Which kind of sagging does an Aptos thread lift suit best? Who is a good candidate?
An Aptos thread lift suits best a face whose tissue has already come down and needs a strong lift. It has greater tensile strength than other thread lifts, so we choose Aptos when the sagging needs a definite pull, not just a light touch-up.
By the shape of the sagging, a face where the jowls have dropped and blurred the jawline, or where the whole lower and midface contour has moved down, is one with clear tissue for Aptos to move. A face whose nasolabial area or cheeks are hollowing while only the jowls hang is also one that truly needs pulling. The fat layer has places where it must not be lost and places where it should be reduced, so for this kind of face, rather than reducing fat everywhere, we pull up the sagging area and reduce only that spot. People in their 40s and older who feel other lifting treatments have done nothing also tend to end up choosing Aptos.
What decides Aptos is not age but tissue that has come down. From what age it is done and when to repeat it are covered in a separate guide on Aptos timing.
Which faces do we not recommend Aptos for?
We do not recommend Aptos for a face with barely any sagging. That includes people who have not really sagged yet but feel they have, and people who want it because they believe early care makes things better even though no layer of the skin shows a problem. It is true that many people get better results later by taking care early, but we do not force treatment on a face that does not need it.
Sometimes a face looks saggy for a different reason. Among people who are not that old but say their face looks saggy, many simply have full cheeks that make it look that way. In that case, rather than pulling, just reducing the subcutaneous fat layer makes the face look much lighter and younger. Sagging that comes from hollowing also needs filling, not pulling. Which kind your sagging is has to be judged by looking at the inside of the skin layer by layer, and it sometimes turns out quite different from what you thought, so seeing it in person is more accurate.
Which faces may not get enough from Aptos alone?
Aptos may not be enough for a face whose tissue has stretched too much or is heavy. The more tissue the thread has to move, and the heavier it is, the harder it is to lift as much as you want with the thread’s strength alone. So for this kind of face, we often do not stop at Aptos alone, and use another lifting treatment to reduce fat or to firm the skin surface as well.
The literature is also clear about the limits of thread lifts. It considers thread lifting unsuitable when sun damage to the skin is severe or wrinkles are very deep, and a review of thread lift studies concludes it is still too early to regard it as a replacement for a surgical facelift. The paper that first introduced the Aptos method also wrote that the same method should not be recommended to everyone, and that the right method, or combination, should be chosen for each person.
What are the benefits of Aptos? How do thread lift results show?
The biggest benefit of Aptos is that its tensile strength is greater than other thread lifts. A long thread crosses about three times inside the face as it pulls, so one Aptos thread does close to the work of three cog threads, and because it supports the tissue across a surface rather than at points, it holds firmly. So if a strong lift is needed, we choose Aptos, and for something lighter, other absorbable threads.
Fewer dimples is another benefit. If a thread is placed too shallow under the skin surface or a one-directional thread is pulled hard, the skin can pucker into a dimple, but Aptos, which pulls across a surface, carries less of that worry. The thread structure and how it differs from cog threads are in What are the types of thread lift (absorbable, cog, Aptos), and how many Aptos threads go in and how?. The lift shows right after treatment and the effect fades gradually, and how long it lasts is covered in a separate guide on Aptos timing.
Why are lipolysis injections done together with a thread lift?
Most people who have Aptos also have lipolysis injections. Even when the thread pulls up the fascia side, if the subcutaneous fat layer above it is sagging, the result does not fully improve. That is why we almost always combine a thread lift with lipolysis injections blended for fat dissolving, to get the best result. Especially when there is a lot of sagging fat above the nasolabial folds, pulling alone does not fix everything.
The reverse is also true. If you only reduce facial fat, the face can sometimes feel saggy, like a deflated balloon, so a face with hanging jowls and nasolabial folds improves much more when fat is reduced and lifting is done together. Ways to reduce facial fat are covered in a separate guide on double chin and face fat with ONDA.
For hollow cheeks, is filling done before an Aptos thread lift or together with it?
For hollow cheeks, rather than filling first with filler or a collagen stimulator injection and then pulling with Aptos, it is best to pull with Aptos and fill at the same time. Filling itself has a pulling effect on the tissue, so doing both together often gives the best result. Sagging that comes from hollowing rather than drooping is not solved by pulling; it has to be filled.
Nasolabial folds are often a mix of both. The part that is grooved because volume has hollowed is filled, and the part where the fat above the fold has sagged is improved with a thread lift at the same time, sometimes with lipolysis injections added. Which kind your folds are closer to is more accurate when seen in person. Hollow cheeks and nasolabial folds are covered further in a separate guide on Ultherapy and ONDA for hollow cheeks and nasolabial folds.
Can a thread lift and Ultherapy be done together? How are they split with energy-based lifting?
A thread lift and energy-based lifting such as Ultherapy or Thermage do different jobs, so we combine them when needed. Aptos hooks tissue that has already come down and moves it upward, while energy-based lifting heats the inside of the skin to work on firmness, the surface and the fat layer. Ultherapy is somewhat more effective on sagging of the subcutaneous fat layer, and Thermage is geared toward tightening the dermis. How Ultherapy and Thermage differ from each other is in How are Ultherapy and Thermage different, and which should come first?.
They can be done on the same day. The order is the device, such as Ultherapy or Thermage, first, and then Aptos goes in. Once the device has been done first, putting the threads in on the same day causes no problem. Still, both are strong treatments, so more often they are done separately on different days. If you are coming from far away and cannot come several times, doing both on the same day in this order is fine.
Which combination fits is decided by looking at your face layer by layer in person.