Are threads the future of lip augmentation?

With aesthetic procedure trend predictions for 2020 indicating a backlash against the large, obviously filled lips that have come to define the market in recent years, could lip thread lifts present a far more natural-looking method of lip augmentation? 

“I have only used monofilament PDO threads in a crosshatch fashion for the perioral lines”, says Dr Sotirios Foutsizoglou, founder of SFMedica. “Prominent perioral lines are quite difficult to be effectively treated because of the thinness of the skin, the very small amount of adipose tissue and the mobility of the lips. Botulinum toxin and low G’ HA fillers, either alone or in combination, are the most commonly used treatment modalities to soften those lines, but both are associated with potential problems. Too many units of Botox will paralyse the orbicularis oris, the sphincter of the mouth, too much filler will create a prominent subnasale”, he explains. 

“Using threads for the perioral lines is based on the principle of mechanotransduction, whereby a mechanical stimulus such as the insertion of a thread into the dermis will stimulate the fibroblasts to produce more collagen, elastin and ground substance that could potentially ameliorate the texture of the perioral skin, reverse age-related elastosis, tighten the skin through neocollagenesis, and increase the thickness of the dermal layer”, he said. 

As well as the perioral lines, threads can be used to lift the upper lip to create the illusion of more natural fullness. “People are always intrigued by a new application of an existing product”, says Jonquille Chantrey, who runs a practice in Cheshire. “But I think the idea of lip threads also started to become more popular when Kylie Jenner had her lip filler reversed. Public opinion on filler has started to change, and some may think threads can give more lift with a natural look.” 

Second thoughts

Dr Victoria Manning, co-founder of River Aesthetics, with clinics in London, Dorset and Hampshire, says the clinic group previously used monofilament PDO threads to treat the perioral lines but stopped offering the procedure over a year ago owing to unsatisfactory results. “We stopped using them because you just don’t get very good results from trying to regenerate the skin with a little tiny thread”, she says. “You don’t have much control, it’s far better with a needle, or cannula.” 

Foutsizoglou says that the number of “minor yet troublesome” complications he has experienced from using threads in the lip area outweighs any potential of good results. “Threads are probably my least favourite treatment modality for lip enhancement and perioral rejuvenation”, he says, listing a few key reasons: “Lips have a rich blood supply, so using a sharp needle to insert thin monofilament threads into the dermis will inadvertently go through fine small vessels of the sub-epidermal and dermal plexuses, precipitating bleeding and leading to bruising. 

“The cutaneous part of the lip is extremely thin – only comparable with the periorbital skin, creating a mesh-like pattern to increase fibrous bridging and neocollagenesis can result in a temporary protrusion of the upper cutaneous lip”, he explains, adding: “Due to the mobility of the lips I have had patients complain of being able to palpate and see the end of the thread like a whisker. Thread migration can also occur due to the mobility of the lips.”

Special considerations

Facial animation and mobility of the lips is a key consideration where lip augmentation is concerned, and Chantrey says this is one of the main reasons she doesn’t offer the procedure herself. “I’ve done a lot of work with facial animation. I want a natural result for my patients when they’re speaking and animating, and sometimes threads don’t quite give as natural a result. It can give a nice lift but you need an option with a lot more versatility when you understand all of the structures around the lip from an animation perspective”, she says. “I’ve seen tethering – so uneven areas – asymmetry, puckering, and in one case, it had created almost scar tissue around the vermillion border.”

Foutsizoglou also expresses concern around the pain inserting threads into or around the lip can cause patients: “The lips are rich in sensory nerves, so any treatment in that area can be particularly painful, necessitating either a topical or a local anaesthesia”, he says. “Topical anaesthetics cause vasodilation precipitating bruising and potential haematoma formation, whereas any local anaesthesia injected including infraorbital and mental blocks can temporarily distort the anatomy of lips making asymmetries more likely.” 

Every doctor we spoke to is of the opinion that threads are far better suited to other areas of the face, having experienced minimal completely satisfactory results. “Threads are great for the face but they’re very difficult to reverse”, says Manning. “I’ve also tried them in the arms and stomach and I think there are better treatments for those areas too.” 

The difficulty of removing threads from the lip area is also a red flag for Chantrey, who says she personally prefers to only carry out non-surgical procedures that are reversible. “Threads are better used in areas of the face that aren’t as mobile or dependent on natural animation”, she advises, adding “Anything in regards to the lips has always got to be about understanding the muscles and the anatomy, what’s going on with the teeth, maxilla and mandible. If threads are something you’re really keen on you can always become much more proficient in other areas.” 

Different approach

If patients desire a subtle augmentation to the natural lip shape rather than increased volume, or a soft lift to the upper lip, Manning advises using a HA filler. “It’s about being skilled as an injector. If someone wants a subtle lift of the cupid’s bow or vermillion border, you can still do that with filler but by using a softer product. Choose your product accordingly and use a small amount”, she says. 

As ever, it’s vital to assess the patient’s full face and consider how their desired results will look in relation to their other features. “Lip filler has become so trend-led that you see so many people with overfilled and badly filled lips”, says Manning. “If someone asks for lips like a particular celebrity, don’t just do it. They don’t know what that’s going to look like on their face, they’re not an aesthetician. You’ve got to assess their face and decide if those lips would suit them – everything has to be in proportion.”