Leading dermatologist predicts surgical facelifts obsolete within ten years
Leading US dermatologist, Harold Lancer has predicted that surgical facelifts will be “a thing of antiquity” with a decade. Rodeo Drive based Lancer is shunning surgery more and more in favour of dietary advice and a host of less invasive treatments when advising clients. Currently, his favourite new procedure is the Silhouette Instalift, for which he charges between $1,500 and $5,000, depending on the number of strings used. Lancer, who is one of approximately 25 physicians currently performing the procedure in the US, is confident that the Instalift is “the future” and that other practitioners will be offering the treatment soon. 

Sitting at his desk in his Rodeo Drive office, Harold Lancer, a dermatologist with one of the largest practices in the country (he has more than 30,000 patients in his database), makes a prophetic statement about the future of aesthetic medicine.

"The days of the face-lift are coming to a rapid, screeching halt," he says, elbows on the desk, hands clasped in front of him in a way that emphasizes his silver-haired sensei authority. A small flock of gulls circles outside his window, cawing in agreement. "I predict that in 10 years the surgical face-lift will be a thing of antiquity." Even in Beverly Hills.

When Lancer advises his patients on how best to maintain their faces and figures, his protocol these days includes a strict diet low in salt, sugar, and dairy, and a host of less invasive treatments to delay the knife or avoid it entirely. But compared with resurfacing and skin tightening, which employ machines that look like tiny spaceships and cost a small fortune, Lancer's new favorite procedure, the Silhouette InstaLift (which he calls the Sugar String Lift), is lo-fi verging on retro: It weaves a filament throughout tissue to lift and reposition the planes of the face.

"There isn't a single person over the age of 20 who doesn't do this in the mirror," Lancer says as he places his fingers on top of the outer edges of his cheek bones and gently pushes the skin up and out toward his hairline. "Everyone wants just that much of a lift, and that's what this string does."

"I predict that in 10 years the surgical face-lift will be a thing of antiquity."

But the InstaLift of today sounds distinctly like the thread lift, which experienced a brief heyday and quick demise in the U.S. around 2000. In thread lifting, barbed sutures were sewn into the face. The threads were difficult to remove and susceptible to breakage, and patients were prone to infection as well as irregular or ropy contours in the skin. In the worst cases the blue thread was visible beneath fine, pale skin, and there was visible tugging or pulling where the sutures were attached.

"The old thread lifts had lots of problems for many reasons, and they did not gain wide acceptance among doctors or patients. The methods and materials are vastly improved now, but they're still not used too much in the U.S.," says Wendy Lewis, an aesthetic medicine consultant and author based in New York City who recommends the InstaLift procedure to clients who are under 55, have mild to moderate skin laxity, and are looking for methods that are one step up from Botox, fillers, and lasers but not as invasive as an incisional face-lift. "Some women will go to great lengths to avoid the F-word," Lewis says.

The new procedure uses a soluble material—a polylacticoglycolic acid resin, which is essentially a string of sugar—that looks like thick surgical suture material studded with small bi directional cones. The string is woven through the tissue to create tension and hoist the sagging skin around the nasolabial folds and jawline (albeit by only a few millimeters).

The small cones on the strings keep it suspended in the tissue without being connected to a bone. A pleasant side effect is that the tissue's natural response to the foreign material is to heal around it, which creates springy new collagen. So far the results have been mostly temporary (24 to 36 months) but impressive. Two more bonuses: Its relatively low cost (Lancer charges around $1,500 to $5,000, depending on the number of strings used), and the procedure takes only about 30 minutes to complete.

Despite InstaLift's successful outcomes, many doctors who practiced in the '90s and early '00s can't shake their memories of the thread lift. "There was a study released in 2009 that stated that as many as 60 percent of thread lift patients reported complications," says Patricia Wexler, a New York–based dermatologist. "Sixty percent! That's not good. Personally, I've never met a patient who was pleased with the results of a thread lift. But then again, the happy people don't come to me to be fixed."

She points out that there's no guarantee that even the new, absorbable materials will dissolve at the same time, which could lead to unpleasant facial drooping or asymmetry.

The attitude toward threads in Europe is far more positive. About a decade ago doctors there (the Italians were most enthusiastic about it) started using a new and improved version of the procedure, which has some similarities to InstaLift; the more advanced materials were dissolvable and more sterile and hence less prone to infection.

"For a person in her forties or fifties with mild to moderate signs of aging, who doesn't want surgery because of the expense or for medical reasons, it's a simple and safe procedure," says Yannis Alexandrides, an American and British board-certified plastic surgeon who is the founder and medical director of the 111 Harley Street cosmetic surgery clinic in London.

"The material creates a reaction that helps to build connective tissue that holds the skin up, making it stronger and thicker. The results we see outlive the time it takes for the thread to dissolve."

The Soft Thread Lift that Alexandrides uses, which is fairly standard in Europe (with some variation among providers), involves weaving 30 to 40 fine threads under the skin, which are stitched through tiny needle incisions near the nose and along the outer edges of the face and jawline, and sometimes along the brow.

Alexandrides says there's typically minimal swelling and bruising following the procedure, and he claims that it doesn't create scar tissue, which could make it difficult to go back in and do again. He says that because the results are temporary, most patients expect to have to repeat the process.

In the meantime Lancer is chipping away at his 30,000-patient roster, performing dozens of InstaLifts in his office with "uniformly wonderful" results. He is optimistic—and not only because he is one of approximately 25 physicians currently performing the procedure in the United States.

The InstaLift is FDA-cleared only for the midface, but Silhouette's parent company, Sinclair, is looking into the possibility of lifting other body parts, including brows, breasts, and knees (basically anything subject to gravity's whims—so, everything). In any event, it's not an overstatement to say the potential for this low-cost procedure with minimal downtime is huge.

"The results I have seen, by some very experienced surgeons, are quite good," Wendy Lewis says. "I saw a few live cases at the Instituto de Benito in Barcelona. The results were instant, patients walked off the operating table and were comfortable, and you could already see the results before all the swelling set in."

Lancer is an InstaLift pioneer in America, but he's confident that others will soon be onboard. "This face suspension with string," he says, "it's the future."

As long as you're willing to forgive and forget its past.