Long-Term Benefits Seen With Minimally Invasive Facial Rejuvenation

Medscape Medical News from the:
International Society of Aesthetic Plastic Surgery (ISAPS) 20th Biennial Congress

James Brice

August 17, 2010 (San Francisco, California) — Positive long-term results from a unique percutaneous approach to rejuvenating face-lift surgery had plastic surgeons buzzing here at the International Society of Aesthetic Plastic Surgery (ISAPS) 20th Biennial Congress about the growing impact of minimally invasive procedures.

Aesthetic plastic surgeons are adapting to growing consumer demands for botulinum toxin (Botox) injections, soft tissue fillers, and chemical peels as relatively inexpensive and less painful alternatives to open surgery. "The specialty is really transitioning from surgery 100% of the time," said Renato Saltz, MD, scientific program director of the 1700-member society, in an interview with Medscape Medical News. He practices at Saltz Plastic Surgery in Park City, Utah.

Injections of botulinum toxin to treat facial crow's feet, a symptom of normal aging or sun overexposure, for example, are leading to the obsolescence of sophisticated surgical procedures that took years to perfect, Dr. Saltz said.

The long-thread lift technique developed in 2002 by Woffles Wu, MD, at his surgical clinic in Singapore, proposes moving invasive face-lift surgery in the same direction.

Treatment begins with a minimally invasive procedure to lift sagging facial structures. It continues with follow-up sessions to apply several nonsurgical strategies to maintain the cosmetic effect over time.

A medical-grade nylon thread, studded with nearly microscopic barbs, is a key component to the initial intervention, Dr. Wu explained. With the patient under local aesthesia, Dr. Wu uses needle guidance to stretch 6 to 8 filaments through subcutaneous fat from the neck and jowl (above the jaw) to the temple (above the hairline). The tension of the threads is adjusted to lift skin, facial fat, and some muscle to a more physically attractive position. The filaments are left after surgery and become a permanent fixture under the skin.


Pre (left) and post (right) procedure. Higher cheeks and jowls create a more youthful appearance in women who undergo a minimally invasive long-thread face lift and long-term nonsurgical follow-up. (Courtesy of Dr. Wu)

"As we age, the ligaments that attach skin to the face become relaxed and less efficient at sticking skin to the underlying muscle," Dr. Wu told Medscape Medical News in a phone interview after his presentation. "So when you put these threads in, you create almost artificial ligaments between the skin and deeper layers of the face."

Dr. Saltz noted that Dr. Wu's approach doesn't replace conventional face lifts, but it is a short-term solution for adults who want to counter the effects of aging without undergoing a highly invasive procedure.

During conventional surgery, facial skin is stripped back from a long incision extending from below the ear lobe to above the hairline, which enables the surgeon to excise fatty deposits and suture sagging tissue. The procedure leads to substantial bruising and swelling. Recovery can take several weeks.

With the long-needle approach, patient trauma is limited to a few small skin punctures and bruising around needle entry and exit points, Dr. Wu said. Short-term patient discomfort can be controlled with nonprescription analgesics. Recovery typically takes 3 days.

The technique is completely scarless, Dr. Wu pointed out. Minor facial swelling and skin tightness are common in the first few days after the procedure. Adverse events have been rare in the approximately 1100 procedures he has performed. Problems with local skin infections along the hairline following the first few hundred surgeries were solved after Dr. Wu stopped knotting the thread at the temple and began looping it through the temple and stringing it back to the jowl, he explained.

Thread spitting — where the thread spontaneously breaks through the skin — is reported in about 2% of cases. The incidents are treated by simply trimming the filament flush with the skin, Dr. Wu said.

Follow-up treatments involving more thread placements and nonsurgical medication are performed about every 18 months to address the ongoing effects of aging.

Dr. Wu coined the term "the 4Rs" to signify the restoration of tissue volume with synthetic fillers, the relaxation of muscles with botulinum toxin, the resurfacing of skin with nonablative techniques (such as intense pulse light and chemical peels), and the redraping or relifting of skin.

Case histories described during Dr. Wu's presentation at the ISAPS meeting showed the fresh faces of older adults who appear to have aged little from the initial procedure and follow-up treatments at the lab.

"I showed a 68-year-old male after 8 years of treatment, and he actually looked younger than he did at age 60." Wu said.

The study did not receive commercial support. Dr. Wu invented the long-needle lift technique and is the owner and lead plastic surgeon at the Aesthetic Surgery & Laser Center in Singapore, where the research was performed. Dr. Saltz was not involved in the research and has disclosed no relevant financial relationships.

International Society of Aesthetic Plastic Surgery (ISAPS) 20th Biennial Congress: Session 2. Presented August 15, 2010.