With the advent of beauty enhancements come a slew of “lunchtime procedures“—all in the form of minimally-invasive techniques with little downtime and almost instantaneous results. Lately, thread lifts have grown increasingly popular as a solution to fill the gap where anti-wrinkle injections and dermal fillers fail at bridging—and for good reason. Thread lifts literally elevate parts of the face and body without the need to create incisions (eek), and some varations of thread can reportedly brighten, tighten and hydrate skin.
We sat down with Dr Alice Prethima Michael, Managing Medical Physician, CEO and founder of Dr. Alice Total Wellness Centres and Ageless Medispa, to discuss the latest in thread lifting technology and what you can expect from this skin-tightening procedure:
What are some of the different kinds of threads that are currently administered in thread lifts?
Previously, monofilament threads were mostly used in thread lifts. We call them PDO threads—they are smooth, very fine threads and were originally used for surgical stitching; later on they were adapted for non-surgical methods.
I am not a great fan of them: as they are monofilaments, they are very short and fine (like hair); and it would require a thousand needles punched into the entire face to insert these threads for a full-face rejuvenation—which would result in a bit of swelling but with short-term results.
Each thread is different. Aptos is a very long-lasting thread that isn’t technically new. Actually, I had my first introduction to proper threads—that can surgically or minimally, invasively enhance a person’s look—with Aptos. 15 years ago, it was only used for surgical procedures. Since then, Aptos has developed a lot of different threads and now we are using its third-generation threads. Aptos was created by doctors for doctors, so they have that experience working with other threads (which I’ve also previously used). Those are slightly different in terms of thickness, thread formation, directions of the cogs that hold the tissues so that we can utilise the threads in different ways etc.
What are some of the benefits of Aptos threads?
Aptos offers two kinds of lifts: one is volumising, and another one would be mechanical—basically by creating anchor points (sans cutting) with tiny needle points going in and out. That is done to anchor the threads to strong, hard tissues like in the temple area. When it’s anchored to the points, your face gets a mechanical lift, which is immediately visible upon leaving the doctor’s office.
There are histological changes from the collagenising properties of the threads itself, which help improve skin tone, colour, texture and hydration. Many threads that are made of PDO (polydioxanone) have high tensile strength, but its longevity is only about three months. Then we have PLA (polylactic acidase) thread which is a strong collageniser, but the results aren’t long-term because the threads are quite soft and so they dissolve faster.
However, Aptos has a very good combination of tensile strength that comes from PCL (polycaprolactone)—commonly used for fillers to lengthen the effects on correcting scars, noses and chins—and polylactic acid for collagenising and countering the softness.
How long do thread lifts last, and what is the downtime like?
For Aptos threads, I’d say at least three years. Other PLA threads can last for about one and a half to two years, and PDO threads only last for three months. When we do advanced thread lifts—with proper training—there is far less injury inflicted to the face. You can actually go to work the next day as there will only be very, very fine puncture marks on the face.
I usually tell my patients that it’s almost like taking an intramuscular injection—that’s the size of the needle! The marks will fade within a couple of hours or at worst, it will take a day for the swelling to subside. We want to create less injury yet give the best results.
What are some of the risks and side effects of thread lifts?
With Aptos threads, we seldom have any problem with threads breaking with insertion or after the procedure. There have been such cases with older threads—patients will suddenly occur a droopy side because a thread broke inside. But thanks to PCL, the threads are stronger and will not break easily.
But when it comes to the procedure, it’s important to consult a formally-trained doctor for thread lifts. Wrong placement of threads can result in irreversible side effects. I would never advise anyone without basic medical training to carry out these procedures—they would need to have at least three years of mentoring before they can sit for the exams and get qualified, so they need to have the basics down pat. That’s why it’s very concerning to me how beauticians are offering thread lifts in aesthetic centres.
Generally for basic threads, we won’t insert it anywhere in the middle of the face—this is a dangerous area (from the inner corners of the eye, draw a straight line down). We would only touch this area if we’re fixing the nose, in which case you would need to know the anatomy of the nose, the veins and the vessels and so on.
What anatomical areas are highly requested by patients when it comes to thread lifts?
Of course, the face is the most popular. Most people request for lifts around the jawline as we tend to accummulate more fats around this area with age. We Asians tend to look younger in our 30s, but when we hit our 40s, the effects of gravity start showing because all the fats in the cheeks will descend and result in a flatter, upper part of the face.
Eyebrows are very popular as well with females—the general guideline is that it has to be at least 1cm above your browline. Most people want to fix their eyebrows because they are lower than desired. As we grow older, it’s one of the first parts of the face that sag. In your 30s, your lateral eyebrows will already start to droop, so I have many younger clients who opt to lift their eyebrows.
I used to say that threads don’t work very well on the neck area, but now with Aptos, we are able to use hammock methods—basically needle methods where we can create many anchorage points and push the entire area in, similar to how a hammock is suspended between two points. I would typically stitch it to the back of the ear with a small needle point—we don’t really cut. We can also stitch it to the bone for a very strong hold. It all depends on the doctor’s training.
For the first time ever, we have threads that can narrow the tip of the nose. For a lot of different types of markets in Asia, it is very important that the nose shape is nicely managed. We’re not just going for a high nose bridge, but to correct the tip of the nose (one that is bulbous or slightly bigger in front).
Nose surgery tends to be very particular—sometimes they would require two to three corrections to get the perfect nose shape. But now with threads that are specialised, I can actually give them a look that they covet in a half-hour procedure, with no downtime and beautiful results.
Do thread lifts work to lift other parts of the body as well?
Yes, breast and buttock lifts are very popular in my medical centre, possibly because I am a lady physician. Those are more common than what people think, as most assume that thread lifts are only for the face.
The least in-demand would be vaginal procedures and I think that is because there is no awareness. Many opt for laser treatments, radiofrequency and surgical methods instead as thread lifts for the vagina is still quite a novel idea for them.
So how does it work for the vagina?
So what we do is insert threads along the vagina ring to rejuvenate it, and because it’s a muscular structure, it cannot be rejuvenated with lasers or radiofrequency. It’s a great alternative for those who do not want to undergo surgery (because of the longer downtime). With threads, we are able to reloop the vaginal ring and tighten the muscular structure. There is minimum downtime and you can actually lift the vagina area, which is a common area that sags after childbirth.
What is the aftercare like for face thread lifts?
They have to be very careful. They should avoid opening their mouths excessively wide, and to refrain from sleeping on one side or the other. I would normally advise my patients to sleep on a travel pillow or place two soft, small pillows on either side. While the threads are not going to break, the face can droop down on one side right after the procedure, and it distresses the patient because they think that their face is not symmetrical. But this is actually uneven swelling whereby one side is more swollen than the other.
I would tell them to avoid putting too much pressure on the areas. No massages for at least a month, and no dental work for up to six months—patients can risk getting infection from inside the tooth, which may spread to the adjacent tissue. Also, they should avoid eating crunchy or tough food as they need to limit the movement of their mouths for the first month.
Is there a target age demographic that thread lifts are best suited for?
I’d say that age is only a number. I have had 25-year old clients telling me they want a thread lift, but I’m not going to say no to them straightaway because each person’s tissue may be different; there may be laxity and we cannot generalise their skin condition based on their age. I would typically see them first and discuss the options. If it’s possible not to do that, then I would advise accordingly.
The latest generation threads come with hyaluronic acid, which is a big advancement especially for the younger market because many of them have issues with their skin. They could opt for chemical peels, laser treatments, and even hyaluronic acid injections. When it comes to hyaluronic injections, the result will only last for six months, and then patients will have to start another round so they may get injection fatigue.
Now these threads are going to give them a two-year (or more) supply of hyaluronic acid! There’s no need for other injections, and you can get your skin lifted and improved at the same time. Once we give hyaluronic acid regularly to the skin, it’s going to speed up on the fibroblast production, making your skin glow and stay hydrated for a longer period of time.
It also works wonders on scars, and we’ve seen amazing results. I have patients in their 60s who come back and tell me that their scars have improved so much. 60% of facial beauty is judged by the quality of the skin (if you omit the facial shape and features) so it’s very important to have seamless beauty as well.
With regards to skin type, are thread lifts safe for those with skin conditions such as hormonal acne?
If they have acne Fulimans then it means that there is some infection with bacteria in their skin so we usually will not suggest thread lifts. We will treat the skin first—not necessarily for the acne to completely clear up, but it shouldn’t have infected pustules or what we call Grade 2 acne.
For some acne (such as dry and sensitive or dry and irritated acne), the skin will improve after thread lifts. After a hyaluronic product is introduced, the dryness and the sensitivity will reduce immediately, which also reduces inflammation and so acne wouldn’t be a problem anymore. Following that, the patient will just have to maintain his/her hygiene and skincare habits.
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