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Featured Doctor: Michele D. Koo, M.D.

Michele D. Koo, M.D.
333 S. Kirkwood Road
Suite 203
St. Louis, MO63122

One of the most significant trends sweeping through plastic surgery for at least a year has been almost any cosmetic procedure that can be done without a knife, general anesthesia, stitches or scarring.

Those procedures are often referred to as “lunchtime” because the operations can be done in an hour or less. People additionally like shorter procedures because they can resume all the areas of their lives afterwards, avoiding the dreaded “downtime” of recovery. So, even if the results of surgery last only a few years, more patients are opting for the shorter procedures that provide almost as much rejuvenation as longer surgeries. And, they are willing to go back to their surgeons sooner to keep the refreshed, younger look up to date.

According to many plastic surgeons, this year’s top contender for the most desired, minimally invasive procedure is the thread lift. That’s an operation that uses special surgical threads to lift sagging facial and neck tissues.

Normally, a more youthful facial look is created by trimming away excess skin and underlying muscles, pulling the remaining tissues up tighter and then stitching it all back into place. That’s where general anesthesia and a longer recovery period enter the picture. When the skin and other tissues are pulled away from its blood supply, it takes longer for everything to reconnect again.

But in a thread lift, special sutures are placed under the skin, using a larger-than- normal, hollow needle that only punctures the skin. The needle contains the threads that do the actual lifting.

“The F.D.A. has approved a type of thread lift known as the ‘Contour Thread Lift,’” says Michele Koo, M.D., F.A.C.S. in St. Louis. “Patients love that the procedure can be done in my office with only a local anesthetic, after which they can return to their normal activities.”

While the operation is not meant to replace a surgical facelift and may only provide a more youthful look for, anywhere from six months to several years, surgeons report more people from 25 to 55 are asking for a thread lift to tighten up that thick fold of skin (the nasolabial fold) that runs from the corner of the nose to the corner of the mouth. Also high on consumers’ hit lists are the facial lines that run from the corner of the mouth down to the chin (the marionette lines) and the so-called “turkey gobbler neck,” that wrinkled bunch of extra skin that often grows around a rapidly aging neck.

“However, a person with a significant amount of thick, heavy skin and a very full face would not be a candidate for a thread lift but would probably want to consider a full face lift instead,” says Dr. Koo.

The surgical threads that lift fleshy skin have been in development for many years. Any physician could take some surgical sutures, thread it through muscle just under the skin and tighten things up. But sutures alone cut through muscle and do not do the job. Eventually, plastic surgeons in France, Russia and China developed a type of thread with small feathers, then cogs and now barbs which provide more support. It’s because the barbs become fixated in their surrounding tissues and more-or-less act like opening an umbrella under the skin. Once the barbs are in position, the excess skin which is lifted relaxes and shrinks in two to six weeks, thereby creating the new lifted look.

The actual lifting happens when the surgeon, using that thick, hollow needle, puts a thread into the fat layer just under the skin, starting near the cheekbone, if the procedure is lessening the nasolabial folds. One end of the thread is then tied to deeper, more firm internal structures in the face. The other end travels under the skin about four inches. When the surgeon withdraws the needle, the barbed sutures deposit themselves in the droopy part of the face. The physician then gently tugs on the thread which pulls the loose flesh up, closer to where it once was in the patient’s youth. The technique can be used to lift sagging cheeks, eyebrows and to create a better balance for eyebrows that may be asymmetrical.

Of course, all this new technology comes with a caveat or two.

After a thread lift, a patient would not want to go to a hilarious movie, enjoy his or her favorite stand-up comic or engage in some marathon yakking on a phone. After the lift, a patient must keep the face stiller and quieter than usual for about two weeks until the body grows collagen around the barbs, providing still more support for the lifted tissues. You also would not want to get in a wrestling match or even sleep on your side for fear of rubbing your cheeks the wrong way.

Common side effects of the procedure include some swelling, bruising or headache. Surgical makeup allows most patients to be presentable the next day.

“After a contour lift, patients will feel some lumps and bumpiness under the skin for one to two weeks but they will not feel the barbs themselves,” says Dr. Koo.

Possible risks of the procedure include threads popping out of the skin, infection and rejection. According to the company that makes the threads, a little less than one percent of cases have complications which are usually managed by the surgeon.

So, at least in facial rejuvenation, the old saying about “a stitch in time” can now officially be changed to “a thread in time.”

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