In recent years, the utilization of barbed tensor threads has surged in popularity as a means of rejuvenating the face, particularly in cheek rejuvenation. However, when it comes to neck rejuvenation, there is a scarcity of comprehensive techniques and explanations regarding the use of barbed sutures. This innovative approach employs minimally invasive methods to elevate and tighten the neck skin by employing barbed threads. These threads are equipped with small barbs that securely grip and uplift the tissue. Through the careful insertion of these threads using tiny needles and strategic placement, the desired lifting effect is achieved. Due to its minimal invasiveness, minimal downtime, and absence of scarring, it has become a favored option for individuals seeking a non-surgical alternative to traditional neck lifts.

Keywords: neck lifting, neck rejuvenation, barber tensor threads, noninvasive procedure

The desire for a youthful appearance and the influence of social media have contributed to a significant rise in the demand for non-invasive or minimally invasive facial rejuvenation procedures in recent years. Patients are now seeking treatments that can provide results similar to traditional facelifts, but with reduced downtime, discomfort, and risks. In response to this growing demand, medical professionals have been continuously developing new techniques such as thread lifts, injected fillers, laser treatments, and radiofrequency treatments. These innovative approaches aim to deliver effective and long-lasting results while minimizing the invasiveness of the procedures. However, it is important to recognize that successful facial rejuvenation still relies on the ability to lift soft tissues and maintain them in an elevated position. This requires meticulous planning, precise execution, careful patient selection, and appropriate follow-up care. Patients should understand that the outcomes of these procedures may not be as dramatic or enduring as those achieved through traditional facelifts. They should also be aware that maintenance treatments may be necessary over time to sustain the desired results.^1,2

The emergence of thread lifts has been particularly noteworthy in the field of facial rejuvenation. This technique involves the insertion of special threads into the skin, which are then lifted to create a more youthful appearance. Thread lifts offer several advantages, including minimal scarring, shorter recovery periods, and the potential for immediate improvements. However, it is crucial for patients to have realistic expectations and understand that the effects of thread lifts may gradually diminish over time.³

This article aims to provide a detailed description of a minimally invasive technique for treating neck flaccidity. It specifically addresses two common issues associated with traditional approaches: the inadequate durability of sustentation threads and the undesirable scarring resulting from rhytidectomy. By adopting this innovative technique, patients seeking to address neck flaccidity can enjoy the benefits of longer-lasting results and minimal visible scarring.

The described technique is well-suited for patients experiencing mild to moderate cervical flaccidity who desire a natural appearance without visible scarring. In cases of more severe flaccidity, the technique can be combined with a mini facelift to achieve more significant outcomes. Furthermore, if there is localized excess fat in the cervical region, liposuction may be performed to enhance the contour of the neck, particularly when superficial fat is present.

It is crucial to customize the choice of technique for neck rejuvenation according to the patient's specific anatomy, expectations, and the surgeon's expertise. Prior to the procedure, meticulous surgical markings are essential as they guide the surgeon on the precise entry and exit points for the barbed wires and identify the areas that require treatment.

In this case, the markings are made with the patient sitting in a natural and comfortable position, with the head in a neutral position, to identify the central point of the cervico-mentonian angle in the area between the chin and the neck. Next, the hyoid depression point is marked on the cervical midline using lateral bidigitated traction (as identified in the Figure 1A). The width of the lateral traction will influence the amount of skin laxity to be treated in the neck (Figure 1B & Figure 1C). The greater the width, the greater the need for rotation of the central pulley. I suggest performing one rotation for the treatment of a 5mm width, two rotations for 10mm, three for 15mm, and one more rotation for each 5mm of skin to be treated.

Figure 1 A) Bidigital lateral traction to evidence the cervicofacial angle; B) Marking the passage of the wire in the central region of the neck and its width according to the degree of flaccidity; C) Lateral wire exit near the earlobe.

Once the marking is complete, the next step is to inject a tumescent solution consisting of lidocaine and adrenaline into the treated area to provide anesthesia, minimize bleeding, and aid in fat removal through liposuction if necessary. It is crucial that an experienced and qualified professional performs the anesthetic infiltration to reduce the risk of complications, while monitoring the patient throughout the entire procedure to ensure their comfort and safety.

The technique consists of passing a double-needle barbed wire through the marked region on the neck, creating a single, double, or more according to the need to treat the central sagging, with another double-needle barbed wire going to the opposite side. When lateral traction is applied to the wires, the central pulley is pulled through the hole previously created, where it is placed under the subcutaneous tissue. The two ends are then tied together near the exit hole near the earlobe (Figure 2).

Figure 2 Technique: A) Schematic drawing of the technique; B) Passing the first needle in a medial direction lateral to the neck; C) Realization of the central pulley that will tie the two wires; D) Lateral traction of the wires with exit close to the earlobe.

The technique utilizes absorbable support wires composed of a material that is gradually absorbed by the body, eliminating the requirement for future removal. These wires are securely anchored to specific points within the muscles and tissues of the cervical region. The traction applied to these wires is carefully adjusted to achieve a natural and enduring lifting effect, as depicted in Figures 3. When combined with neck liposuction, if deemed necessary, this technique yields compelling and long-lasting results, as illustrated in Figure 4.

Figure 3 Clinical cases: A) Post immediate wire passage in a 52-year-old man; B) Post-procedure 6 months in a 65-year-old woman; C) 8-month post-procedure in a 70-year-old woman.

Figure 4 12-month post-procedure in a 48-year-old woman associated with neck liposuction.

Barbed sutures have emerged as a minimally invasive method for rejuvenating the face and neck. This technique entails the delicate insertion of thin wires equipped with small barbs into the skin, followed by gentle pulling to lift and tighten loose skin. When the pointed thread traverses the midline of the neck, it produces a notable lifting effect. Barbed sutures are especially effective in addressing the early signs of aging, helping to forestall further sagging and wrinkling of the skin.^1,2,3

While suture suspension techniques have been employed for facial rejuvenation for an extended period, the utilization of barbed sutures in minimally invasive facelifts is a recent advancement. This technique entails the insertion of barbed sutures through the skin, followed by the application of tension to lift and tighten the soft tissues of the face and neck. It is crucial to recognize that despite being promoted as a convenient alternative to traditional surgical facelifts, this technique remains a medical procedure and should exclusively be performed by skilled and experienced medical professionals.^3,4

Limited evidence suggests that barbed suture suspension techniques can lead to a modest enhancement in facial appearance. However, it is crucial to manage patient expectations and acknowledge that the outcomes may not be as striking or enduring as those attained through traditional surgical methods. It is also important to recognize that any medical procedure carries inherent risks and potential complications. Patients contemplating barbed suture suspension techniques should engage in thorough discussions with their medical provider, carefully assessing the potential benefits against the possible risks involved.^3,4,5,6

The Sulamanidze technique, employing self-sustaining sutures, is a tissue suspension method that utilizes barbed sutures. These sutures possess the advantage of distributing force evenly along the suture, potentially yielding superior outcomes compared to traditional smooth sutures. Over time, this technique has been refined, incorporating more robust anchoring techniques to enhance its effectiveness. These modifications may include the addition of extra fixation points or adjustments to the sutures or procedure itself.⁴

The objective of this minimally invasive technique is to offer patients an alternative for enhancing the appearance of their necks without resorting to more invasive surgical procedures. However, it is crucial to acknowledge that, like any medical procedure, there are associated risks. Therefore, patients should engage in thorough discussions with their healthcare provider to fully understand the potential benefits and risks before undergoing treatment.

The "Magic Neck Lifting" technique offers a cervical lifting approach that avoids submental scarring. This method utilizes absorbable support wires inserted into the midline of the neck to lift and support flaccid cervical tissues. The wires are crossed in the midline, creating a pulley-like effect that lifts the submentonian region's tissues. To secure the desired results, the two wire extremities are tied either at the level of the lobes or posterior to them, depending on the degree of skin flaccidity.

The utilization of barbed sutures as a minimally invasive cosmetic procedure has garnered attention; however, the existing evidence regarding their safety and effectiveness is currently limited and inconclusive. While they may offer benefits in reducing severe fractures and dislocations, there have been reports of mild and self-limiting side effects. The duration, magnitude, and long-term impact of the corrective effects achieved with these sutures remain uncertain due to the absence of objective outcome measures and long-term follow-up data. To ascertain the potential advantages and risks of barbed suture suspension for facial rejuvenation, further rigorous studies are required.^7,8

The careful selection of the type and placement of sutures is of utmost importance to prevent any harm to facial nerves and muscles. Additionally, close monitoring and management of potential complications, including infection, suture crushing, and asymmetry, are essential. It should be noted that the placement of barbed sutures might impose limitations on future cosmetic or reconstructive procedures. Therefore, the choice of suture material and placement technique should be made with great consideration to minimize these associated risks.^9,10

Achieving optimal outcomes and minimizing complications in facial rejuvenation with suspension threads necessitates thorough consideration and meticulous planning. There is a clear need for objective clinical and laboratory studies to comprehensively comprehend the benefits and risks associated with this technology and establish evidence-based guidelines for its utilization. Nonetheless, the use of traction suture spines presents a promising option for neck rejuvenation. It is crucial to acknowledge that the success of the procedure heavily relies on the expertise and experience of the surgeon. Therefore, it is imperative to select a qualified and experienced professional to perform the surgery.

None.

Author declares that there is no conflict of interest.

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