J Cosmet Med 2020; 4(2): 96-100  https://doi.org/10.25056/JCM.2020.4.2.96
How to correct and prevent mid-face widening after using floating (or non-fixation) type polydioxanone thread-lift
Kyoungjin Kang, MD, PhD1, Sun Woo Lee, MS2, Phoebe Kar Wai Lam, MBChB (Otago), MRCS (Edin), MScPDerm (Cardiff)3
1Seoul Cosmetic Surgery, Busan, Rep. of Korea, 2Bison Medical, Seoul, Rep. of Korea, 3Perfect Skin Solution, Hong Kong
Phoebe Kar Wai Lam
E-mail: drlamkarwai@gmail.com
Received: October 8, 2020; Revised: November 22, 2020; Accepted: November 26, 2020; Published online: December 31, 2020.
© Korean Society of Korean Cosmetic Surgery. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Thread-lifting is a minimally invasive face-lifting procedure that lifts and reposition ptotic soft tissue associated with ageing. This procedure has become increasingly more popular in the last decade. mid-face widening (MFW) is a frequent complaint after thread-lifting, as the descended ptotic soft tissues gathered to the middle of the thread during repositioning. The bunching up of the lax soft tissue increases both the facial volume and the MFW. We attempt to overcome the MFW as an unexpected common complication. Three patients underwent our thread-lifting procedure and followed up for six months. The assessment parameter, bizygomatic diameter (BZD), taken at baseline, three and six-month follow-up with standardised digital computerised 3-dimensional (3D) images using MIRAGE 3D, Taiwan. The floating 90 mm and 115 mm threads, were inserted in the following sequence: first, two single-layers (temporal and high temporal, along the superior temporal line) and then, one dual-layer (zygomatic/cheek region). This thread arrangement aims to overcome and correct the position-dependent downward sagging and volume loss associated with facial ageing, but without increasing the MFW of the patients. None of the patients developed MFW following thread-lifting at three- and six months following treatment. An observed reduction between 4.7–17.9 mm (average, 11.3 mm) in BZD recorded at six-month follow-up. There was no significant discomfort or complications have been reported. Based on the results of our cases, this floating technique, combining two single and one dual-layer, in the three regions (temporal, high temporal and zygomatic/cheek) appears favourable in achieving satisfactory face-lifting and rebalancing facial volume without an increase in MFW.
Keywords: aging; polydioxanone; rhytidoplasty; sutures; zygoma
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