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Received: 24 May 2022 | Revised: 18 August 2022 | Accepted: 22 August 2022

DOI: 10.1111/jocd.15325

LETTERS TO THE EDITOR

An innovative technique for thread-­lifting the neck using a

nonbarbed nylon suture

To the Editor, fully. Eighteen months following the procedure, the cosmetic im-
Thread-­lifting, also known as suture suspension, is a minimally provement from the thread lift has been dramatic and sustained
invasive procedure involving the passage of absorbable/nonabsorb- (Figure 2B).
able barbed thread under the facial skin surface to tighten and lift Conventional nonbarbed nonabsorbable surgical suture is a cost-­
flaccid tissue.1 Presently, thread-­lifting relies on suture barbs elic- effective, durable, and safe alternative to lift facial tissue without
iting fibrotic inflammation, leading to collagen formation. This is promoting an inflammatory response. The use of nonabsorbable
thought to improve anchorage to local tissue and add bulk. However, nylon sutures to lift ptotic buccolabial folds has been reported. 2
retrospective analyses demonstrate this approach does not achieve Nonbarbed suture produces significantly greater lifting com-
sustained lifting and is associated with significant postoperative pared with barbed threads, despite minimal collagen generation.3
complications including scarring, hyperpigmentation, and thread ex- Employing a fixed anchorage point provides greater certainty re-
trusion. We present a novel technique for facial thread-­lifting with garding placement, in contrast to freely suspended barbed threads.
standard 5–­0 nonbarbed nylon used in regular wound closure. This A possible disadvantage of our technique is that it relies on
technique challenges the requirement for barbed sutures and the knowledge of facial anatomy as the needle and thread traverse in
reliance on tissue fibrosis. close proximity to the great auricular nerve and the marginal mandib-
Our technique is performed under local anesthesia. An incision ular branch of the facial nerve. However, the extraction/reinsertion
is made over the mastoid process to establish an anchorage point incisions allow for careful positioning of the suture in the vicinity of
to the overlying periosteum. Standard 5–­0 nylon suture is then ad- these important surgical landmarks. In comparison, barbed threads
vanced in the plane of the superficial musculoaponeurotic system (if traverse long distances within tissue without direct visualization.
the objective is to lift superficial skin structures, such as to correct
sagging skin) or in the dermal plane (to lift deeper structures and cor-
rect skin puckering). For either application, small superficial incisions
along the mandibular margin are made to the subcutis or dermis
level, to enable needle extraction from the subcutis, and for subse-
quent reinsertion at the same location to advance the thread pro-
gressively. Approximately 1.5× of the curved needle diameter can
be used to guide the separation distance points between incisions.
This is repeated until the contralateral mastoid process is reached,
whereby a final incision is made to enable anchorage to periosteum
and tensioning of the thread to achieve the desired degree of lift.
Any incision whose edges require apposition is closed by an inter-
rupted suture. A standard curved needle may be straightened with
needle holders or artery forceps for ease of maneuverability. The
braided suture is an alternative in situations where subcutaneous
tissue density is inadequate to support monofilament (Figure 1).
A 78-­year-­old woman presented with jowls and pronounced
chin laxity without excess submental fat (Figure 2A), unsuitable for
ursodeoxycholic acid injections but ideal for this technique. The
patient experienced only minimal discomfort during the procedure F I G U R E 1 Dotted light representing the advancement of suture
and to date has not developed any postoperative complication. through the dermis, with small incisions (solid lines) to enable
Within 1 month, the suture extraction/reinsertion incisions healed needle extraction (a) and subsequent insertion (b)

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in
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© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

J Cosmet Dermatol. 2022;00:1–2.  wileyonlinelibrary.com/journal/jocd | 1

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2 LETTERS TO THE EDITOR

F I G U R E 2 Photographs taken prior to

(A) and 18 months after (B) the procedure

Further, our procedure carries minimal risk of visible scarring as inci- E T H I C S S TAT E M E N T
sion points are only small and superficial. Ethics approval was not required for this study.
In conclusion, this thread-­lifting technique is a safe, durable,
and cost-­effective alternative to current popular methods, with the Nicolas Zubrzycki BA1
added potential of achieving more predictable lifting without the Liang Joo Leow MPH&TM, FACD, FACMS2,3
need for additional recovery time.
1
Faculty of Medicine, University of New South Wales, Sydney,
AC K N OW L E D G M E N T New South Wales, Australia
2
Open access publishing facilitated by University of New South St. Vincent's Private Hospital, Sydney, New South Wales,
Wales, as part of the Wiley - University of New South Wales agree- Australia
3
ment via the Council of Australian University Librarians. Aesthetic Dermatology, Sydney, New South Wales, Australia

K E Y WO R D S Correspondence
cervicoplasty, facelift, platysmaplasty, rhytidoplasty, suture Nicolas Zubrzycki, Faculty of Medicine, University of New
techniques, sutures South Wales, Sydney, NSW, Australia.
Email: n.zubrzycki@student.unsw.edu.au
F U N D I N G I N FO R M AT I O N
This research did not receive any specific grant from funding agen- ORCID
cies in the public, commercial, or not-­for-­profit sectors. Nicolas Zubrzycki https://orcid.org/0000-0002-0099-4119
Open access publishing facilitated by University of New South Liang Joo Leow https://orcid.org/0000-0002-9686-7682
Wales, as part of the Wiley -­University of New South Wales agree-
ment via the Council of Australian University Librarians. REFERENCES
1. Tong LX, Rieder EA. Thread-­lifts: a double-­e dged suture? a com-
C O N FL I C T O F I N T E R E S T prehensive review of the literature. Dermatol Surg. 2019;45:​
931-­940.
There is no conflict of interest to declare.
2. Hidayani M, Hidayat S, Amiruddi D. Chin Enhancement Using Serdev
Suture: Five Case Reports. InTech; 2013. doi:10.5772/56711
DATA AVA I L A B I L I T Y S TAT E M E N T 3. Padin VL. Experience in the Use of Barbed Threads and Non-­barbed
Data sharing is not applicable to this article as no new data were cre- Serdev Sutures in Face and Body Lift –­Comparison and Combination.
InTech; 2013. doi:10.5772/51399
ated or analyzed in this study.