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Barbed sutures allow brow lift without invasive surgery
Polypropylene suture lifts the skin with minimal discomfort and scarring. Results are immediate, with minimal swelling, surgeons say.
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A polypropylene barbed suture material is now available to allow oculoplastic surgeons to perform minimally invasive brow lift procedures. The self-anchoring Contour Threads, distributed by Surgical Specialties Corp., are approved by the Food and Drug Administration for use in plastic and aesthetic surgery.
Contour Threads, which are 25 cm in length, are made from polypropylene material with unidirectional cogs running along the length of the suture. The devices are inserted into the midface area and anchored in an immobile area of the scalp, according to Gregory Ruff, MD.
When the suture is pulled, the barbs of the suture open and engage the tissue, lifting the tissue for a facelift-like result, Dr. Ruff told Ocular Surgery News in a telephone interview.
Without the need of performing an invasive face-lift, the lifting is done by the threads pulling the skin taut, according to a press release from Surgical Specialties. Typically, the procedure takes 45 minutes under local anesthesia, and the patient takes 2 to 3 days to heal, according to the company press release.
How the threads work
Contour Threads work to reverse tissue expansion. The cells of the epidermis multiply when the skin is stretched, and collagen can multiply to make the skin look unnatural, he said.
Dr. Ruff explained that, even though the dermis is stretched when using the Contour Threads, collagen cells multiply and bulk up that area of the skin that was pulled taut, creating a natural look. The forehead is lifted by the sutures and the brow goes up. As each of the barbs shares the load, the slack is taken from the lower forehead and pushed up toward the hairline, Dr. Ruff explained, and the slack tissue tightens up.
“The barbed suture is necessary for several months while the tissue of the forehead is tightening up to give the appearance of a lift,” Dr. Ruff said.
The patient loses some of the lift in the first couple of months after insertion of the threads, and the skin plateaus to its best result at about 5 to 6 months postoperative, he said.
“At about 6 months you have set the clock back, and then you are going to age,” Dr. Ruff said. The lift generally lasts for about 2 to 3 years.
“Because you see some loosening in the immediate period, you try to overcorrect patients,” Dr. Ruff said.
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  Brow lift with Contour Threads in a 44-year-old patient: (a) before the procedure, (b) immediately after the procedure, (c) at 2 months postop and (d) at 6 months postop. Images: Ruff G |
Another option
Dr. Ruff said he has been using the polypropylene sutures for more than 2 years and has implanted about 300 threads in 50 patients. He has not seen any complications except for one suture break.
“The sutures generally do not break, but if they do, the surgeon can go in with a needle to smooth out the suture and place another suture to readjust the lift,” he said
There is no lengthy recovery period; patients can return to work in 2 to 3 days, Dr. Ruff said.
According to a company press release, the scarring associated with the thread is minimal, and most patients are unable to discern where the needle entered the face.
“The threads can be used in addition to a blepharoplasty, but I recommend doing the suture lift first and then the blepharoplasty 3 to 6 months later,” Dr. Ruff said. If this staged approach is not used, the surgeon will not know exactly where the brow will end up, and it will be difficult to know how much skin to take out of the blepharoplasty, he said.
Dr. Ruff said he has his brow lift patients look into a mirror to decide how dramatic a lift they would like.
“The vast majority of my patients are under local anesthesia and do not react negatively to seeing the procedure in a mirror,” Dr. Ruff said. If the patient has excessive skin in the jowl area, it may be distressing for them to watch the procedure in the mirror, he said.
A brow lift has a broad range of application, according to Dr. Ruff.
“I personally feel that anyone is a candidate for the brow lift. I have done lifts for a 31-year-old and for a 76-year-old, both with good results,” he added.
Advantages and results
Benjamin Schlecter, MD, FACS, has used the Contour Threads in 26 patients for midface lifts.
Among the advantages of using the Contour Threads is that the surgery can be performed under local anesthesia, thereby eliminating the risks associated with general anesthesia and hospitalization, Dr. Schlecter said in an interview with Ocular Surgery News. The sutures can be applied in the office setting with two tiny pinprick incisions, he said.
The midface procedure presents a more uniform and symmetrical gathering and lifting of tissue when performed with Contour Threads, according to company information.
Any asymmetry that results from the Contour Threads is usually immediately detectable and can be corrected before the patient leaves, Dr. Schlecter said. Additionally, patients can return for touch-ups if necessary, he said.
Results of the 45-minute procedure are discernible more or less immediately, compared with traditional facelift surgery, after which it can take up to 6 months for full healing to occur, Dr. Schlecter said. Within 24 hours of the procedure the patient is able to clearly see the change in facial contouring. Full healing and final results take between 1 and 2 months, at which time collagen has formed around the threads, he added.
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  Brow lift with Contour Threads in a 65-year-old patient: (a) before the procedure, (b) immediately after the procedure, (c) at 2 months postop and (d) at 6 months postop. Images: Ruff G |
For Your Information:
- Gregory Ruff, MD, can be reached at 55 Vilcom Circle, Suite 310, Chapel Hill, NC 27514; 919-967-0000; e-mail: GRuff@ruffmd.com.
- Benjamin Schlecter, MD, can be reached at the Reading Hospital at Spring Ridge; 2603 Keiser Blvd.; Suite 207; Wyomissing, PA 19610; 610-678-9200; e-mail: centerplas@aol.com.
- Surgical Specialties Corp., the manufacturer and distributor of Contour Threads, can be reached at 100 Dennis Drive, Reading, PA 19606, 800-821-8349; fax: 610-404-1037; Web site: www.contourthreads.com.
- Quill Medical Corp., the patent holder for Contour Threads, can be reached at 2505 Meridian Parkway, Suite 150, Research Triangle Park, NC 27713; 919-806-1961; fax: 919-806-1953; Web site: www.quillmedical.com.
- Kim Norton is an OSN Staff Writer who covers all aspects of ophthalmology.