Thread Lift Problems

Janet Kinney, a 58-year-old bookkeeper from Bakersfield, Calif., is less enthusiastic. In August, after a dermatologist showed her a "Today" segment on the lift, she spent $4,000 to have one. But it turned out to be painful and disfiguring, and dealing with the consequences is taking far longer than a lunch hour.
The barbed suture lift, nicknamed the thread lift, is a quick outpatient procedure in which doctors thread serrated plastic sutures through the fatty layer beneath the face and use them to hoist sagging tissue. The idea is to pull the skin taut, so the face looks smoother and more youthful.

But ever since the dermatologist finished Ms. Kinney's lift, the threads have been visible through her skin. They run like railroad tracks up her forehead, down her cheeks and along her neck, she said. When she washes her face, she said, the barbs feel like "little prickles." And, if she sleeps on the right side of her face, she wakes up with pain shooting from near her nose up to her temple.
"People are very kind, and they tell me it doesn't look so bad," Ms. Kinney said. "But my forehead looks like I had a lobotomy." She has scheduled an appointment in January to have a plastic surgeon remove the threads at a cost of $3,000.

Ms. Kinney is not the only patient who has had problems. According to an informal poll of members at an April meeting of the American Society for Aesthetic Plastic Surgery, conducted by Dr. V. Leroy Young, a plastic surgeon in St. Louis, 198 out of 900 doctors said they had tried the technique, and 60 percent of them said they had experienced complications. In some cases, they said, the threads broke or popped out of the skin.

Only a few years old, the thread lift is one of the fastest-growing cosmetic procedures in the United States, thanks in part to the exposure it has received on television. Since September 2004, when the Food and Drug Administration cleared Contour Threads, one of two brands of barbed sutures, for use in the United States, 1,400 doctors have taken courses in how to use them, according to the manufacturer, Surgical Specialties Corporation, in Reading, Pa., which conducts the courses. These doctors have now done more than 8,000 thread lifts, the company says. Thousands more have been done with Aptos brand sutures, which are made abroad, although they have not received official clearance from the F.D.A.
But the thread lift has come under fire from many plastic surgeons and facial surgeons, the kind of doctors who perform most of the traditional face-lifts. Some of them charge that the thread lift has not yet been subjected to the kind of peer-review clinical studies that they say are needed to demonstrate that it is safe and effective and to indicate which patients it is right for.
"A new procedure should be predicated on a good 10 years worth of lab work, animal models and clinical studies before it is widely adopted," said Dr. Thomas Romo III, director of facial plastic and reconstructive surgery at Lenox Hill Hospital in Manhattan. "I'm not going to practice this on my patients like guinea pigs to see if it works."
Surgical Specialties plans to release clinical data on procedures done with Contour Threads in 2006, said Greg Toso, the company's director of marketing for branded products.
Dr. Romo and other plastic and facial surgeons complain that many doctors who perform thread lifts - a group that includes not only plastic surgeons but also ophthalmologists, obstetricians and family practice physicians - have had little training in facial anatomy or surgery beyond the two-day course given by Surgical Specialties.
Dr. Robert Singer, a plastic surgeon in La Jolla, Calif., said, "A physician who doesn't have full surgical knowledge and training could mistakenly get into structures like facial nerves that could cause problems like drooping and infection."
The thread lift was invented by Dr. Gregory L. Ruff, a plastic surgeon in Chapel Hill, N.C., in 1992. Searching for a way to raise the crushed cheek of a car-accident victim, he cut little notches into a few of his surgical sutures, threaded the sutures under her skin and used them as a sling to move her cheek back into position.
After using hand-notched sutures in several more reconstructive surgeries, Dr. Ruff decided they would also make a useful cosmetic tool. In 2004 he introduced Contour Threads, which are transparent sutures with one-directional barbs, designed to tighten sagging skin on the face and neck.
"The barbed threads are like clothes hangers that you hang tissue on," said Dr. Ruff, now the medical director of Surgical Specialties.
Around the same time, in Moscow, Dr. Marlen Sulamanidze, a surgeon who was looking for a way to do face-lifts without making large incisions, developed Aptos threads - blue sutures with two-directional barbs - also to pull tissue upward.
The thread lift became popular quickly because patients like the idea of a procedure that does not require large incisions and long recovery, said Dr. Trevor Born, a plastic surgeon in Toronto.
In a traditional face-lift, which typically costs $10,000 to $12,000, a surgeon trims away excess skin from around the cheek and the neck, then cuts into the muscle tissue of the face so the tissue and skin can be moved and reattached higher up. This involves much stitching and bruising, and recovery can take four to six weeks. But after the scars have healed, the face can maintain its new position for 5 to 10 years.
A thread lift involves no transplanting of tissue, so recovery can take as little as a week. The scar tissue that forms around the threads helps suspend the skin, but only for several months to a few years.
Thread lifts appeal to people seeking subtle cosmetic changes that are quick and relatively inexpensive. Lana Frye, 57, a retired phone company manager from Charleston, W.Va., for example, did not want a face-lift; she dislikes the pulled-tight expression that face-lifts sometimes create. But after watching the "Today" segment, she decided to have a thread lift.
"I wanted a little something to improve my double chin and my wrinkly neck," Ms. Frye said. So one day in October she had the procedure done by Dr. Lawrence S. Reed, a plastic surgeon in Manhattan who has performed about 50 thread lifts this year.
Dr. Reed began by giving Ms. Frye small doses of Valium and Percocet, and a few injections of local anesthesia. Then he drew four stripes on either side of her face and neck to indicate where he would place the sutures. Next, with a scalpel, he made a small incision in the hairline above her ear, inserted a long thin needle and drew a barbed suture through the deep fatty layer of her face. He zigzagged the needle downward to just above her mouth and then popped it out, leaving the thread behind. After he had run four sutures through her cheek, about five-eighths of an inch apart, he knotted the scalp ends of each pair together inside the muscle.
Finally Dr. Reed ran his finger along Ms. Frye's face to push the sutures deeper and upward, so that the barbs would hook into the tissue and drag it toward her hairline. He then did the same thing on her other cheek and likewise ran four threads on either side of her neck. Ninety minutes later she sat up, looked in the mirror, and declared that she looked "at least 10 years younger." Dr. Reed's bill came to $6,500.
A month later Ms. Frye has a smoother face and a tighter neck. "My husband says I'm beginning to look like a daughter, not a wife," she said. If all goes well, Dr. Reed said, these results may last a few years.
Not all thread lifts work out like Ms. Frye's, however. Dr. C. B. Boswell in St. Louis is one of many plastic surgeons who say they see little difference in patients' faces after the treatment. Initially the swelling from local anesthesia and post-operative inflammation plump the face, making it look smooth, Dr. Boswell said. But when these effects wear off, it is difficult to see a pronounced improvement.
"I can get them better and longer-lasting results at one-third the cost using just Botox and Restylane," said Dr. Boswell, who has stopped offering thread lifts.
The initial swelling is what changes the appearance of patients who get thread lifts on television, Dr. Born said. "But there is no follow-up on TV," he said. "Three months later, they might not look so good."
Because the procedure is so new, doctors cannot easily predict how long its results will last. Dr. Ruff, who has performed about 110 thread lifts in the last year, said he expects the best ones to last five years. But other doctors say they have seen cases in which the sutures do not hold patients' flesh taut for more than a few weeks. The tissue slides off the barbs like an ill-hung coat from a hanger. Sometimes this happens because the knotted threads in the scalp come untied or because the threads break.
"One cough and a sneeze, and the thread lift is all over," said Dr. Robert C. Silich, a plastic surgeon in Manhattan who has removed sutures from several patients operated on by other doctors.
A variety of strange-looking side effects have been reported. The blue Aptos sutures can show through the skin if they are placed too superficially in the fatty layer. Aptos threads also have been known to migrate.
Dr. Nicanor G. Isse, a plastic surgeon in Burbank, Calif., said he has seen several cases in which the sutures have slid down patients' foreheads and "bunched themselves into knuckles" in the eyelids. Contour threads, for their part, can cause the skin to fold temporarily into accordion pleats, a problem that usually goes away within a couple of weeks. Both types of sutures, if improperly inserted, can be visible when patients laugh or smile, like rows of bulging veins in the face.
But Dr. Reed and other proponents say these side effects will become less common as the sutures are improved and as studies determine the best ways to place them.
"The thread lift reminds me of liposuction," Dr. Reed said. "In the beginning, when it flew in the face of everything we knew, we all said it was dangerous, nonsensical and untested. But now it is the most popular operation. The thread lift may turn out to be exactly the same, a good technique in evolution that will find its place."
Dr. Singer agrees the jury is still out. "Maybe the thread lift will turn out to be O.K. for somebody looking for short-term results," he said. "Maybe it will turn out to work best as an adjunct to a face-lift. But right now, it's much more hype than reality."