When a beauty procedure goes wrong
The holiday season is the time of year when people set aside their personal problems and give in to the spirit of giving and sharing. For some, however, it’s the best time to get a makeover. So I’m expecting a lot of inquiries related to aesthetic procedures by late November.
Let me share with you the story of a patient who underwent an aesthetic procedure but didn’t get the results she wanted due to a complication.
EK, a woman in her 50s, consulted me for what appeared to be the result of an aesthetic procedure gone wrong. It was an extremely rare complication of a thread-lift procedure.
A thread lift provides the same benefits of surgery without the cutting, scars, and recovery time. It is performed in the clinic under local anesthesia in less than an hour. It is a minimally invasive, non-surgical procedure that lifts and restores skin elasticity.
As its name suggests, threads are sewn into the skin to lift it and thus result in a more youthful appearance. If you don’t like the results, a thread lift is reversible except in certain cases, like EK’s. And though the procedure has little downtime, it also has a downside.
EK’s concern was her dimples, which the procedure appeared to have distorted. There’s a long concavity that passes above and below her dimples. After the procedure, a long, depressed track replaced her once-visible dimple, which ended on her melomental fold (the deep lines from the corner of the mouth to the lateral chin).
Each patient has a different capacity to heal, and each may respond differently to a certain procedure. In EK’s case, she got an infection. And so, before you decide to undergo an aesthetic procedure, particularly a thread lift, here are some things you need to know:
• There are risks and complications. Rippling, dimpling and puckering may arise when one undergoes a thread-lift procedure. There are special threads—like barbs and cogs—used in skin lifting. Cog threads are designed to anchor more firmly within the skin, as it consist of barbs. Cogs provide an immediate face-lifting effect, help in producing a brighter skin tone, and rejuvenate the skin.
When the threads are tightened excessively, the skin ripples over the thread. As long as the thread is placed at the correct depth and layer, this issue will resolve itself. Also, persistent dimpling can be managed with manual manipulation only after post-treatment.
• Asymmetry. A great concern for patients who undergo this procedure is that they will experience asymmetrical results. Many frequently scrutinize their own appearance in great detail after the procedure. To avoid potential post-procedure disappointment, you should be informed about any pre-existing asymmetries. In the case of barbed and cogged threads, it may be helpful to have the patient observe the skin-tightening process by offering them a handheld mirror so that any potential problems regarding asymmetry can be avoided.
• Infection. Although rare, infections may develop after a thread-lift procedure. This may be caused by the thread buckling or curling under the skin. One way to treat this is to perform a subcision treatment, which releases the thread from the skin and allows it to unwind. The cosmetic surgeon can also make a small stab incision to remove the thread completely and replace it at a later time.
Incorrect placement of threads may also lead to localized infection. Overall, infections are few and far between. They are often easily managed by the removal of threads or by oral medication.
EK came to me after her infection was already treated. Maintaining an aseptic technique throughout the procedure to further reduce the risk of infection is best. Use chlorhexidine solution to prep the skin and surgical drapes to create a sterile field for the cog and barb threads.
• Granuloma. Great caution must be exercised to not place the thread on a superficial plane, because the risk of granuloma formation will be higher. A study that examined 100 patients after a breast biopsy noted that a buried knot eroded through the skin in 17 percent of patients due to granuloma formation and positioning.
• Thread breakage. Breakage is when an inexperienced practitioner attempts to tighten the threads during placement when it is still protected by the needle. The tissues should be manipulated to avoid breakage while inserting and tightening the threads.
• Thread loss. During the placement of barbed and cogged threads, ensure that the thread is cut and that the ends are tucked back into the skin to avoid any protrusion, as it will increase the risk for infection and granuloma formation. For monofilament threads, the ends should not be cut, but instead grasped firmly and removed.
• Scarring. Generally, thread lifts do not result in scarring and are designed to keep scars hidden, if any. However, it may still occur in patients who are prone to keloid formation or hypertrophic scarring and those who experienced infection.
Other potential side effects include hematoma or bruise formation, procedure-related nerve damage (sensory modifications), and hypersensitive reactions.
The emergence of minimally invasive barbed, cogged, and monofilament threads for the aging face is an exciting new innovation in the field of aesthetics.
However, the best results have so far been hard to reproduce, as they are mainly operator-dependent.
Complications from the procedure remain mild and limited to the perioperative period and can be corrected by manual manipulation or removal.
As the safety and technique of minimally invasive procedures advance, the future of thread lifting with respect to reducing facial sagging and providing rejuvenation remains bright.