Barbed thread facelift: A personal journey

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Abstract

Surgeons and patients alike are constantly searching for methods of facial rejuvenation that can be done with minimal invasion of tissues, with the least amount of anesthesia and with "no" downtime. This is the holy grail of aesthetic surgery. One of the latest players in this field is the barbed thread lift; however, the use of suture suspension during lifting has been successfully done for around two decades [1-4]. However, this type of suture suspension for the midface and neck required an open or a semiopen procedure. The mechanical reason why in these cases the suture suspension worked was because of the wide undermining and repositioning of the soft tissues in the elevated position, which was held long-term by these sutures until the scar formation allowed tissue reattachment in the new position. When this suture suspension was applied in a percutaneous fashion, the general complaint was that this suture tended to act like a cheese wire cutting through the tissues and diminishing the effect over a period of time. The reason for this was that these sutures were smooth without barbs. The advent of the barbed suture was a new concept in facial lifting because of the ability of the barbed suture to hold and support tissues along its entire length rather than just the loop made by the smooth sutures. This mechanical advantage of the suture has made it possible to use it without tissue undermining. The mechanical principle of the barbed suture is to make it easy to insert it in one direction and difficult to move it in the opposite direction. Once the suture has been introduced in the soft tissues, these can be lifted to a position in one direction and the barbs of the sutures will theoretically prevent the tissues from dropping to the original position. Although, in principle, this made a lot of sense, in practice the early configuration of the barbed sutures was not reliable enough and other ingenious surgeons modified and improved the configuration with the barbed sutures as well as the surgical principles. The senior author (Ramirez) initially tried the technique and did a few procedures without significant improvement in the quality of rejuvenation. Later on, after becoming involved in a couple research projects with poor results and almost abandoning the technique and technology, one of the coauthors (Giampapa), after modifying several key points of the technique, was able to obtain better results which convinced the senior author to become an advocate of the operation, albeit with some limitations. © Springer-Verlag 2008.

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APA

Ramirez, O. M., Giampapa, V., & Chapa, E. P. (2008). Barbed thread facelift: A personal journey. In Simplified Facial Rejuvenation (pp. 293–301). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-540-71097-4_38

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