Shortly after 7 a.m. one recent morning, Annette Padussis winced as Baltimore plastic surgeon Ricardo Rodriguez injected her face with an anesthetic in preparation for a "thread lift," a new cosmetic procedure touted as a less drastic alternative to a face-lift.
An hour later the 54-year-old Towson pharmacist was in her car, headed for a full day at work. Flesh-colored bandages covered bruises caused by the clear sutures, or threads, that Rodriguez had snaked underneath the skin beside her chin and around her mouth to hoist and anchor sagging tissue.
A week later, after the bandages were removed and the swelling subsided, Padussis was delighted by what she didn't see: Her small jowls were gone and what plastic surgeons call "marionette" lines running from the side of her nose to the corner of her mouth had been smoothed.
"I look about eight or 10 years younger," she said. "The whole thing was such a great experience that I'm going back to have my neck done in February."
In the eternal quest for cosmetic enhancements that promise speedy recovery and instant results, the thread lift -- also known as the feather lift, lunchtime lift or suspension lift -- has emerged as one of the most requested new fixes. The minimally invasive procedure, which usually takes about an hour and typically costs $3,000 to $4,000, is performed in a doctor's office under local anesthesia. The time and cost of the procedure vary in part according to the number of threads used.
A typical face-lift, by contrast, takes about four hours, is performed under general anesthesia, costs $8,000 to $15,000 and requires weeks of recovery. Unlike a face-lift, a thread lift is reversible.
The apparent ease of a thread lift and its promise to subtly "refresh" a sagging middle-aged face without weeks of downtime, has made it especially popular with baby boomers leery of the pop-eyed, taut-skinned appearance commonly associated with a face-lift, which removes excess skin.
"I didn't want that deer-in-the-headlights look, or anything radical," said Douglas L. Kohler, 44, a Northern Virginia advertising executive who was back at work the morning after undergoing an afternoon thread lift in the office of Washington plastic surgeon Paul G. Ruff.
In the past eight months, the lift has been performed on the "Today" show, "Oprah" and "Good Morning America" as well as on local television stations around the country. More than 9,000 procedures have been performed using Contour Threads, which were approved by the Food and Drug Administration (FDA) in 2004. Thousands of other procedures have been performed using another brand known as Aptos sutures.
While Rodriguez is enthusiastic about the procedure, other plastic surgeons characterize thread lifts as the latest expensive fad. They say the procedure has not been adequately studied and is being performed by too many doctors who lack the necessary skills. Some of these physicians, critics say, operate on patients after taking a one-day course -- sometimes with unfortunate results.
Safe and effective?
Even in the deft hands of a board-certified plastic surgeon, there can be complications: threads that bunch up, break or protrude through the skin. In some cases the nondissolving sutures, which are made of polypropylene and have tiny barbs similar to a fishhook, can be felt or seen.
Then there are the results. Some detractors say that once the swelling disappears, so does the younger look.
"It's hard to tell which are the before and after pictures," said Michael J. Olding, chief of plastic surgery at George Washington University Medical Center, who does not perform thread lifts. "The optimal patient is someone who doesn't need anything done."
New York plastic surgeon Robert W. Bernard calls the results "underwhelming."
"I'm extraordinarily reluctant to jump on the bandwagon until this has stood the test of time," said Bernard, a past president of the American Society for Aesthetic Plastic Surgery. "I would tell patients to wait a couple more years. The quick fix has got to work, be safe and do what it's supposed to do."
But other plastic surgeons say that although the procedure will probably never supplant face-lifts, which achieve more dramatic results, thread lifts do serve a purpose.
At first "I was very skeptical, but patients have been very happy," said Craig A. Vander Kolk, director of the Johns Hopkins Cosmetic Center, who has performed about 25 thread lifts. "I think they provide a result many people are looking for."
Although some patients say they have been told their thread lifts could last three to five years -- about half the life span of a face-lift-- it's impossible to know for certain because the procedure is so new.
Even so, Rodriguez, chief of plastic surgery at Greater Baltimore Medical Center, said he thinks the lift may have an impact similar to liposuction, the fat-sucking technique that was initially shunned by some plastic surgeons after it was introduced in the 1980s. In the past few years liposuction has become a mainstay of plastic surgery and is now the most commonly performed procedure, according to the American Society of Plastic Surgeons.
"Everything that is new in plastic surgery is usually controversial," Rodriguez observed. "But there are always a bunch of early adopters."
Longer than lunch
Two surgeons -- Gregory Ruff, a plastic surgeon in Chapel Hill, N.C., and Marlen Sulamanidze, a Russian physician -- are credited with inventing the thread lift sutures independently in the 1990s. Ruff is currently medical director of Surgical Specialties, which makes Contour Threads, the market leader in the U.S. Sulamanidze invented blue Aptos sutures, which are popular abroad.
Surgical Specialties, based in Reading, Pa., requires doctors who buy Contour Threads, which cost about $100 each, to take a one-day course. So far about 1,400 have done so, according to company marketing director Greg Toso. Sixty percent of these doctors are plastic surgeons, oral surgeons or dermatologic surgeons, Toso said, while 40 percent practice other specialties such as otolaryngology or family practice.
Toso said that although consumers are "asking for procedures that are minimally invasive," the view that a thread lift can be done during a lunch hour is not endorsed by the company.
"The downtime is not a lunch," he said. "It can be a day or a week, depending on the area that is being done."
The complication rate from the Contour Thread procedure is low, Toso said, less than 0.3 percent, and the procedure is not difficult to learn.
A doctor makes a tiny incision at the hairline in the area to be treated and, using a thin hollow needle, threads the barbed sutures into tissue below the skin's surface. The barbs on the thread catch tissue, lifting it like an open umbrella; the tension can be adjusted by the surgeon, who attaches the threads to underlying tissue and gently tugs skin into the desired position. The needle is then removed and the threads are cut and knotted. The body subsequently produces collagen around the barbs, which help support the skin in its new, elevated position.
As for criticism that the results of thread lifts are temporary and unimpressive, Toso said, "There are surgeons who are more skilled than others."
Manhattan plastic surgeon Robert C. Silich would undoubtedly agree.
In the past year Silich said he has removed threads from the faces of three patients. Two women developed dimpled skin, while a third contracted a postoperative infection, which Silich characterized as rare. None of the procedures had been performed by a plastic surgeon, he said.
"People jump on anything that's new," said Silich, who adds that his patients frequently ask him about thread lifts, which he does not perform. "If they insist, I try to get them to a board-certified plastic surgeon."
Cosmetic dermatologist Ben Treen of Greenville, S.C., who has performed 60 thread lifts, said that physician specialty is no guarantee of a good outcome. "The thesis that plastic surgeons should do all cosmetic surgery is easily disproven," he said.
Hopkins's Vander Kolk said that about six of his 25 thread lift patients have experienced minor complications; one woman had her threads removed.
Another of his patients, a 54-year-old Montgomery County real estate executive, said she decided to undergo the $3,000 procedure last July after watching it being performed on television.
She asked that her name not be published because she said she told colleagues and relatives she had undergone sinus surgery.
"It's not like the 'Today' show, where they say she had the procedure and went shopping," recalled the woman, who was out of work for a week. "I had quite a bit of swelling, and it took a month for it to go down."
When she returned to work also sporting a new haircut, she said she received numerous compliments on her new look. "People told me, 'Oh my God, your haircut looks great.' It was mild enough so it helps you with your self-confidence. It really is a pick-me-up."
She was unprepared, she said, for several new and unwelcome sensations. When she rubs her hand along her cheeks she can feel a thread; if she smiles too broadly she experiences a "ping" in her jaw.
"I think the most important thing is that people need to be prepared and understand the worst scenario of how you might feel," she said. "It was hardly a lunchtime lift." ·