Taking the nip out of cosmetic surgery

Threading technology creates youthful, refreshed appearance

Threading technology creates youthful, refreshed appearance

September 12, 2005|by KRISTIN WILSON

There's a new wind blowing in the field of plastic surgery and it's breathing more natural life into face-lift procedures.

Increasingly, patients demand procedures that are less invasive, leave fewer and less noticeable scars and produce a more natural appearance, says Dr. Donald Kress, a plastic surgeon in Frederick, Md.

Enter barbed sutures, a recent U.S. Food and Drug Administration approved technology that uses the design of porcupine quills to help both women and men get a more youthful, refreshed appearance.

"You do about 60 percent of a face-lift with no cuts in about an hour in the office," says Kress, summarizing the procedure.


Barbed sutures are about the thickness of fishing line with small barbs that extend in one direction, much like a porcupine quill. To implant the threads, surgeons insert them using a hollow needle and pass the strings under the skin and between the fat tissues and facial muscles. Once in place, the doctor pulls the threads up creating the desired lift effect.

"When all of the threads are in, you can watch everything go up," Kress says. "The patient is very much a part of the procedure both for the marking, and adjusting the threads in the end." The patient is awake for the entire procedure, which can be done in a doctor's office.

Much like a quill that embeds barbs into tissue as it is pulled out of the skin, barbed sutures technology uses Mother Nature's defense mechanism to engineer a new way to move skin and close wounds.

Internal lift

Contour Threads inventor Dr. Gregory Ruff is the chairman of Quill Medical Inc., a company that uses the porcupine concept to develop multiple surgical devices with uses in general surgery and orthopedic fields as well as in plastic surgery. Quill Medical has patented barbed sutures under the name Contour Threads.

"Greg Ruff is an academic," says Kress, who knows Ruff well. "He is very interested in improving wound closure. He started out with noncosmetic (motives)."

Contour Threads represent a shift in approach to moving skin. Rather than stretching skin externally, the threads are an internal way to move tissue around. One application for the technology is to implant threads under the skin to close wounds instead of using stitches on the surface.

"Every time you put a stitch on the surface, you risk breakage and also leaving a scar," Kress explains. Quill technology offers the possibility of minimizing such scarring.

Kress said he believes Contour Threads or related barbed thread technologies eventually could be used to lift breasts or the butt for more shapely appearances, he says.

Take it easy, doc

"Plastic surgery patients want shorter, minimally invasive procedures that produce results and have limited downtime," said Dr. Leroy Young in a written statement. Young is chairman of the American Society of Plastic Surgeons Committee on Emerging Trends. According to Young, technologies that incorporate barbed sutures meet demands of plastic surgery patients.

For now, Contour Threads can be used to lift sagging skin through the cheeks, forehead, brows and neck.

The "thread lift" is considered to be more akin to "mini" or regionalized face-lifts than a traditional face-lift. The results are expected to last three to five years "which is about half the time of a traditional face-lift," Kress says. The procedure also costs less than a traditional lift. Depending on how many threads are used, a thread lift can cost $3,000 to $4,000, Kress says.

Men see appeal

The ideal thread lift patient is between 35 and 45 years old or has already had a traditional face-lift and would like a "touch up," Kress says. It is important that the patient have an average weight. Someone who is too thin wouldn't have enough fat to properly place the threads, he explains. For a more overweight patient "the tissues just won't move," he says.

Men are taking to thread lifts in greater numbers than traditional face-lifts, Kress says. About 30 percent of his threading patients are male - compared to 10 percent of his traditional face-lift patients - and he expects that amount to grow.

"Most men are not interested in a full face-lift," he says. "There are good reasons for that too. Men wear their hair short and it's much harder to hide scars."

New in America but not world

Some surgeons are skeptical about the technique and the amount of time the threads will hold skin in a position that counters gravity. Since the threads have only been used in the United States for about a year, it's not known how long the results will last.

Canadian surgeons have been using the threads for several years and reports indicate the majority of women and men who received the thread lift are pleased with the results for at least three to four years. The American Society of Plastic Surgeons continues to monitor the technology and has discussed it at annual meetings.

Contour Threads is the only FDA-approved barbed suture thread on the market. Versions of the thread have been produced by companies in Russia and Singapore, all of which Kress has used. However, he feels the approved thread is the best option for patients.

There are possible complications reported with the surgery. Swelling, bruising and headache have been reported as well as infection and thread rejection. It is also possible that the thread can break and work its way out of the skin. Swelling and some bruising can be expected for a few days after the procedure, Kress says. Surgical Specialties Corporation reports that less than 1 percent of the people who are implanted with the threads have complications.

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