Threading: The Future of Face-Lifts?

The worlds of plastic surgery and dermatology get closer together each year, with less-invasive anti-aging treatments at the forefront of what patients want and doctors are working toward. The variety of techniques, substances, and theories on how to turn back the clock with as natural a look as possible are near-infinite, at this point.

One under-the-radar approach that’s sending A-listers flocking to Europe and Asia is the concept of threading, i.e., inserting a tiny—sometimes barbed—thread into the face (or knees, or neck, or…) and carefully pulling up the skin to create a natural-looking lift that’s not at all Botox-y. Sound too good to be true? We’re pretty intrigued. Below, some questions and answers with two of the more prominent physicians out there who are doing this type of procedure: Dr. Maurice Dray in Europe, and Dr. Woffles Wu in Singapore.

Dr. Maurice Dray

French dermatologist Maurice Dray has become famous throughout Europe for his less-invasive face-lift-alternative treatments, combining fillers with antioxidants and injecting them deep beneath the surface of the skin to stimulate the body to make collagen (the structural part of skin that decreases as we age), and inserting sugar-based threads into the skin for a face-lifting effect that lasts two years. The sugar-threading technique is not yet FDA-approved (he performs treatments in his clinics in London and Paris); many dermatologists in the U.S. treat the face deeply with fillers, but every doctor’s technique is unique.

You use Vitamin E and hyaluronic acid in a lot of treatments—why are they so powerful? Are they all natural?

Yes we do. We also use Vitamin A and Vitamin C as well as minerals. They are all great antioxidants for the skin and all possess healing properties. They are injected as a combination directly into the dermis, which is where the skin’s cells stimulate and produce collagen.

Everything is absolutely natural. It’s the body’s own collagen-stimulation process, generated as a result of this treatment.

How do you inject them into the skin, what are the results, and are they permanent?

We inject with a specially designed gun. We can customize the depth, control, and speed directly into the dermis and it is completely painless.

Visible results are increased glow, hydration, and elasticity. We suggest three sessions one month apart to begin with, and then customize the follow-up treatments depending on the patient.

The results are not permanent but it nourishes skin to feed its own rejuvenation.

What exactly is sugar threading? Did you develop this?

This is a natural thread that melts three to four weeks after the procedure. It can be inserted into any area or region of the body that has problems with sagging—most commonly in the neck, chin, and jawline. It helps to create fibrous tissue and to stimulate new skin tissue. The treatment itself is not mine but I’ve customized this particular method.

How long does it last and what are the side effects?

The improvement will last two years. After the first treatment, patients should expect to see a 50% improvement. I can do a follow up treatment six months later for another 20-30% improvement. All my patients are delighted with the results from the first treatment, which they typically see after a month, once the threads have melted and the new skin cells and tissues are born.

There are no side effects. Down time is minimal—there can be slight bruising for a few days, but nothing that cannot be hidden with some makeup or a scarf.

Any sense of whether this will eventually become legal in the United States?

I would think so: There are no side effects; the results are successful; it’s natural and safe. For now, it’s is available at my London or Paris clinics.

On average, how long does it take and how many threads do you use in a typical face?

It usually takes 30 minutes. I tend to use 5-10 threads (subject to area) per treatment. They are painless and straightforward to put in.

Can you do it elsewhere on the body? What are the most common requests?

I can do this everywhere. This treatments targets areas of the body where skin sags. This includes; face, neck, arms, breast, legs and knees.

Can you give us an example of a price?

$1,850 for the neck.

Dr. Woffles Wu

Dr. Woffles Wu, a top plastic surgeon in Singapore, has pioneered a new threading technique as a (relatively) noninvasive alternative to a surgical face-lift. Since inventing it in 2002, he’s been asked to train doctors in countries all over the world, which lifts the face for one to five years (traditional face-lifts generally last five to seven). While recovery is not nothing, it’s drastically less intense than the recovery (or the risks) for a traditional face-lift.

Brought up in England and trained in Singapore, Wu (His beautician mother nicknamed him Woffles after the rabbit character in the Enid Blyton novel The Magic Faraway Tree) worked as a plastic surgeon for 12 years before setting up his own private practice at Camden Medical Centre in Singapore. He’s a Fellow of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore. He treats local patients as well as those who fly in from all over the world, and volunteers repairing cleft palettes in Myanmar, Java, and West Timor.

Can you tell us a little about your iconic treatment, The Woffles Lift? What exactly is it, and how does it work?

The Woffles Lift is the most innovative approach to face-lifting in the last 100 years. It is a paradigm shift in facial aesthetics—a non-surgical procedure that can lift sagging soft tissues, rejuvenating and reshaping the face without having to delaminate any soft tissue or create unsightly scars around the ears. It does not rely on any heating device or external lifting mechanism. The technique utilizes a special thread called the Woffles Thread that was invented in 2002. These threads are 60cm polypropylene threads with multiple barbs distributed in a spiral fashion along the length of the thread. They are inserted via a needle introducer with the surgically cleansed, draped patient in a sitting position. No knots are used either at the point of insertion or fixation. Over time, the threads elicit a fibrous capsule reaction around them which creates bands of fibrosis or “new ligaments” that hold the skin envelope to the underlying fascial structures. The procedure is performed under local anesthesia without sedation, and takes thirty minutes to complete. Patients leave the clinic immediately after and experience minimal swelling or downtime over the next three to four days, and are able to resume social life thereafter.

Is anyone else practicing it?

Prior to the development of these threads, I had experience using short barbed facial sutures that did not have any areas of stable fixation and therefore could not give the type of results I wished to see in my patients. I conceptualized and designed the Woffles thread in a small medical device facility in California which I happened to be visiting at the time. I wanted to see a more visible lifting of facial soft tissues in a more vertical direction which is the logical counterpoint to the effect of gravity. I designed the technique primarily to treat my own patients but having presented it at many conferences around the world, many physicians and surgeons have been keen to learn how it works. They have flown to observe me perform the procedure in Singapore, and attended special teaching workshops that I conduct periodically. I have trained several doctors from Japan, Korea, Singapore, Australia, Europe, and the USA.

Is there visible downtime?

Compared to a traditional face-lift which can take two to three weeks to settle down, the downtime of three to four days is negligible. Some swelling, bruising, and surface undulations can be seen but within a week, the facial surface is stable and smooth. Patients can cover up any needle marks or bruises from the first day after the procedure.

Is it permanent?

Nothing is permanent! Not even a traditional face-lift (for which there is a considerable recovery time and the threat of more potential complications) lasts longer than five to seven years. Continued aging is inevitable and sagging re-occurs. The average face-lift surgeon is all too aware that the jowls, marionette lines, and nasolabial lines can all re-occur within a year to 18 months after traditional face-lift surgery. The Woffles Lift can create significant lifting for between one to five years, depending on the patient’s own rate of aging and activity profile. The average longevity is approximately two years. When sagging does re-occur, it is a simple matter to repeat the procedure with any number of desired threads, again with no cutting, no delimitation, and minimal downtime. We have noticed that with repeated procedures, the result becomes more stable and lasts longer and longer.

Is it safe?

It is very safe. The worst thing that can happen during the procedure is temporary bleeding, but with compression and tamponade, this will stop within several minutes and the procedure can be continued. Post-operatively, there is a very small risk of thread infection or granuloma formation but if proper surgical sterility is followed, these risks are very low. Thread rupture and extrusion can also occur, but these are considered minor complications and they are easily corrected.

What are the prices?

$11,000 for a full mid-face and upper neck lift, $6,000 for neck lift alone, $4,500-6,000 for forehead/brow lift, and $9,000 for a mid-face firming.

Do you know if anyone is practicing anything like this in the U.S.? How common are procedures like this?

There are many different kinds of thread products available in the U.S.; each has its own merits, but in my opinion, none provide the vectors and strength of lifting achieved with the Woffles Lift to give consistent and predictable results.

Do you think that ultimately procedures like this will replace traditional plastic surgery?

Yes. For sure. If you provide logical, safe, and predictable non-surgical techniques to patients, they will never want to have major invasive surgery. Many surgeons performing traditional face-lifting have seen the numbers drop in recent years: Patients just don’t want the protracted downtime, the visibility of scars, and the risks involved. Recently, a 63-year-old patient who’d had a traditional face-lift two years ago felt that she was having prominence of the jowl and marionette lines again. In under 30 minutes, we had fixed this with the Woffles Lift to the jowls—and the patient was delighted with the result. She was able to compare the two procedures and liked the simplicity and immediacy of the Woffles Lift.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice.