Aesthetic Plastic Surgery

, Volume 38, Issue 1, pp 69–74 | Cite as

Facial Rejuvenation With Fine-Barbed Threads: The Simple Miz Lift

  • Tae Hwan Park
  • Sang Won SeoEmail author
  • Kwi Whan WhangEmail author
Multimedia Manuscript Aesthetic



Since the invention of the first barbed (short) suture by Sulamanidze in the late 1990s, different techniques have been described including Woffles (long) thread lifting, Waptos suture lifting, Isse unidirectional barbed-threads lifting, and silhouette lifting. The authors have implemented a newly developed type of thread integrating more small cogs and a soft and fragile feeling of the material (medical grade polypropylene: 16.5 cm long, 15 cm of length covered with cogs, and 0.40 mm in diameter). This study aimed to describe the authors’ thread and the surgical techniques they have adopted to counteract the descent and laxity of facial soft tissues.


A retrospective chart review was performed during a period of 2 years, from March 2010 to February 2012. The procedure was performed with the patient under local anesthesia and intravenous sedation. The face was marked preoperatively to determine the appropriate vector of the thread and its five end fixation points. The superior border of the incision was approximately at the level of the lateral brow, and the lower border was about 2 cm above the superior margin of the helical root. After the temporal incision was made, the dissection was carried all the way down to the deep temporal fascia to create a plane between the superficial and deep temporal fascias. Using blunt cannulas, the dissection was continued in an inferomedial direction from the temporal incision to the lower face through the sub-submucosal aponeurotic system (sub-SMAS) plane, which was marked preoperatively. This sub-SMAS dissection could easily proceed to the premasseteric space (PMS). The face-lift sutures (Gusan Inc., Seoul, Republic of Korea) then were inserted through the cannula from the lower face to the temporal incision line. The sutures were trimmed, and the proximal ends were secured on the deep temporal fascia reinforced with Vicryl interrupted sutures. The results were assessed objectively using serial photography and subjectively according to patient assessment. Complications also were recorded.


All but two patients (100/102, 98.1 %) were satisfied with the outcomes after surgery. Consensus ratings by two independent plastic surgeons found that objective outcomes were divided among “excellent,” “good,” and “fair.” The postoperative course was uneventful except for one patient (1/102, 1 %) who presented with minor skin dimpling and another patient (1/102, 1 %) who had a temporary facial weakness. These two complicated cases were resolved spontaneously without any surgical interventions.


The reported technique has several advantages over current approaches. First, the use of nonabsorbable sutures with sufficient maintenance potential can produce long-lasting, satisfying results. Second, use of the authors’ fine thread can avoid complications such as extruded or visible thread, which often have been complaints with thread lifting. Third, use of a loose areolar plane, including sub-SMAS and PMS free of vital structures, which is deeper than the traditional lift procedure, can avoid any traction line during rest or animation without any significant complications.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Rejuvenation Rhytidoplasty Thread 



Mi-Yeon Lee, biostatistician of the Medical Information Department, performed the statistical analyses. Kwan Koo Yeo, M.D., and Ji Hwan Lee, M.D., helped in assessing the objective aesthetic results. All these individuals are associated with Kangbuk Samsung Hospital in Seoul, South Korea.

Supplementary material

Supplementary material 1 (MP4 51028 kb)

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Fig. S1 Preoperative frontal view of a 38-year-old woman (case 1). (JPEG 34 kb)
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Fig. S2 Preoperative oblique view (case 1). (JPEG 38 kb)
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Fig. S3 Frontal view of both infraorbital areas 6 months after a thread lift and free fat grafting (2 ml, respectively) (case 1). (JPEG 40 kb)
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Fig. S4 Oblique view 6 months postoperatively (case 1). (JPEG 39 kb)
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Fig. S5 Preoperative frontal view of a 34-year-old woman (case 2). (JPEG 28 kb)
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Fig. S6 Preoperative oblique view (case 2). (JPEG 29 kb)
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Fig. S7 Frontal view of both mid-cheek areas 1 year after a thread lift and free fat grafting (2.5 ml, respectively) (case 2). (JPEG 33 kb)
266_2013_177_MOESM9_ESM.jpg (33 kb)
Fig. S8 Oblique view 1 year postoperatively (case 2). (JPEG 33 kb)
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Fig. S9 Preoperative frontal view of a 48-year-old woman (case 3). (JPEG 33 kb)
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Fig. S10 Preoperative oblique view (case 3). (JPEG 33 kb)
266_2013_177_MOESM12_ESM.jpg (36 kb)
Fig. S11 Frontal view 1 year after a thread lift alone (case 3). (JPEG 35 kb)
266_2013_177_MOESM13_ESM.jpg (38 kb)
Fig. S12 Oblique view 1 year postoperatively (case 3). (JPEG 37 kb)


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Copyright information

© Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2013

Authors and Affiliations

  1. 1.Department of Plastic and Reconstructive SurgeryKangbuk Samsung Hospital, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Miz Aesthetic Surgery ClinicSeoulRepublic of Korea
  3. 3.Research DepartmentMiz Aesthetic Surgery ClinicSeoulRepublic of Korea
  4. 4.Health Care ServiceIncheonRepublic of Korea

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