The Science of Absorbable Poly(L-Lactide-Co-ε-Caprolactone) Threads for Soft Tissue Repositioning of the Face: An Evidence-Based Evaluation of Their Physical Properties and Clinical Application

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Abstract

The use of bioabsorbable threads has become a common minimally invasive technique for the nonsurgical lifting of sagged facial tissues. It entails the passage of barbed threads that form a support structure under the skin of the face and neck to mechanically reposition sagging tissue. Poly(L-lactide-co-ε-caprolactone) has long been used as absorbable sutures and as such has a well-demonstrated efficacy and safety profile. This biomaterial also has a well-defined biocompatibility and degradation profile. All studies reviewed in this paper show that thread lifting with absorbable barbed threads is an effective and well-tolerated procedure for correction of ptosis in facial and neck soft tissue and is associated with minor and reversible adverse effects. Most patients and surgeons consider the procedure satisfactory, with good to excellent results. This publication reviews the literature and clinical data supporting the degradation, absorbability, biocompatibility, safety, and effectiveness of these threads when used for tissue repositioning and facial rejuvenation procedures.

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Most cited references 23

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PCL and PCL-based materials in biomedical applications.

Elbay Malikmammadov, Tugba Tanir, Aysel Kiziltay … (2017)

Biodegradable polymers have met with an increasing demand in medical usage over the last decades. One of such polymers is poly(ε-caprolactone) (PCL), which is a polyester that has been widely used in tissue engineering field for its availability, relatively inexpensive price and suitability for modification. Its chemical and biological properties, physicochemical state, degradability and mechanical strength can be adjusted, and therefore, it can be used under harsh mechanical, physical and chemical conditions without significant loss of its properties. Degradation time of PCL is quite long, thus it is used mainly in the replacement of hard tissues in the body where healing also takes an extended period of time. It is also used at load-bearing tissues of the body by enhancing its stiffness. However, due to its tailorability, use of PCL is not restricted to one type of tissue and it can be extended to engineering of soft tissues by decreasing its molecular weight and degradation time. This review outlines the basic properties of PCL, its composites, blends and copolymers. We report on various techniques for the production of different forms, and provide examples of medical applications such as tissue engineering and drug delivery systems covering the studies performed in the last decades.

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Synthesis, structure and properties of poly(L-lactide-co-ε-caprolactone) statistical copolymers.

Jorge Fernández, Agustin Etxeberria, Jose-Ramon Sarasua (2012)

Four poly(L-lactide-co-ε-caprolactone) (PLCL) copolymers were synthesized at 120, 130, 140 and 150 °C by ring opening polymerization using stannous octoate catalyst at a 2000:1 comonomer:catalyst ratio. Gel permeation chromatography (GPC) and (1)H NMR measurements were performed to determine the molecular weight, composition and chain microstructure of copolymers of L-lactide(LA):ε-caprolactone(CL) synthesized using 90:10, 80:20, 75:25 and 70:30 feed ratios. The overall conversion of these PLCL copolymers was in the range of 80%-90% leading to weight average molecular weights (M(w)) between 98,500 and 226,000 g mol(-1) depending on feed composition and polymerization temperature. At temperatures lower than 140 °C, the incorporation of CL units into polymer chains was incomplete because of the low reactivity of CL, thus at 120 °C the copolymer composition was difficult to control obtaining more LA in the copolymer than the desired, hence the blocky character of PLCL copolymers also increased. At 150 °C the catalyst was less effective and the molecular weights of the copolymers took lower values. A temperature of 140 °C was established as optimal to obtain highest yields and molecular weight. The number average crystallizable lactide sequence lengths (l(LA)) shifted from 6.5 to 16.7 LA repeat units for PLCL polymerized at 140 °C while the randomness character (R) value shifted from 0.4 for polymerization at 130 °C to 0.6, at 150 °C. Increasing the LA content in the copolymers the glass transition temperature and the crystallizability and melting temperature of PLCLs approached to that of PLLA homopolymer. The aging sensitivity of PLCLs increased with CL content. A double T(g) behavior due to phase separation associated to crystallizing LA blocks was observed during aging. The mechanical properties, however, evolved toward the PLLA character when the molar content of LA in PLCL was increased from 66% to 90%, observing a shift from an elastomeric thermoplastic behavior to that of a glassy plastic, reflected by an increase in tensile modulus (from 12.0 to 1343.1 MPa) and a decrease in strain recovery after break (from 93.5% to 25.0%). Small amounts of CL content in the copolymers produced large improvements in their deformability with regard to PLLA. In addition, thermogravimetric analysis demonstrated that PLCLs are more stable to thermal degradation than PLLA and they undergo a more complex degradation mechanism than those of the corresponding homopolymers. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Outcomes in Thread Lift for Facial Rejuvenation: a Study Performed with Happy Lift™ Revitalizing

Antonella Savoia, Ciro Accardo, Fulvio Vannini … (2014)

Introduction Barbed suture lifting is a minimally invasive surgical technique for facial rejuvenation. This study examined the efficacy and associated risks with this procedure, using a new synthetic, monofilament suspension thread named “Happy Lift™ Revitalizing” (Promoitalia International S.r.l, Naples, Italy). Methods All the patients had average aging signs and required a lifting of modest degree. A total of 37 thread lifts were performed over a 24-month period. Results In the majority of patients (89%), the results obtained were considered satisfactory. The incidence of complications was low. Only 6% of the patients had slight post-operation asymmetry that was easily corrected. Minor complications experienced by patients included small ecchymosis (62%), mild erythema (40%), small hemorrhage (25%), mild transitory esthesia (6%) and mild post-operation tumefaction (40%). Histopathological and ecographic analyses were performed on the treated skin of selected patients, demonstrating that the lifting effect is guaranteed and fortified by the cutaneous reaction that appears along the length of the thread. Conclusion Thread lift with “Happy Lift™ Revitalizing” is a safe procedure associated with minor complications, when performed on cohorts of patients requiring a facial lifting of modest degree. Electronic supplementary material The online version of this article (doi:10.1007/s13555-014-0041-6) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Cosmet Investig Dermatol

Journal ID (iso-abbrev): Clin Cosmet Investig Dermatol

Journal ID (publisher-id): ccid

Journal ID (pmc): ccid

Title: Clinical, Cosmetic and Investigational Dermatology

Publisher: Dove

ISSN (Electronic): 1178-7015

Publication date (Electronic): 13 January 2021

Publication date Collection: 2021

Volume: 14

Pages: 45-54

Affiliations

[1 ]Vindoc Aesthetics , London W1G 9PF, UK

Author notes

Correspondence: Vincent Wong Vindoc Aesthetics , 10 Harley Street, LondonW1G 9PF, UKTel +44 20 7299 0380 Email info@drvincentwong.com

Author information

Vincent Wong http://orcid.org/0000-0002-8825-8705

Article

Publisher ID: 274160

DOI: 10.2147/CCID.S274160

PMC ID: 7812524

PubMed ID: 33469333

SO-VID: 0c977e23-8ef9-422f-b2d7-09c8d08cdc3a

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This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 01 October 2020

Date accepted : 08 December 2020

Page count

Figures: 5, Tables: 3, References: 29, Pages: 10

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