#7-2. Surgical methods for different degrees of sagging

Mid to lower face sagging correction using thread lift

For mid to lower face sagging, face lift or thread lift can be ideal options.

The suture materials used in thread lift can largely be categorized as the floating type and fixed type. The floating type usually has bidirectional cogs which pull together the skin and soft tissues (Changing the direction of cogs can create an outward push and some threads are cogless and target improved elasticity).

Most lifting procedures are simple but have limited lifting effect. The fixed type has one-directional cogs and mainly pull the tissues upward, and is usually anchored to hard tissues such as the deep temporal fascia. The procedure is complicated but has strong lifting effect. Avoid lifting the lateral face as it could make the face appear wider and the lifting effect does not reach the anterior face.

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I published a study on AAPS (Arch Aesthetic Plast Surg 2014;20(3):160-164) on the very first combination of floating and fixed type thread lift, which is a way of compensating for the above shortcomings. Draw a perpendicular line through the lateral orbital rim. The area lateral to this line is “fixed lateral face” that has low mobility and the area medial to this line is “mobile anterior face” with high mobility (Image 2).

Image 2. The fixed lateral face that lies over the lateral masticatory structures. The frontal face can be categorized as the mobile anterior face. Source: AAPS(Arch Aesthetic Plast Surg 2014;20(3):160-164).

I place the fixed type thread in the fixed lateral face at the deep temporal fascia (Image 3).