Traditional facelifts are effective but cause considerable morbidity. Noninvasive laser
and radiofrequency skin tightening cause minimal morbidity but have limited efficacy.
Lying between these extremes is "antiptosis subdermal suspension thread" skin lifting (Aptos).
At its heart is a polypropylene suture having numerous barbs in both directions; the suture
is inserted in a zigzag pattern in the subdermal plane along the direction of skin laxity to
hold skin in the desired position against the pull of gravity. Any bunching of the overlying
skin is smoothed before leaving the suture in place. Several sutures may be placed to achieve the
desired effect.
One physician described his experience using this technique in 350
patients over 4 years. Results were analyzed subjectively by the surgeon and empirically by blinded
evaluation of pre- and postsurgical photographs. Fifty-seven percent of patients experienced reductions
in ptosis of 80% to 100%, 28% had reductions of 60% to 80%, and 13% had reductions of 40% to 60%. Only
two patients had threads removed due to dissatisfaction with the results. Touch-up adjustment was required
in 15% of patients, but the need for touch-ups declined rapidly as the surgeon gained experience.
Mild bruising, swelling, erythema, and visibility of the thread through the
skin resolved with little or no intervention. Longevity of the original correction declined gradually: 85%
to 100% of the correction persisted after 1 year, 70% after 2 years, and 60% after 3 years. Additional insertions
reestablished the original degree of correction.
Comment:
The Aptos nonsurgical skin-tightening procedure is an evolving technique for patients with mild-to-moderate
skin laxity who are not yet candidates for surgical facelift and who want better results than other minimally invasive
technique can achieve. Currently available in Canada, South America, and
several European countries, this promising technique is done under local anesthesia, takes less than an hour, and is minimally invasive. Revision is
occasionally necessary, and the thread may remain visible, but more trouble are reports of thread traveling from
the original path, which may considerably alter results and require extraction. More clinical data will be
needed before the safety of this deceptively simple procedure can be established. Detailed knowledge of facial
anatomy and hands-on training will be important to reduce the complication/revision rate.
-George J. Hruza, MD
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