Novel Polypropylene Barbed Threads for Midface Lift—“REEBORN Lifting”

Ji Hoon Kim, MD Jae Don Seo, MD Jae Don Plastic Clinic Seoul, Republic of Korea Sir: I recent years, minimally invasive procedures for facial rejuvenation have become more popular. In 2012, the official statistics of the American Society of Plastic Surgery showed that the cosmetic surgical procedures decreased 12% when compared with 2000, but in the same time period, minimally invasive cosmetic procedures increased by more than 130%.1 Face lift with barbed thread is a novel alternative for these patients as it is less invasive procedure and can be performed through minimal incisions or punctures. Since the introduction of the first antiptosis threads (APTOS) by Sulamanidze et al2 in the late 1990s, several other techniques have been described using modifications of the initial threads in terms of the material, the direction of the barbs, and the insertion technique. Recently, novel polypropylene barbed threads sealed with distal mesh and temporal fixation mesh were introduced in the market with the name REEBORN (PrestigeMedicare, South Korea). Ideal candidates for thread lifts include patients with minimal signs of ageing, getting prominence of the jaw, deeper nasolabial folds, and ptosis of the malar fat pad. The REEBORN threads consist of 5 parts from distal to proximal as follows: (1) a smooth part that is used as a guidance for the insertion to the needle, (2) a segment with cogs, (3) mesh segment, (4) proximal cogs segment, and (5) smooth segment for fixation to the mesh and deep temporal fascia (Fig. 1). The advantages of the REEBORN barbed threads are the increased tensile strength and the placement in the sub-SMAS plane. The tensile strength apart from the cogs is ensured by the distal mesh, which with a pore size of more than 1 mm allows for less extensive scar formation. Furthermore, a separated segment of mesh is provided for the fixation to the deep temporal fascia, increasing the stability of the threads and the longevity of the lifting effect. The thread placement in a deeper plane compared to other threads reduces the suture extrusion and also the traction line during rest, and animation is avoided. The procedure can be performed under local anesthesia and sedation. For midface correction, 4 threads on each side of the face are indicated: 2 on the midface for malar fat pad lifting and nasolabial fold correction and 2 on the lower face for jowl correction. After a 2-cm incision in the temporal area, inside the hair-bearing skin to be invisible, a sub-superficial muscular aponeurotic system plane is created with a trocar and the threads are passed with a needle through a cannula. The proximal end of the threads is fixed to a mesh, and the deep temporal fascia and the distal free ends were cut. Our preliminary results using REEBORN threads for facial rejuvenation are satisfactory. Minor skin dimpling, bruising, and edema are common after the procedure and usually last 3 days to 1 week. Seven patients completed minimum follow-up of 6 months (6–13 months). During this period, the lifting effect was maintained and the patients were satisfied with the final result. None of the patients experienced major complications necessitating thread removal. Longer follow-up and more studies are necessary to prove the safety of the procedure and the longevity of the results (Fig. 2).