Written by Dr. Jonathan Zelken
2020 has been known for a lot of things. From a plastic surgery standpoint, we have had a chance to rebuild. One of the most notable trends (ignoring all the controversy and tragedy that has occurred), is the emergence and popularity of what some people call a “cat-eye” surgery or brow lift.
Most of these procedures are neither surgical nor do they meaningfully lift the brow. Although they are popular and they can confer at least temporary change, there are inherent limitations of a thread lift procedure that I cannot ignore.
I have been trying for years to incorporate thread lift procedures into my practice, but simply cannot convince myself that the longevity and predictability of outcomes warrant my investment.
But the idea is really a great one, it is, and the concept is tried-and-true in plastic surgery. For years, plastic surgeons have been performing suture suspension of the brow for correction of things like ptosis, or lid droop, or drooping of the brows.
In addition, suspension is useful in the midface with a facelift and can even be used for breast lifts and in other body parts. A suture-suspended brow lift would eliminate a lot of issues inherent to more traditional brow lifts including downtime, swelling, numbness of the scalp, wound problems, and fluid collections.
I openly embrace the concept, but the thread lift in the form of a barbed temporary suture needs to be revised. In the fall of 2020, I spent a significant amount of time researching literature and more contemporary thread lifting procedures.
I endeavored to design the optimal procedure, which is an operation, that allows me to place a thread permanently, with durable and predictable results. Furthermore, despite the permanence of the suture, the procedure would be reversible, by removing the thread should a patient so desire it.
The same technology would be used potentially, to elevate the midface, neck, and other facial areas. We created a video to chronicle the process of design and evolution of a surgical procedure aimed to reap all the benefits of a contemporary thread lift or “cat-eye” procedure, but with more predictability, anatomic foundation, and durability.
The cons of what we know as a thread lift are that the sutures placed are dissolvable, they are barbed and rely on dermal attachments to catch these tiny barbs, they are not easily adjustable, and they are expensive. The pros of these thread lifts are they are truly nonsurgical procedures, they can be performed by nursing staff, and they are widely available.
In the thread lift I designed, a permanent braided stitch would replace a dissolvable stitch, it would be fixated in a fixed anatomic structure over the skull, and it can be reversed by removing the stitch later, and only if so desired.
As this video shows, the earliest such operations were successful but there were some issues. The biggest issue that I saw was wrinkle formation above the lateral tail of the brow. Despite efforts to release any ligamentous attachments before placement of the stitch, this was still seen. Fortunately, it was easily correctable; the correction of this deformity allowed me to identify the forces in play and allowed me to improve this procedure.
A second iteration allowed me to successfully address this issue and now I no longer see the irregularity the irregularities, quotation marks around the eyebrows, and other issues that I initially aimed to eliminate with my procedure.
This suture suspension browlift procedure, which shall remain “catchphrase” nameless, is designed to treat crow’s feet and lateral hooding, shorten blepharoplasty scars, widen the eyes, allow for more Botox use in people who are sensitive to Botox, and give young patients that exotic “Bella Hadid” or “cat-eye” look at so many women desire.
The operation is designed to be as permanent as you would like it to be, and reversible should one so desire.
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