lateral view.

Figure 11A. 50 years old female patient submitted for barbed thread lifting
alone with sensational lifting and high satisfaction at 2 years. Pre-thread lifting
photo frontal view. Figure 11D. 2 years post-thread lifting lateral view.

In group 1, where thread lifting was used alone it showed also
considerable degrees of facial skin lifting. At 1 year, measuring of
skin lifting, recorded 95.5% showed 3–6 mm lifting, 5% showed
more than 6–10 mm, considerable skin lifting. At 2 year, measur-
ing of skin lifting, recorded 33.3% showed 3–6 mm, moderate skin
lifting, 57% showed 1–2 mm, minimal lifting, 9.5 % showed no
lifting.
The study also shows potent effect of Botox for lifting and
rejuvenation of forehead and fillers for nasolabial lines, marionette
lines, nasal, facial, mandibular angles, and other lines by dermal
filling and lifting, but their effects are temporary and limited till
6 months.
In group 3, it was 100 % shows 3–10 mm skin lifting,
couple of days after triple rejuvenation by Botox, fillers, and
PRP without thread lifting, but skin lifting has declined to
zero in this group after 6 months.
Study conducted by Khrustaleva (13), et al reported follow-
up for 1 year has used lifting thread in Baker groups from 2 to
3, and showed 91% satisfaction and 86 % satisfaction, respec-
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tively. In this study, I did not use any patient of Baker 3 facial
aging and confined to Baker 1 and 2 only, and this could
explain our relatively higher results of satisfaction. This study
also differs from Khrustaleva et al one’s in another point, as it
not depends only on subjective assessment but also on objec-
tive one and continued up to 2 years of follow-up. This study
results showed 100% of the highly satisfaction at 3 and
6 months, then all patients declined to 100% moderate satis-
faction after 1 year. Satisfaction after 2 years follow-up, was
moderately in 47.6% of the patients treated only by thread
lifting only and 38% were less satisfied.
While this study shows augmented results of patient
satisfaction when Botox and fillers were added to group2
populations to be 71.5% of the patients were moderately
satisfied, 12.5% highly satisfied and 12.5% continued fully
satisfied. After 2 years follow-up, 43% of the patients in
group 2 were moderately satisfied, 43% highly satisfied,
and 14% got fully satisfied, but no patient of this group
has been dissatisfied during the period of the study.
Clinical overall observation of the face is reflecting the
thread rule in correction of heights of lateral eyebrows, naso-
labial angle, checek mandibular groove, cheeks’ contouring,
prominence of jowls, marionette lines deepening, and has
effect in refining the jaw line curvatures (nephritis’ curvature).
Conclusion
This study supposes methods for assessment of facial thread
lifting techniques. Thread lifting technique is neither alterna-
tive to surgery, nor magic per say, but it might have good
effect for rejuvenation, and skin lifting, especially when com-
bined with another method of facial rejuvenation. Significant
View publication stats
JOURNAL OF COSMETIC AND LASER THERAPY 9
facial skin lifting and rejuvenations were long lasting achieved
by threads throughout the 24 follow up months, although
results are showing gradual decrease in the degree of skin
lifting by time. The effects of the threads were highly aug-
mented when they were combined with Botox, fillers or plate-
let rich plasma rejuvenations. Further studies are required to
assess the longevity beyond 2 years.
Conflict of interest
Author declares that there is no conflict of interest or any financial
funding for this study.
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