Threading—even the newest, safest versions—continues to be an under-the-radar and highly controversial technique, practiced by some doctors who hail it as the ultimate replacement for traditional facelifts and spurned by others as dangerous and ineffective. It came into the limelight when GOOP published an article in November 2015 claiming it was the go-to technique of European women. But has any progress been made since then? If it works, is it safe? Will it ever be safe?
FIRST OF ALL, WHAT EXACTLY IS THREADING? (AND WE DON’T MEAN EYEBROWS)
Threading refers to all varieties of facelift that employ threads, often barbed but sometimes coned, inserted in the skin to both lift and encourage cell growth. It’s marketed as minimally invasive (threads in your skin? You decide!), so women who are interested in injectables are drawn to this style. And because some doctors use threads made of dissolving sugar materials, they include words like “all natural” in marketing materials.
You may also see it referred to as The Silhouette Instalift, PDO lift, the Woffles Lift, Contour Lift, Aptos Lift, and simply “threading”. But remember, not all procedures are the same, and not all are FDA-approved for use in the United States. The difference is usually in the shape and material of the thread being used, but there are also differences in approach to inserting, and where the threads are inserted. Here’s a quick breakdown of the differences, issues, and our experts’ opinions.
REFRESHER: A HISTORY OF THE THREADING FACELIFT
In the 90s and early 2000s, a form of threading facelift sometimes referred to as the Woffles Lift—after Dr. Woffles Wu, who was born in Singapore but grew up in England and is currently a Fellow of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore—was performed regularly both abroad and in the United States. A line of short polypropylene threads with multiple barbs is inserted into the face to lift and encourage cell growth. This form of facelift was approved by the FDA in 2004, but after patients complained of infection, protruding threads, and dimples, the FDA withdrew approval in 2007.
The process eventually morphed into something more friendly, using things like “sugar threads “ which dissolve more easily, or “PDO” threads, made from polydioxanone that dissolve over 4-6 months (this absorbable formulation is often used for suturing in traditional surgery). PDO lifts are approved in the United States, and the procedure doesn’t involve knotting or tying—after 4-6 months, the threads dissolve, which stimulates a mild inflammatory reaction that can result in some modest tightening and collagen build-up. Anywhere from 20-60 threads are placed at one time.
What happened to the old permanent thread lifts? “They have been largely abandoned by cosmetic surgeons,” says Dr. Brett Kotlus, a plastic surgeon practicing in Eastcheaster, New York. Dr. Kotlus does performs threading with the new dissolving PDO (otherwise known as Miracou or Nova threads) at his New York office.
Dr. Kotlus says PDO thread lifts can last from 6 to 18 months, or more. “On average,” he says, “the results last longer than Botox or Dysport, and similar to some filler injections. The longevity of the procedure depends on many factors, including the degree of aging you have at the onset of the procedure, how many threads are used, the thickness of your skin, and the degree of firming that ensues after the thread lift.”
In Beverly Hills, well-known dermatologist Dr. Harold Lancer is also performing what he calls the Sugar String Lift. “I predict that in 10 years the surgical face-lift will be a thing of antiquity,” he told Town & Country just last year.
CAN WE ALL AGREE, IT’S SAFE, THEN? NOT EXACTLY
But a difference of opinion remains in the cosmetic doctor community. Are the new threading methods safer than the old thread lifts? Yes. “Threading has been around for a long time, and it has gotten better,” says Dr. Idriss. But are they effective or safe? “I have still seen complications even with the new threads where the the points of entry moved and the threads dropped. So you can certainly have complications if you’re not in the right hands,” she explains. “It’s a technology that can only get better from here, but has a ways to go.”
Since its FDA approval in 2016 and the change in threads, doctors like Dr. Kotlus and Dr. Lancer are preaching that threading is the future of anti-aging non-invasive treatments. But they’re in the minority: our experts continue to point out several issues.
THE ISSUES WITH THREADING
There are several issues with threading. Firstly, patient reports of threading experiences say it doesn’t last long. Because of the dissolving threads, results unfortunately also dissolve. Second, aging is not just about sagging, it’s about volume loss, which threading does not address. Lastly, Dr. Idriss emphasizes that seminars on threading teaching techniques aren’t good, thus those offering this technique may be operating with little to no training.
THE BOTTOM LINE
Most CB doctors believe there are better and safer ways to achieve the same effect. Also, as Dr. Idriss points out, the advances in cosmetic dermatology are great, but it only underscores the point that it’s truly important to see a skilled and experienced doctor. “Your doctor needs to know what tool to pick,” explains Dr. Idriss. “There are so many options in cosmetics now, which is great, but you need to know what tool to pick. In the past, cosmetic doctors were much more limited. Now you have different kinds of hyaluronic acid fillers, and all kinds of injectables: your doctor needs to know how and when to use each for each facial type and what works best for you. And even if threading becomes safer, you likely will still need injectables and fillers with it to achieve best results.”
We agree. And here’s one more thing to consider: Even if you pick the most skilled doctor, the risk of an adverse reaction (or a mislaid thread) still exists. “It’s much harder to reverse the effects of the threads then it is to reverse fillers and injectables,” says Dr. Idriss. Until further advancements, we’ll be sticking to injectables.
Illustration by Rebekah Flores
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