Improving the Durability of Thread-Based Rejuvenation with Facial Liposuction
- Admin
- May 16
- 6 min read
Based on Dr. Kwang Il Bae et al. | Archives of Aesthetic Plastic Surgery, 2019
Introduction
Minimally invasive procedures are redefining the way we approach facial rejuvenation. Among them, barbed thread lifting has become increasingly popular due to its convenience, short downtime, and lower complication risk compared to conventional surgical lifts. However, thread lifting alone often lacks durability, and many studies report a decline in results within months after treatment.
In an effort to address this limitation, Dr. Kwang Il Bae and colleagues explored whether combining thread lifting with facial liposuction could lead to longer-lasting and more effective rejuvenation. Their retrospective study evaluated clinical outcomes in patients treated with thread lift alone versus those who underwent thread lifting with concurrent liposuction, measuring improvements using both physician-assessed GAIS and patient satisfaction scores.
Surgical Technique: From Design to Anchoring
For all patients, thread lifting was performed using absorbable barbed PDO threads (MINT Lift ML-1043). The threads were anchored in the deep temporal fascia near the superior temporal line. The design process began with the patient in an upright seated position, where the area for liposuction was determined using a pinch test, and threads were mapped with an exit point spacing of 1 cm. The lifting vectors were designed to be almost vertical, focusing on lower face sagging.
In the thread-liposuction group, liposuction was performed first through a small stab incision near the infra-auricular or infra-jowl area. A tumescent solution with lidocaine and epinephrine was injected to emulsify fat and create a safe dissection plane. Then, using a 14G spatula-type cannula, the surgeon performed controlled liposuction, carefully avoiding over-resection that might lead to contour irregularity.
Following fat removal, the barbed threads were inserted using a long curved needle passed through the subcutaneous layer and exited at the designed lift vectors. Threads were then tensioned, trimmed, and any dimpling was gently resolved by manual compression. In patients who received thread lift alone, the same thread protocol was followed, but liposuction was omitted. Depending on the degree of laxity, 8 to 14 threads per side were used.
Clinical Results: Enhanced Rejuvenation with Combined Treatment
The study evaluated a total of 27 female patients, dividing them into two groups: Group A, which received thread lifting alone (11 patients), and Group B, which received thread lifting in combination with facial liposuction (16 patients). The mean age of participants across both groups was 43 years, and none had significant differences in baseline skin laxity or facial aging scores.
To assess aesthetic improvement, the study utilized the Global Aesthetic Improvement Scale (GAIS), a 5-point standardized metric evaluated independently by three board-certified surgeons. Lower GAIS scores indicate more favorable outcomes. Results clearly demonstrated that the combination of liposuction and thread lifting produced statistically and visually superior results.
Patients in Group B, who underwent the combined treatment, achieved an average GAIS score of 1.85, indicating noticeable and sustained facial rejuvenation. In contrast, Group A, which received only thread lifting, showed a mean GAIS of 2.54, suggesting more modest and shorter-lived improvements. In photographic comparisons, patients in the thread-only group often showed lingering jowling and submandibular fullness within 3 to 4 months post-procedure. Conversely, patients who underwent the combined procedure maintained defined jawlines and reduced facial heaviness for up to 7 months.
Patient satisfaction also aligned with the physician evaluations. Group B reported an average satisfaction score of 3.06 out of 4, while Group A averaged 2.36. This finding underscores not only the visual success of the combination approach but also the emotional and psychological satisfaction patients experienced from achieving more balanced facial contours..
Source: Bae, K. I., Han, D. G., Kim, S.-E., & Lee, Y. B. (2019). Minimally invasive facial rejuvenation combining thread lifting with liposuction: A clinical comparison with thread lifting alone. Archives of Aesthetic Plastic Surgery, 25(2), 52–58. https://doi.org/10.14730/aaps.2018.01550
Figure 2 depicts a patient who had thread lifting alone, showing persistent fullness. Figure 3 shows a similar result with residual jowling. Figures 4 and 5, on the other hand, highlight patients treated with the combined technique, maintaining well-defined facial contour several months post-procedure.
Together, the objective scores, patient-reported satisfaction, and visual documentation support the conclusion that thread lifting alone may not suffice for patients with excess subcutaneous fat. The combination of mechanical lift and volume reduction offers superior outcomes across the board.
Safety and Recovery
One of the most valuable findings from this study was the strong safety profile observed in both treatment groups. No patients in either group experienced serious complications, such as hematoma, infection, nerve injury, or thread exposure, risks often associated with more invasive surgical approaches.
The most commonly reported side effect was bruising (ecchymosis). This was observed in five patients in the thread-only group and in two patients in the thread + liposuction group. Importantly, the bruising was mild in severity, self-limiting, and resolved completely within a few days to a week. There were no cases of asymmetry, dimpling, or overcorrection in either cohort.
Recovery time was also remarkably short. All patients were able to return to daily activities within one week, with most resuming light activity or work within three days. This minimal downtime further strengthens the case for the combined approach as a safe and efficient option for facial rejuvenation.
The addition of liposuction did not significantly prolong the procedure or increase complication rates. When performed carefully, with attention to fat removal depth and preservation of critical structures, the facial liposuction component was not only safe but synergistic, amplifying the effectiveness of the thread lift without increasing patient risk or discomfort.
Why Liposuction Makes a Difference in Thread Lift Outcomes
One of the fundamental limitations of thread lifting is its inability to remove bulk, it repositions soft tissue but does not reduce volume. When used alone in patients with facial fullness or thick subcutaneous fat, threads may provide temporary lift, but the effects tend to relapse as fat exerts downward force during healing.
Liposuction addresses this issue by debulking redundant fat, creating space for tissue contraction, and enhancing the mechanical support provided by the threads. Additionally, the inflammatory response from liposuction itself may stimulate fibroplasia, contributing to longer-lasting tissue tightening.
This study highlights that thread lifting and liposuction are synergistic, especially for patients with round or full lower faces who might not benefit as much from lifting alone. The removal of fatty volume also improves thread grip and anchorage, especially in patients with moderate laxity and heavier jowls.
Conclusion
This study reinforces the growing clinical impression that thread lifting alone may fall short in certain facial types, particularly those with soft tissue fullness or resistant jowling. By pairing thread lifting with targeted liposuction, surgeons can achieve not just lift, but also contour definition, volume reduction, and enhanced thread longevity.
For the right patient, this combined approach offers a scalpel-free solution to lower face aging, with a strong safety profile, fast recovery, and sustained satisfaction over months. As the field of aesthetic medicine moves toward multimodal treatments, thread lifting combined with liposuction represents a well-balanced, practical innovation that delivers on both form and function.
Reference:
Bae, K. I., Han, D. G., Kim, S.-E., & Lee, Y. B. (2019). Minimally invasive facial rejuvenation combining thread lifting with liposuction: A clinical comparison with thread lifting alone. Archives of Aesthetic Plastic Surgery, 25(2), 52–58. https://doi.org/10.14730/aaps.2018.01550
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