surgical Dr Viraj Tambwekar
Silhouette thread lift Conventional face lifts carried out on patients with South Asian skin types can result in noticeable scarring. Dr Viraj Tambwekar discusses the silhouette thread lift alternative for facial rejuvenation
T
he face lift is undoubtedly the gold standard treatment for patients who want to rejuvenate their youthful looks. But plastic surgeons are still trying to develop the ideal facelift procedure—one that is less traumatic, with less downtime and longer lasting results than the average 7–10 years that the current procedure lasts. Facelifts have evolved over time and, from being skin-only procedures, they have run the gamut of various degrees of aggressiveness. Common to all is the principle of lifting and fixating. The relative popularity of various procedures is measured by the amount of time the results last and how quickly patients can get back to their routine lifestyle. Conventional facelifts have consistently produced good results but have had a few problems—duration of surgery, length of hospitalisation, recovery time, occasional facial nerve related problems and visible scarring, hairline deformity and ear lobule deformity. Scarring is not really an issue for Caucasian patients. But in South Asian body language www.bodylanguage.net
patients, the scar stands out clearly as a white line in stark contrast to their darker complexion, no matter how well the surgeon hides it. To address this concern, I first started performing thread lifts for facial rejuvenation, and realised this procedure had many other benefits, including less recovery and surgical time, minimising the complication of nerve damage and the amount of dissection. The concept is quite simple. The technique relies on remote access when lifting the malar tissues in the temporal hairline, therefore hiding the scar. The lift is achieved from fixing and elevating the malar tissue to absorbable cones in the thread at multiple points. We have to provide firm fixation and suspension to and from a firm structure—the deep temporal fascia (DTF). The elevation and fixation differs from the conventional technique as it is achieved as a differential lift at multiple points. This reduces the tension at each point of elevation, as opposed to the conventional open facelifts where the eleva-
tion and fixation is at a single point with considerably higher tension. The thread lift achieves the lift much like a shish kebab and a collapsing accordion; with the thread being the metal rod of the shish kebab and the tissues differentially piling up on each other like a collapsing accordion. This prevents the thread from cutting through the elevated tissue like a wire through cheese. The chemical composition of the cones promotes collagen formation and the building up of a strong fibrotic scar that maintains the lift after the cones have been absorbed. The technique is minimally invasive and can be performed quickly with minimal dissection thereby decreasing the operating and recovery time. History Thread lifts were introduced in the late 1990’s by Dr Marlen Sulamanidze and have evolved through the contributions of Dr Woffles Wu, Dr Gregory Ruff and Dr Nicanor Isse. The technique began by using barbed threads without any firm 25