New anti-aging technique may spare you the nip and tuck

Karen Hogue isn't trying to look 20. Or 30, even. A mother of two teenage girls, the 51-year-old Southern Californian isn't ashamed of her age. Still, when it comes to looking a little bit younger, she's not opposed to some outside help.

"I don't like women who try to act like they're 21 when they're 50," said Hogue, who last year underwent an anti-aging procedure called a Contour ThreadLift to lift the drooping skin around her jaw line. "I'm doing this to soften the aging effect, not take it away."
These days, people who want to soften the aging effect have plenty of options. They can be nipped, tucked, filled in, plumped up, smoothed out and now pulled up with strings.

"Nobody wants to see their face sagging," said Hogue, an athletic-looking woman with long blond hair and, since the procedure, a more sculpted jaw line. "I'm not trying to look like a 30-year-old, but I don't want this sagging jowl. Who wants that?" The ThreadLift, which was approved by the Food and Drug Administration in September 2004, is touted as a minimally invasive procedure designed to lift sagging eyebrows, reposition drooping cheeks and adjust and lift the aging neck area.

"We lose four to five CCs of volume from our face per year," said Dr. Gail Humble, a board-certified anesthesiologist who regularly performs the ThreadLift and other nonsurgical cosmetic procedures at Blue Pacific Aesthetic Medical Group in Manhattan Beach, Calif. "So it's not so much that you're hanging as that your volume is going away and you're deflating."

To perform the procedure, doctors make an incision at the hairline and, using a long, thin needle, insert the barbed threads - most people get three or four threads on each side - beneath the skin. Threads are made of clear polypropylene, a material that has been commonly used in the body as sutures, and have tiny barbs that fixate under the skin in an umbrellalike fashion. The barbs catch onto the tissue, allowing doctors to pull at the threads until the skin lifts into the desired position. The needle is then removed and the threads are cut and knotted. Contour Threads are the only barbed suture cleared by the FDA for use in the brow, midface and neck.

"Patients should be aware of this," said Contour Thread spokeswoman Fran Kelly, because some physicians import threads or make their own.

If the patient changes his or her mind after the ThreadLift procedure is completed, the threads can be removed within the first few weeks; after that time, scar tissue builds around the threads and the tissue heals in its new, elevated position. The result: Sagging skin is lifted into a higher, younger-looking position.

Humble said the procedure is best for people in their 40s and 50s who aren't yet ready for a face-lift but who want a subtle, "fresher" look. It's also an attractive option for those who are wary of surgical procedures and would rather have a less-invasive approach.

"I would rather do these things that we can reverse, or that will wear off," said Hogue, who said she has also gotten Botox shots to soften the lines around her eyes. "(Surgery) scares me too much."

She's not alone. Last year, about 80 percent of the nearly 11.5 million cosmetic procedures performed in the United States were nonsurgical, according to the American Society for Aesthetic Plastic Surgery, with Botox injections, laser hair removal and microdermabrasion the three most common procedures.

ThreadLifts, which cost between $2,000 and $5,000 depending on the number of threads used, take about 60 minutes to perform and are done under local anesthesia. Patients can go home soon after the procedure, though full effects aren't achieved for two or three weeks.

A face-lift, by comparison, costs about $6,200 (not including other charges such as the facility fee, anesthesia and medical tests), takes three or four hours to complete and is often performed under general anesthesia. Most patients require several weeks of recovery time.

The effects of a ThreadLift last two to five years, practitioners say, whereas a face-lift lasts five to 10 years. In both cases, the duration of the results depends on the age of the patient and the condition of his or her skin.

"Patients want results, but they don't want downtime," said Mark L. Jewell, president of the American Society for Aesthetic Plastic Surgery. "They're looking for a minimally invasive approach that will produce visible results without the surgery."

When it comes to the ThreadLift, though, what some doctors see as a less-invasive road to a younger-looking appearance, other doctors view as uncharted territory demanding more study.

"A lot more needs to be known in terms of safety," said Jewell, a former Manhattan Beach resident who now works as a plastic surgeon in Eugene, Ore. "We place breast implants in all the time but we know how well breast implants work. The face is a whole different thing.

"Show me the data that these things are safe and they are effective," he continued. "It would be nice if the people who are promoting the threads can do a follow-up a few years later."

One of the concerns is the question of what happens when too many threads are sewn under the skin. Threads don't absorb into the body, and though no ill effects have been documented, Jewell said there hasn't been enough time to know for sure.

"In some cases, you're putting in enough of these threads to turn someone's face into a tennis racket," he said. "Sometimes, they've got more than 10 threads on one side of the face. These are permanent sutures that don't dissolve."

But according to Humble, that could change.

"Within nine months, we should have FDA approval on a thread that's bioabsorbable," Humble said.

Meanwhile, patients are told they can come back every two to three years for new threads. And when the time comes, Hogue said she has no second thoughts about it.

"I would definitely do it again," she said. "I think it's wonderful that we have the technology that we can do these things. Why do women use anti-aging creams? If you can keep your face looking younger and smoother, why not?"