Nova Threads: Facial Lifting – Without the Knife!

History of Thread Lifting

We’ve all heard the saying; “necessity is the mother of invention” and this aphorism certainly holds true in the case of using suture material to lift sagging tissues of the face (aka thread lifting). This idea was formulated by Dr. Gregory Ruff, a plastic surgeon in Chapel Hill, N.C. In 1992, while searching for a way to raise the crushed cheek of a car-accident victim, he cut little notches into a few of his surgical sutures, threaded these sutures under her skin and created a sling to move her cheek back into position.  After using hand-notched sutures in several more reconstructive surgeries, Dr. Ruff decided they’d also make a useful cosmetic tool. In 2004, he introduced these modified sutures and christened them Contour Threads.  These transparent sutures with one-directional barbs were designed to tighten sagging skin on the face and neck.

Meanwhile, half-way across the globe, another surgeon in Moscow, Dr. Marlen Sulamanidze, was actively searching for a method of face-lifting that would not require large incisions. His search proved fruitful and in 1999, he developed the Aptos threads.  The name Aptos was a derivation of the two words: against ptosis (sagging).  These were blue sutures with two-directional barbs.

These thread lifts quickly became popular. Patients liked the idea of a procedure that was less costly, did not require large incisions and did not demand a long recovery period.  Unfortunately, this technique was a little ahead of its time.  These threads were non-absorbable and their use  fraught with difficulties: Placement was complicated, skin ‘bunching’ occasionally occurred and the sutures sometimes extruded through the skin.  So in 2007, Contour Threads were taken off the market. Although great in theory, the mechanics of this procedure clearly needed more refinement.

A Better Solution

Subsequently, around 2010, a simpler, less invasive, lower risk thread procedure was developed by surgeons in Korea. They employed PDO (polydioxanone) sutures taking advantage of the outstanding safety profile of this material. PDO sutures has been used extensively in Cardiothoracic, Plastic, OB-Gyn and Trauma surgeries for over 30 years and excels in being highly flexible, strong and elastic.  Best of all, this suture is entirely absorbable – in four to six months the suture is degraded by the body’s immune system. However, the PDO material is a powerful collagen stimulant. It is this new collagen which provides long-lasting lift or skin thickening which can remain in effect 12 – 15 months.

The Four Nova Thread Types:

1. Smooth threads: These are utilized for collagen stimulation and cause firming and thickening of the skin.  They are often placed in a ‘net-like’ or mesh pattern and are beneficial in treating crepey skin of the face, neck or décolleté. They are also used for superficial wrinkles of the forehead, glabella, cheeks, smoker’s lines, marionette lines or lines in the neck. Additionally, they work well to define lip borders.

I had the [smooth] threads put in my lips and laugh lines. They are absolutely amazing & I love how they have made my face look flawless with no fine lines. Thank you Dr. Cohen for once again making me feel fabulous.” ~ Amber Nolte

2. Twisted threads: These are smooth threads which have been coiled. This feature results in more collagen production. These threads are used in the nasolabial folds and marionette areas but also in lips for subtle volumization.

3. Single-barbed threads: As their name suggests, these threads are ‘notched’. They are used to lift and tighten sagging skin and are applied for lifting  brows, cheeks, jowls and upper neck. (Heavier threads of this type are also now being used to create lift in the knee, buttock and breast areas.)

Barbed Threads

4. Double-barbed threads: These are similar to single–barbed threads in that they’re notched but they differ in that there are two sets of barbs in directions opposite each other. The indications for double-barbed threads are the same as for single-barbed threads but they can provide additional lifting and create fullness to the cheek.  Both single and double barbed threads result if the formation of a ‘collagenous tendon’ which maintains the lifting effect.

Areas amenable to Nova Thread placement

Benefits of a Nova Thread Lift:

  • Nonsurgical, safe, in-office procedure using topical or local anesthetic
  • No incision. No scars
  • Affordable
  • Immediate lifting
  • Progressive restoration of collagen (neocollagenesis)
  • Improved skin quality
  • Natural-looking results without the possible ‘stretched look’ of a surgical face-lift

Ideal candidates:

  • Men and women 30 – 65 years old
  • Mild sagging of cheeks, jowls or neck
  • Good skin quality
  • No history of previous facial surgery

Poor candidates:

  • Excessively thin or severely saggy, heavy skin
  • Prior facial surgery/ face lift(s), or previous cheek/chin implants
  • Severely sun damaged, hyper-pigmented skin
Before Brow Lift

After Brow Lift

Thread Procedure:

The process of PDO thread placement is straight-forward and mimics that of dermal filler injections. A topical numbing cream is first applied and the threads are then inserted just underneath the skin with a tiny needle or blunt cannula (about the size of a sewing needle). The threads themselves are slimmer than fine fishing line. The number of threads needed is determined by the area requiring correction and the amount of laxity present.  The procedure is quick (10 – 30 minutes), virtually painless and with short recovery. Outcomes last about 12 – 15 months. Results are immediate for tissue lifting.  Since collagen must be inducedwhen using smooth threads, results for wrinkle reduction will require about six to twelve weeks to be fully appreciated.

Threads for Lip borders

Most common side effects are localized tenderness, swelling and bruising for a few days after the procedure. As with any procedure that breaches the skin barrier, infection is possible but unlikely.  Occasionally sutures may become visible or skin irregularities (tissue ‘tenting’) occur however this is easily corrected.

After-Care Instructions:

  • Avoid hot baths – showers only for 1 week.
  • Avoid facial massages (or use of a Clarisonic device) for 1 month
  • Avoid laser, IPL, RF and other energy-based treatments for 1 month
Mid & Lower Face
Nasolabial & Melomental Folds

Finally, the wait is over and their time has come. Thread lifting is rapidly gaining world-wide recognition as an effective, non-surgical option for treating facial laxity. It has been clearly demonstrated to lift the tissues of the face and neck in patients with mild to moderate ptosis (sagging). PDO Nova Threads are long over-due in the field of non-surgical rejuvenation and they are a welcome addition to the realm of Aesthetic Medicine.

“First off I just want to say, I love Dr. Alice Cohen. I trust her suggestions and her judgement. She knows her business and always has the patient’s best interest and comfort at heart. My biggest concerns were the lines at the corners of my mouth. When people start telling me to ‘smile!’, I know it’s time to have something done. This time Dr. Cohen suggested the fully absorbable PDO Threads (Polydioxanone). We are all born with collagen in our bodies, but by the time we hit our 20’s, our collagen starts to deplete, and our skin begins to sag causing lines and wrinkles. By inserting the PDO Threads, your skin begins to heal itself by creating new collagen. The procedure is like this: Dr. Cohen marked on my face where she wanted the threads to go (these threads are preloaded into a needle). She inserted the needle into my skin and gently guided it to where she wanted the threads to go. The PDO Threads stay beneath the skin as she removed the needle. It only took a minute and Dr. Cohen has the procedure down so well that I felt essentially no pain (and I hate pain!!) The unbelievable thing is that there is instant gratification. As soon as she was finished she handed me the mirror and I could see the result — and it was exactly what I was hoping for!! I had no downtime and no bruising at all (you can even have it done over your lunch hour!) I have always highly recommend Dr. Cohen, and now I recommend the PDO Threads too.”

~ Casey Allyn Radio Host

“I am so excited about the results of my Nova Thread procedure that I want to share my story.  I am in my early 50″s but for the past 1 1/2 years, every time I looked in the mirror, I was bothered by my saggy jowls.  I must admit, when I scheduled my appointment I was very nervous but Dr. Cohen explains everything before and during the procedure and there was truly nothing to be nervous about.  It did not hurt at all and I did not bleed or bruise.  And, the result was immediate.  I am so happy!  I will definitely have this done again in the future.  Thank you Dr. Cohen.

~ Kelly B

” The fact that it [the thread procedure] took no time and was without down time, the results were phenomenal!  I noticed the improvement right away and am now happy with the appearance of my neck.”

~ Mary L

“I recently received my first Nova Threads procedure.  I was extremely nervous and anxious. [Dr Cohen reassured me and offered nitrous oxide with the ProNox machine.  This definitely took away my anxiety and I felt no pain.]  The procedure was fast and painless.”

~SB in Lancaster