Thread lifting 4.0

Once a media darling touted by Oprah, thread lifts fell from grace rather unceremoniously in the early 2000s after reports of scarring, infection, and lumps under the skin with the then-used non-absorbable threads.

Fast forward at least 10 years and there are now two new thread-ish lifts making the rounds. Approved for midface suspension, the Silhouette InstaLift uses resorbable suspension sutures with bi-directional cones to redefine the contours of the face. The sutures lift and reposition tissue while the cones anchor the suture and facial skin in an elevated position. The cone material, also made of glycolide/L-lactide (PLLA/PLGA), stimulates fibroblasts for neocollagenesis. And then there's the Nova Thread Lift. Nova's sutures are composed of polydioxanone (PDO), which has been used in cardiovascular surgery for years. These PDO threads don't require anchoring and are being increasingly used for midface lifting and even non-surgical nose jobs.

Thread lifts are back, better, and safer than before and will likely find a place in our toolboxes, but these minimally invasive lifts will never replace surgical facelifting or rhinoplasty.


Botox for Bat Mitzvahs

Cross Botox off of your list of high school graduation specials and distance yourself from lip fillers for Sweet 16 and other not quite so appropriate or safe cosmetic procedures for teens and tweens. Partially driven by social media and the selfie craze, growing numbers of adolescents are seeking cosmetic enhancements to keep up with reality or Instagram stars.

New guidelines created by two Dallas plastic surgeons—Rod J. Rohrich, MD and Min-Jeong Cho, MD—aim to reign in inappropriate teen cosmetic surgery. The guidelines, which appear in the September issue of Plastic and Reconstructive Surgery, urge surgeons to take age, maturity, growth, development, and other factors into consideration before saying yay or nay to a procedure.

In general, rhinoplasty in teens is OK once nasal growth is complete—typically age 15 to 16 in females and age 16 to 18 in males. Breast reduction is acceptable in teen girls with back and neck pain once the breasts are fully developed, which typically occurs between 12 and 19. Otoplasty can be performed as young as age five, as this is when the ear is almost fully grown.

The new guidelines do take a hard stand against lipo, injectables, and cosmetic breast augs in tweens. Chemical peels and cosmetic lasers and injectables should be reserved for those 18 and older (unless the patient has early tear troughs, small lips, weak cheeks, or premature frown lines).