The History of Facial Threads

Modern barbed suture can trace its origins to Dr John H. Alcamo, who submitted his idea to the US patent office on 13 August 1956 and was issued US patent number 3,123,077 on 3 March 1964 for “… a suture so formed that it prevents slippage in sutured incisions or wounds…” It was the same year that Egypt seized the Suez Canal; Britain and France responded with force. Although Dr Alcamo described the design for this suture, it was not until 1967 that a practical medical use was found for them. In that year, Dr A.R. McKenzie reported using barbed sutures in vitro in human cadavers and in vivo in dogs for the repair of long flexor tendons. Between 1967 and 1994, many patents were filed for their use and application in various fields of medicine.

In 1999, Dr Harry J. Buncke received a US patent for “several surgical procedures for binding together living tissue using one-way sutures having barbs on their exterior surfaces and a needle on one or both ends”. Buncke, who has been called the ‘Father of Microsurgery’ for contributions to reconstructive microsurgical procedures, was an American plastic surgeon and served as a clinical professor of surgery at Stanford University. He also was a past president of the American Society for Surgery of the Hand, the International Society of Reconstructive Microsurgery, and the American Association of Plastic Surgery. Quill Medical was acquired by Angiotech Pharmaceuticals in 2006 and, with Dr Gregory Ruff, produced the Quill? Knotless Tissue-Closure Device. Meanwhile, in 2002, two doctors, Russian Marlen Sulamanidze and French Pierre Fournier, published a sentinel paper in Journal of Dermatological Surgery on introducing a new type of facelift using barbed threads, entitled Removal of facial soft tissue ptosis with special threads. They followed it three years later with another publication in Otolaryngologic Clinics of North America entitled Facial lifting with ‘APTOS’ threads. I am sure the name cleverly came from ‘Anti Ptosis’

Marlen Sulamanidze was born in Georgia in 1947. In 1972 he graduated from the Irkutsk Medical University. From 1974 to 1984 his specialization was maxillofacial surgery and later he started specializing in plastic and aesthetic surgery first in Georgia and from 1993 in Moscow. These events were witnessed in Singapore by plastic surgeon Dr Woffles Wu, who felt that the APTOS procedure gave more of a face-firming than a face-lifting effect. He was critical about the short-barbed sutures with no stable fixation point and decided to develop his own. His bidirectional barbed sutures were effectively a type of sling that was folded on itself and had a stable fixation point in the deep temporal fascia. He claimed this method conferred greater lifting power as it had a higher pull tension, and it was more logical to suspend the loose facial tissues to the dense and immovable fibrous temporal fascia. He called it the WAPTOS (Woffles-APTOS) procedure in acknowledgment of Sulamanidze’s APTOS procedure.

Woffles Wu was born in Singapore, but he grew up in London. He once told me in Paris that his mother affectionately nicknamed him ‘Woffles’ after a rabbit from the novel The Magic Faraway Tree by Enid Blyton. Thankfully, he grew to accept this nickname. Wu is a Fellow of the Royal College of Surgeons of Edinburgh and has worked under Prof S T Lee, a cleft palate surgeon. In 1990, he won the Young Surgeon of the Year Award for his research on nasal anatomy. Woffles says that Sulamanidze saw him present the WAPTOS procedure at the International Confederation of Plastic and Reconstructive Surgery (IPRAS) meeting in Sydney, Australia, in 2003 and he encouraged him to call it the ‘Woffles Lift’ because the technique was different from his APTOS technique. Interestingly, it is said that Nicanor G. Isse from Newport Beach, California, was also in the audience and he was inspired to make his own version of a monodirectional barbed thread anchored at the temple via a surgical approach and to use it in conjunction with the endoscopic face-lift technique he had developed.

Wu and Isse subsequently presented their results in a panel discussion at the Annual American Society of Aesthetic Plastic Surgeons (AASPS) meeting in Vancouver, 2004. In 2005, Isse presented his results to the Journal of Aesthetic Surgery in a paper titled Elevating the midface with barbed polypropylene sutures. His thread design was later acquired by the Contour Thread Company. These were the first thread sutures that I used. With the Woffles Lift Version 1, the loop of the sling was in the distal face and the two free ends were tied together at the temple. This occasionally gave rise to knot palpability or extrusion so he decided to invert the suture slings such that the loop of the sling would be embedded superiorly in the temporal fascia, with the free ends of the thread oriented distally. This conferred better lifting of the soft tissues in the lower face and avoided the need to tie any knots and had a lower complication rate (~2%). He claims that he has not encountered any problems of granuloma, infection, or thread extrusion since then. In 2009, Covidien introduced V-Loc? (Covidien Healthcare, Mansfield, MA) unidirectional barbed suture with a fixed loop, and in 2013, both Angiotech Pharmaceuticals and Ethicon Endo-Surgery (Cincinnati, OH) introduced unidirectional barbed sutures with a variable loop at the end for facilitated fixation. Over the past decade, Marlen Sulamanidze and his son, Georgii, developed differing thread techniques with microscopic, angled barbs (Aptos Thread), double-pointed needles (Aptos Needle) and elastic needles (Aptos Spring).

They have contributed to the history of threads, sufficiently lifting ptosis of the face and neck with minimal cuts or with tiny cutaneous incisions. In 2010,Silhouette Soft? thread lifting was introduced. This was a non-surgical facelift with a unique double lifting and regenerating effect. This new concept in facial rejuvenation is a 30-minute procedure that results in a refined, lifted, and natural appearance restoring the ‘triangle of youth’ without resorting to surgery. Silhouette Soft gave immediate results by redefining and adding volume, and to continue to restore shapeliness for 18 -24 months. At the 2019 Royal Society of Medicine Aesthetic Medicine conference, I had a special section on threads. The innovators of the APTOS? technique, Mr George Sulamanidze and his wife, Dr Albina Kajaia, from Tbilisi, gave a live demonstration of a non-surgical facelift – threads versus fillers – and Dr Kwon, the President, International Association of Aesthetic and Antiaging Medicine (South Korea) and inventor of the Ultra-V PCL Thread Lifting Technique provided a workshop on thread lifting for face and for nose procedure Associate Professor Ivor Lim, plastic surgeon and group chief medical officer, Cell Research Corporation, Singapore, gave a talk on the latest trends in stem cells research. To complete the day, my research on the PLEASE Technique won the Royal Society of Medicine Aesthetic 11 Conference Poster Award 2019.

The Chapter on the history of facial threads is taken from the book 'The Evolution of Aesthetic Medicine' which will be released this 31st March 2022.

The Evolution of Aesthetic Medicine ISBN:?9781398417489

This book will be released on?31st March 2022. Available to pre-order ￡23.99

https://www.austinmacauley.com/book/evolution-aesthetic-medicine

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