A meta-analysis of complications of thread lifting.

[OBJECTIVE] This study aims to systematically review and perform a meta-analysis on the complications associated with thread lifting, a popular minimally invasive aesthetic procedure, to determine the incidence and types of adverse effects.

[METHODS] A comprehensive literature search was conducted across major medical databases including PubMed, Embase, and Web of Science, covering all publications up to April 1, 2024. The search terms included "thread lift," "suture lift," "barbed suture," "facelift," and "nonsurgical facelift," combined with "complications" or "adverse effects." Only prospective or retrospective cohort studies, clinical randomized controlled trials (RCTs), and case series published in English were included. Studies were excluded if they were non-English, review articles, case reports, or conference abstracts with incomplete data. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data on authors, publication year, study design, sample size, patient demographics, follow-up duration, and complications were extracted and analyzed using RevMan 5.4. Heterogeneity among studies was assessed using the I statistic.

[RESULTS] Our comprehensive search initially identified 537 articles. After rigorous title and abstract screening, 213 articles were further assessed, with 26 studies ultimately included in the final analysis, representing a collective sample of 2,827 patients. The meta-analysis highlighted varying incidence rates of complications associated with thread lifts: swelling was reported in 34% of cases, visible or palpable threads in 10%, skin dimpling in 7%, and ecchymoses in 26%. The analysis also revealed high heterogeneity among the studies, with I values indicating substantial to high variability: swelling (I = 92%), skin dimpling (I = 76%), visible threads (I = 88%), and ecchymoses (I = 92%). Less common complications such as ear numbness and pinching sensation were reported in fewer studies, affecting approximately 5% and 7% of patients, respectively. Complications were further categorized into early postoperative events (occurring within the first four weeks, such as swelling, pain, and ecchymoses) and late-onset complications (persisting beyond four weeks, such as visible threads, skin dimpling, and thread migration), which may carry greater clinical significance.

[CONCLUSION] Thread lifting, while generally safe, does carry a risk of several complications, which vary widely in their occurrence. This meta-analysis provides a detailed overview of the risk profile of thread lifting procedures, highlighting the need for careful patient selection and technique mastery by practitioners. The findings underscore the importance of setting realistic patient expectations and preparing for potential adverse effects.