Complications of thread lift about skin dimpling and thread extrusion

Abstract

Dear Editor, Thread lift is known to be a minimally invasive procedure for facial rejuvenation. Barbed absorbable threads become the mainstream of thread lift, including cog threads and cone threads. The efficacy of thread lift depends on three factors: fixation point, vector, and exit point. The main target layer of threads is subcutaneous layer. How to design thread numbers, positions, depth, and vector is an art. We report three patients with complications of thread lift about dimpling and thread extrusion. We treated skin dimpling with manual therapy and subcision, and removed thread when thread extrusion occurred. Treatments of complications of thread lift are highly valued. Suture removal is necessary when displacement of the barbed threads happen. Bertossi et al advised the patient to massage the thread three times a day for 6 days, and the threads subsequently were extracted by the surgeon in the direction opposite that of placement. Mild skin dimpling, erythema, infection, and temporary facial stiffness that happened occasionally.5 Lee et al published a study about PDO thread for Asians. The complications included swelling, bruising, skin dimpling, and asymmetry.6 Sarigul Guduk and Karaca published a study about 148 patients. The most common complication was skin dimpling and irregularity. The other complications were ecchymosis, suture extrusion, pain, hematoma, infection, and suture migration.7 Guida et al published a study about poly-l-lactic acid traction thread treatment for mild-moderate degree of skin laxity of jawline and neck angle. The complications included edema, swelling, temporary skin contour irregularities, and paresthesia.8 Archer and Garcia published a study about silhouette instalift thread. The complications includes minor pain, swelling, rippling, dimpling, bruising, bleeding at the entry or exit sites, edema, asymmetry, dysesthesia, skin irregularities, and inflammatory reactions.9 In these three cases, Case 3 had the severe dimpling complication. The anchor of the thread hooked the dermis too tight. We used 18-G needle to cut the thread in the dermis. During subcision, a needle cut these thread thereby releasing the tension of the dermis, allowing the skin to rise. Other than dimpling, prevention of severe complications is very important. Doctors should avoid injuring the superficial temporal artery, zygomatico-orbital artery, transverse facial artery, facial nerve, and parotid duct. The authors declare no potential conflict of interest.

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