Treatment of Complications following Facial Thread-Lifting

Abstract

Facial thread-lifting, a minimally invasive technique for facial rejuvenation, has gained global popularity because it is easier to perform and has fewer complications and a shorter downtime with lower cost compared with traditional sub–superficial musculoaponeurotic system or subperiosteal lifting.1 However, previous studies have shown that complications of facial thread-lifting are not uncommon. Reported complications include bruising, swelling, skin dimpling, infection, inflammation, abscess, thread extrusion, subcutaneous granuloma, and injury of surrounding structures.2–5 Some of these symptoms will resolve spontaneously within weeks, whereas others may require pharmacotherapy or surgical intervention. Understanding the treatment methods of these complications will help aesthetic surgeons and dermatologists better manage them. However, no study has focused on the treatment of facial thread-lifting–related complications. In this article, we report the most common complications following facial thread-lifting that lead to consultation, their treatment methods, and their clinical outcomes. Electronic medical records of patients presenting with complications of facial thread-lifting between January of 2016 and January of 2020 were retrospectively reviewed. Our sample included 61 patients, all female, with a mean age of 36.3 ± 8.9 years. The most common reason for consultation was infection (31.2 percent), followed by dissatisfaction with changes in facial contour (23 percent), paresthesia (19.7 percent), dimpling and irregularity (16.4 percent) of the skin, subcutaneous induration (13.1 percent), thread extrusion (4.9 percent), and facial nerve injury (3.3 percent). The majority of complications were first treated conservatively by nonsurgical methods, as shown in Table 1. Fifty-one patients (83.6 percent) showed improvement in symptoms following nonsurgical treatments, whereas 10 patients (16.4 percent) required revision surgery that included débridement and thread removal. Preoperative ultrasonography in three patients with infections showed subcutaneous linear hyperecho focus surrounded by heterogeneous or hypoecho flow signals, indicating that the thread was surrounded by infection. In cases requiring thread removal, a 1-cm incision was made along the preauricular hair line. The end of the thread was exposed by blunt dissection. Threads were completely or partially removed in five patients within 3 months after initial facial thread-lifting (Fig. 1). After removal of the thread, the site was thoroughly curetted to remove all necrotic tissues and irrigated with hydrogen peroxide, povidone-iodine, and saline. Hematoxylin-eosin staining of the debrided tissue showed chronic hyperplasia of granulation tissues, intensive infiltration of inflammatory cells, increased proliferation of fibroblasts, and angiogenesis (Fig. 2). In addition, multifocal unstructured crystalline material was detected, indicating the ongoing degradation of thread. During a median follow-up of 1.7 years, nine out of 10 patients recovered well and reported satisfaction, while one patient was dissatisfied due to subsequent scarring at the site of surgical incision. Table 1. - Complications and Corresponding Treatments Complications No. of Patients Treatment Nonsurgical Surgical Infection 19 (31.2%) 13 (68.4%): dressings, oral/topical antibiotics 6 (31.6%) Dissatisfaction with facial contour 14 (23%) 12 (85.7%): physiotherapy 2 (14.3%) Paresthesia 12 (19.7%) 9 (75%): physiotherapy, oral analgesics (pain), oral neurotrophic drugs (numbness) 3 (25%) Dimpling and irregularity 10 (16.4%) 9 (90%): local massage and application of heat 1 (10%) Subcutaneous induration 8 (13.1%) 5 (62.5%): intralesional steroid injections 3 (37.5%) Chronic swelling 8 (13.1%) 8 (100%): oral detumescent drugs 0 Thread extrusion 3 (4.9%) 0 3 (100%) Allergic reaction 3 (4.9%) 3 (100%): topical glucocorticoid ointment 0 Scarring 3 (4.9%) 3 (100%): silicone scar gel and laser therapy 0 Facial nerve disturbance 2 (3.3%) 2 (100%): oral neurotrophic drugs 0 Fig. 1.: A 1-cm incision was made at the anterior preauricular hair line. The end of the transparent barbed thread (green arrow) was exposed by blunt dissection and then removed.Fig. 2.: Hematoxylin-eosin staining of the debrided tissue showed intensive infiltration of inflammatory cells and multifocal unstructured crystalline materials (black stars) (10× magnification).The results of our study show that infection was the most common reason leading to consultation and reoperation. Most complications after facial thread-lifting can be treated nonsurgically. Débridement and thread removal are recommended for patients with recurrent infection, thread extrusion, and subcutaneous induration. Preoperative ultrasonography was helpful in defining the area of thread infection. Threads can be completely or partially removed within 3 months after facial thread-lifting. Most patients recovered well and were satisfied with the clinical outcomes. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

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