Response to "Is There a Role for a Noninvasive Alternative to Face and Neck Lifting? The Polydioxanone Thread Lift"

We would like to thank F.P. Bernardini with his comments on our article “Effectiveness, longevity, and complications of facelift by barbed suture insertion” in Aesthet Surg J. 2019;39(3):241-247 (1). Indeed, regarding costs of a barbed suture lift and that of a modern facelift in current time, there may be, dependent on socio-economic circumstances and the level of the private practice, a great difference in price between these two procedures. However, comparing these two methods with regard to quality and durability there is a huge difference; basically a thread lift results in a short term lifting effect (2) without real solving of the facial aging problem as does a modern facelift; significant long-term lifting effect with mostly additional lipofilling to replace volume loss and initiate rejuvenation of the skin probably induced by the stem cells of the lipograft (3-4). Moreover, a facelift also allows bidirectional lifting: vertical repositioning of the SMAS and repositioning of excess skin in a more oblique direction, which results in far more natural facial rejuvenation than blind unidirectional scrunging up of tissues as with a thread lift. We agree with dr Bernardini that nowadays short-term effects of relative simple non-invasive procedures are popular and definite have become an important corner-stone in our daily practice: these procedures, like the use of fillers, toxins and lasers in combination with microneedling are safe means of non-surgical rejuvenation and therefore a lesser long-term i.e. a short-term longevity is justified. However for thread lifts, this is not the case: whereas dr. Bernardini states that the rate of complications of thread lifts is low, as is apparent from our study (1) he states, we have concluded from the same figures of our study that the rate of complications is high: it is just a manner of reference with regard to what we feel to be a high or low complication rate: in our practice the observed complications rate after thread lifts is regarded to be high because we think and feel that in a high quality demanding private practice, the rate of complications should really be below 1-3 %. If you are used to higher rates of complications, as apparently dr. Bernardini does, one might think 11.2% of superficial displacement of the thread into the dermis and an infection rate of 6.2% is low. Threads to our opinion are not justified as a lunch-time treatment for the aging and sagging face: the modern surgical facelift (which also can be as short scar facelift) mostly combined with lipofilling nowadays is the gold standard to truly address facial sagging, mitigate (mandible) bone loss and deal with the relative skin excess (3,4). Even with great experience in thread lifting the potential chance of complications is much higher as comparted to the use of fillers and toxins. We think that in a semi open surgical procedure, the use of threads may be justified for a selected group of patients that are not suitable for extensive surgery (1).