The Best Thread for Nose Thread Lifts?

Nose thread lifts are rapidly becoming the pre-eminent choice in Singapore when it comes to nose lifting. Fillers are the other popular choice for non-surgical nose augmentation but there are important differences between nose thread lifts and fillers that you need to know with regard to potential risks and visual outcome.

Patients in Singapore often ask: Which is the best thread for nose thread lifts? While information on nose thread lifts abounds online, it is very limited and does not go into much detail. The information that is actually available often ends up confusing patients instead.

Here I hope to demystify the topic and offer a comprehensive look at the types of nose threads available in Singapore for nose thread lifts, their differences and pros/cons.

Nose Thread Lift Material

Bio-absorbable threads are used for nose thread lifts in Singapore. Generally, non-absorbable permanent threads are not used for nose thread lifts as it would be better to get a surgical rhinoplasty instead if a permanent result is desired.

Various materials used for nose threads

PolyDiOxanone (PDO) is the most commonly used nose thread lift material in Singapore. PDO has been used in surgical procedures since the 1980s. Hence we have more experience as to how PDO will perform in terms of stiffness, durability and safety. Although PDO starts breaking down around 6 months, effects often last more than a year and even up to 1.5 years. It has also been proven to stimulate the production of collagen to a similar extent as the other materials available.

Poly-L-Lactic Acid (PLLA) is an established material used in bio-stimulatory fillers such as Sculptra. It lasts longer than PDO but has been shown to swell more after implantation. The amount of collagen stimulation is similar to PDO. It can tend to be somewhat stiff.

PolyCaproLactone (PCL) is a newer material also used in bio-stimulatory fillers such as Ellanse. It lasts longer than PDO and has high tensile strength but is somewhat fragile, being soft, flexible and weak to heat.

Poly-L-Lactic Acid/CaproLactone (p(LA/CL)) is the newest material which combines PLLA and PCL materials to overcome their drawbacks. Longlasting with a good balance of stiffness and flexibility, it sounds like the perfect material – with 2 important caveats:

Comparison between various nose thread lift materials

Patients have two main concerns when it comes to nose thread lifts – cost and shape. A customized PDO nose thread lift would cost about the same as using newer material factory cut (non-customized) threads. Most patients I’ve seen chose the more ideal shape of a customized nose threadlift with PDO over a longer-lasting but less appealingly shaped nose threadlift with PLLA/PCL/P(LA/CL). After all, PDO nose thread lifts already last a significant duration of up to 1 to 1.5 years.

Be particularly cautious with the newer materials especially if it’s your first nose thread lift. You don’t want to splurge on a super long-lasting new material but decide that you don’t like the shape later.

Nose Thread Types

Nose thread lift threads come in a variety of shapes, lengths and thicknesses. Each shape is available in various materials covered in the section above. Common factory lengths are 38mm/50mm/60mm. I usually use the thickest threads (USP 1-4) available and customize the sizes to the exact lengths required by the patient’s anatomy. As PDO is the most established material, almost all the shapes/sizes are available in PDO. Conversely, only a limited range of shapes/sizes are available for the newer materials.

Nose threads are available from the factory in various lengths

Mono

Mono threads are the most fundamental and basic threads used in nose thread lifts. They are straight with smooth surfaces throughout and can be used in the nose bridge and nose tip. Used expertly, mono threads can often substitute for the functions of the other thread shapes. Often, an entire nose thread lift can be completed with just customized mono threads placed in the right location and manner to support the deficient nasal structures. One advantage of mono threads is that they are easier to remove.

Example of mono thread used for nose thread lifts

HiKo

HiKo nose threads are bidirectional barbed threads in which the barbs are designed to push the tissues apart and hold them there, producing an anti-compression effect. This is great for elongating and lengthening parts of the nose that are too short such as the nose tip and bridge. One disadvantage is that due to the cogs, barbed threads are quite difficult to remove after implantation.

Anti-compressive effect of HiKo and MisKo nose threads

MisKo

MisKo nose threads are similar to HiKo nose threads. They have bidirectional anti-compression barbs and are used to expand and support deficient areas in the nose. The split ends of MisKo nose threads, however, fan out in an umbrella shape to help distribute pressure over a wider area and may reduce protrusion risk. However, they are even more difficult to remove than normal barbed threads.

An example of MisKo nose thread

Cavern

Cavern nose threads are wound tightly up into a hollow cylinder. They are good for volumizing and stimulate more collagen ingrowth due to the larger surface area of nose thread lift material. They are more efficient in terms of adding volume with one cavern thread occupying the same volume as a few mono threads of similar thickness. The thicker ends of cavern threads spread pressure and tend to protrude less compared to mono threads. The cavern shape provides more stability and does not buckle as easily compared to mono threads.

Cavern screw nose threads produce a tunnel into which collagen grows

Bidirectional Cog

Bidirectional cog threads are barbed threads more commonly used in face lifting thread lifts. The configuration of the barbs is opposite to that of HiKo and MisKo nose threads, pulling tissues together and producing an anti-tension effect. In nose thread lifts, bidirectional cog threads can be used to lift the nose tip when the bridge of the nose is overly long, or to narrow the alar base in patients with broad wide noses.

Bidirectional cog nose threads pull tissues together

Which thread is the best for nose thread lifts?

As you can see, there is a wide range of nose thread materials, shapes, lengths and thicknesses available. This is more than enough to confuse most patients when I tell them about it. Which is the best?

In reality, what is best for others may not be the best for you. Each thread accomplishes a specific purpose. What may produce good results for someone else may look very bad when applied to your nose thread lift. I’ve found that the most important step to getting a good looking nose thread lift is to take the time to analyze and carefully plan the treatment, selecting customizing the most appropriate thread to reinforce the existing nose structure.

After all, it’s no point having a super high nose bridge that leads down to a flat round nose tip. Aesthetics is all about balance.

Do you have more questions about nose threadlifts or fillers? Did I miss anything? Let me know!


References

  1. Kang SH, Moon SH, Kim HS. Nonsurgical Rhinoplasty With Polydioxanone Threads and Fillers. Dermatol Surg. 2020 May;46(5):664-670. doi: 10.1097/DSS.0000000000002146. PMID: 31517664.
  2. Rezaee Khiabanloo S, Nabie R, Aalipour E. Outcomes in thread lift for face, neck, and nose; A prospective chart review study with APTOS. J Cosmet Dermatol. 2020 Nov;19(11):2867-2876. doi: 10.1111/jocd.13397. Epub 2020 Apr 8. PMID: 32267994.
  3. Lee HY, Yang HJ. Rhinoplasty with Barbed Threads. Plast Reconstr Surg Glob Open. 2018 Nov 13;6(11):e1967. doi: 10.1097/GOX.0000000000001967. PMID: 30881784; PMCID: PMC6414097.
  4. Wong V, Rafiq N, Kalyan R, et al. Hanging by a thread: choosing the right thread for the right patient. J Dermat Cosmetol. 2017;1(4):86‒88.

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