LAUSR

Surgical facial rejuvenation techniques with thread lifting have gained popularity. To effectively rejuvenate an aging face, it is necessary to perform both soft tissue envelop repositioning and volume restoration procedures. With the trend toward less invasive techniques and long-lasting results with minimal complications, many surgeons have continued changing the techniques. In the present study, we developed the 4 M (Multi-target, Multi-vector, Multi-layer, Multi-material) thread lift technique for long-lasting results. A prospective study was conducted on 73 patients who underwent the 4 M thread lifting procedure between January 2016 and February 2018. To evaluate the surgical outcomes objectively, two plastic surgeons compared photographs using a 5-point Global Aesthetic Improvement Scale (GAIS) at 1, 3, 6, 12, 18, and 24 months of follow-up. Based on the GAIS objective assessment, in most patients (85%) experienced better than 3 score (“improved”) changes. Approximately 42.5% of the patients experienced better than 4 score (“much improved”) changes. The mean GAIS grade improved significantly (p < 0.005) without decline throughout a period of 12 months. No serious adverse complication was observed except one patient, who experienced skin irregularities and dimpling for up to 9 months after the procedure. This 4 M thread lifting is the multiple layer lifting and rejuvenation using different materials in addition to the multiple targets. Using the concepts of structural rejuvenation, the 4 M thread lifting technique presented modest to significant improvement, maintaining good results at 12 months after procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.