Regenerating thread lifts for mild sagging of the face and body.

The sagging of the face and body often occurs with age. This is a natural biological phenomenon that occurs in the human body and leads to the atrophy of soft tissues. Indeed, over time, subcutaneous fat tends to redistribute and decrease in the face and body. It is this loss of volume that accentuates skin sagging. Facial and body muscles can also lose their tone, contributing to the sagging of tissues.

Furthermore, as we age, the synthesis of collagen decreases, leading to a loss of firmness, as this protein is responsible for the skin's firmness and resilience. Various factors can accelerate this process, including photoaging due to UV exposure, which causes a degradation of collagen and elastin, as well as hormonal stress and oxidative stress.

The loosening of the skin on the face and body is characterized by several visible signs that vary depending on the areas affected and the intensity of the skin laxity. On the face, it can lead to a sagging of the facial contour, a decrease in skin elasticity , and the emergence of wrinkles and fine lines. One can also observe a loosening of the skin on the neck, with a creased appearance and thinner skin marked by vertical wrinkles. In other areas of the body, the skin can be slack with a loss of firmness, particularly in the arms, abdomen, thighs, and buttocks.

While numerous surgical treatments exist to improve skin laxity, new less invasive methods, such as regenerating thread lifts, are beginning to emerge. Indeed, thread lifts act as tissue inducers, as they gradually stimulate the production of collagen. These are very thin threads that are inserted under the skin using fine needles or cannulas. The areas that can be treated include the folds of the thighs or knees, the stomach, buttocks, neck, cheekbones, and so on.

In 1999, a surgeon secured a patent for the discovery of bidirectional barbed threads to address the issue of skin laxity. Their unique feature lies in the presence of small barbs oriented in two opposite directions, which allows them to grip and hold tissues more effectively. There are different types of lifting threads, either barbed or coned:

• The barbed threads are tension threads that have small notches or roughness along their entire length. These notches, oriented in one direction or sometimes bidirectionally, allow them to anchor to subcutaneous tissues. Once inserted under the skin, the notches create immediate traction on the skin, straightening and strengthening the skin structure. Barbed threads offer a gentler tightening effect and are often used for mild to moderate skin laxity.

• The cone threads are tension threads that have cone-shaped notches arranged along the thread. When inserted under the skin, the cones create a stronger pull than the notches, due to their shape and orientation. They also allow for a more even distribution of tension on the skin. Cone threads provide a stronger pull and are more suitable for areas with more noticeable sagging or for a more pronounced lifting effect.

These threads can be absorbable or non-absorbable. The discovery of absorbable threads came later to address patient concerns about permanent products. Theoretically, non-absorbable threads should offer a longer lifespan. However, the appeal of absorbable threads lies in their ability to induce collagen production. Given that changes in collagen play a key role in the aging process, stimulating its production is one of the pathways to skin regeneration. Indeed, tension threads trigger a controlled inflammatory response, thus stimulating the production of type I and III collagen, inducing an immediate lifting effect.

More clinical studies need to be conducted to confirm this hypothesis of collagen stimulation by resorbable threads.

Resorbable threads are made from absorbable materials such as polydioxanone (PDO), polylactic acid (PLLA), or polycaprolactone (PCL), which exert a mechanical pull and reposition sagging tissues, thereby improving firmness and contour definition. Non-resorbable tension threads have the same lifting effect as the resorbable models. The only difference is that the procedure lasts longer. The same goes for the results obtained, which can last up to 10 years.

Regarding the sessions, the application of tension threads lasts between 30 and 90 minutes depending on the target area. It takes place without hospitalization and does not require general anesthesia. To insert the tension threads under the skin, the doctor performing the procedure inserts and removes the threads under the skin.

The doctor conducts a comprehensive analysis before the thread implantation to better advise the patient. This measure also allows them to establish the appropriate treatment plan. Often, the application of arnica-based cream is recommended before and after the placement of thread implants. The initial results are immediately visible due to the traction action on the skin. The final results, on the other hand, are visible after three months following the thread implantation.

It's important to note that the onset of bruises and contusions may occur in the days following the application of tension threads. Inflammation accompanied by slight skin swelling or redness may also appear. Aside from this, the application of tension threads is considered a relatively safe method.

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• MOREL J.L & others. Thread lifts for facial sagging (barbed threads). French Association of Aesthetic Medicine and Age Management (2022).

• BENOUAICHE L. & al. What is the role of thread lifts in facial rejuvenation?. Annals of Plastic Aesthetic Surgery (2017).

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