The applications of real-time imaging with transillumination, ultrasound, and Doppler for thread lifting

Thread lifting has gained popularity in recent years because of its minimally invasive properties. Regardless of the technique used, the key is threading in the optimal anatomical plane and suspending the correct target tissue. Failure to meet these objectives may result in chronic pain; contour irregularity; thread migration or exposure; and nerve, vessel, and gland injuries. The knowledge of facial anatomy alone is insufficient to corroborate the anatomical variations of a patient. Ultrasound-guided thread lifting can be performed because the trocar presents a hyperechogenic signal with bayonet and reverberation artifacts. Ultrasound is an effective tool because it can provide real-time images of the layers of the facial anatomy, fat pads, muscles, fascia, ligaments, superficial muscular aponeurotic system, arteries, and parotid duct. Transillumination, however, can be conducted to verify the presence of superficial vessels and prevent venipuncture and injury to homonymous arteries. The combination of transillumination and ultrasound provides three-dimensional information. In this study, to evaluate facial anatomy and guide threading, reconfirm the position of the thread, and prevent malpractices, practical strategies such as transillumination, ultrasound, and Doppler imaging are recommended for improving patient safety during, before, and after the procedure.