Background: While there has been substantial mention in the popular press, there is little in the plastic surgery or dermatology literature regarding the safety, efficacy, longevity, or complications of barbed suture suspension procedures. We review the literature to estimate several clinical parameters pertaining to barbed “thread suspensions”.

Methods: MEDLINE search using keywords “barbed and suture”, “thread and suspension”, “Aptos”, and “Contour Thread”.

Results: We identified 5 studies that met our criteria of addressing midface elevation with barbed suture suspension. These detected adverse events of ecchymosis in 3-47%, edema in 43%, discomfort in 14%, hypercorrection in 10%, suture expulsion in 3%, asymmetry in 3%, and skin dimpling in 3%. Most of these were minor, self-limited, and of short duration. The data on the extent of the peak correction and the longevity of effect are less clear. Objective outcome measures and long-term follow-up data were not provided in a systematic manner in the few available studies.

Conclusion: While barbed sutures offer the potential for minimally invasive facial suspension, future research should consider objective, standardized photographic analysis of facial suspension at fixed intervals postoperatively in double-blinded fashion. Comparisons to standard suspension techniques should be done using patients matched for age, sex, and skin characteristics or randomized to experimental and control arms. Laboratory and animal studies should examine the biomechanical and biochemical reactions of suture barbs in a biologic environment. It remains to be seen whether the best results are reproducible and relatively operator-independent. As such, surgeons who use barbed sutures may wish to apprise patients of the limited data on efficacy and adverse events, and especially on longevity of effect.