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Patients intimidated by surgery or without time for a facelift now have more minimally invasive options that produce effective results. Barbed sutures offer patients faster results without the downtime of surgery.
In the Philippines, cosmetic surgeons are also using barbed sutures more and more as an alternative to facelift surgery. The attraction this offers to patients is that it does not involve extensive surgery with its attendant risks, hospitalization, nor long periods of recovery from the swelling and bruising that invariably accompanies facelift surgery.
The Philippine Association of Plastic and Reconstructive Surgeons sponsored a seminar to inform practicing plastic surgeons and residents about this new technique of using barbed sutures, more commonly known as "Aptos threads". The guest speaker at the Philippine Association of Plastic and Reconstructive Surgeons' seminar featuring the Aptos technology for facial contouring was none other than Dr. Marlen Sulamanidze, the Russian scientist, inventor and plastic surgeon who obtained world wide patents on his Aptos threads, also known as Russian threads.
This nonsurgical approach to facial lifting utilizes the use of patented Aptos threads, wires, springs and needles. The threads are polypropylene threads with fine cogs or barbs cut into the thread; the barbs anchor onto facial tissue as the surgeon lifts the sagging skin in order to obtain a rejuvenated new look. The threads can be applied to brow, forehead, neck, jaw line and cheek lifting.
Dr. Sulamanidze claims that the threads can support the tissues in their new position for years. My initial impression is that the Aptos thread will have its best application for a select group of patients with thin sagging skin. Patients with ample facial fat do not seem to have as good results compared to patients with thin skin.
However, when one compares the Aptos thread to the traditional face-lift with all its risks, trauma, suffering, prolonged downtime and high cost, it is apparent that it will have greater acceptance and application in the coming years.
When the Aptos Lift was first introduced in the Philippines, plastic surgeons were skeptical of the claims that it could alleviate the problem of sagging skin. Dr. Sulamanidze's visit to Manila gave them the opportunity to observe the technique as performed by the inventor himself.
The first patient was a middle aged lady on whom Dr. Sulamanidze demonstrated the use of the Aptos threads for lifting sagging skin of the cheek area and the use of Aptos springs to remove so-called "marionette smiles" which are but vertical wrinkles beginning at the corners of the mouth up to the jaw line. Dr. Sulamanidze patiently showed his preoperative markings on the face, injected anesthesia into the target areas, and explained how deep the threads should be placed. At the end of the procedure, there was indeed a remarkable lifting of the cheek skin and the disappearance of the marionette smiles.
The second patient was likewise a middle aged lady with sagging cheek skin, neck skin, and fairly deep nasolabial folds. Dr. Sulamanidze this time showed a different technique of lifting the cheek skin with non-barbed polypropylene sutures attached to specially designed Aptos needles, which are either curved or straight needles pointed on both ends with the suture attached to the needle at its middle portion. The threads are applied around triangular areas of subdermal tissue and anchored onto periosteum below the lateral canthal area of the eyelid. Again, there was a remarkable lifting of the cheek and neck skin. The nasolabial folds were treated by cutting the skin attachments using the Aptos wire which was threaded around the folds.
When asked about how long the lifting effect of his Aptos threads would last, Dr. Sulamanidze replied that he has been doing the Aptos Lift since 1998, and results varied from as short as a few months to as long as 5 years. The short-lived results were due to faulty technique or to poor patient compliance in the immediate period after application of the Aptos threads. But Dr. Sulamanidze remarked that these cases could be corrected immediately by reapplication of the Aptos threads. This alternative non-surgical procedure is indeed something patients can consider to lift and support sagging tissues.
In another live surgery demonstration, Dr. Sulamanidze showed how sagging breasts can be lifted using the Aptos suture suspension technique. Four Aptos 2-0 polypropylene sutures are placed 2 cm deep in the breast tissue and are threaded around the clavicle bone in order to mechanically lift sagging breasts.
The advantage of this technique is that it avoids the vertical or T-shaped scars below the nipple-areola complex in conventional breast lift or mastopexy operations. This is a major benefit for patients who are afraid of getting scars around their breasts.
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