A meta-analysis of complications of thread lifting

ObjectiveThis 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. MethodsA 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 "complication" or "adverse effect." 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. Data on authors, publication year, study design, sample size, patient demographics, follow-up duration, and complications were extracted and analyzed using R 4.2. Heterogeneity among studies was assessed using the I2 statistic. ResultsOur comprehensive search initially identified 537 articles. After removing duplicated records and rigorous title and abstract screening, 80 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 16% of cases, pain in 11%, skin dimpling or asymmetry pain in 7%, paresthesia in 10%, visible or palpable threads in 6%, infection in 2%, ecchymoses in 26% and thread exposure in 5%. The analysis also revealed high heterogeneity among the studies, with I2 values indicating substantial to high variability: swelling (I2 = 92%), skin dimpling (I2 = 76%), visible threads (I2 = 88%), and ecchymoses (I2 = 92%). Less common complications such as ear numbness and pinching sensation were reported in fewer studies, affecting approximately 5% and 7% of patients, respectively. ConclusionThread 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.