What types of thread lift are there? How do absorbable threads, cog threads and Aptos fit together?
There seem to be many names for thread lifts, but almost every lifting thread placed in the face today is absorbable. Cog threads and Aptos are both absorbed by the body over time. Threads sold under product names such as MINT and Epiticon also all belong to the absorbable group. So there is no choosing between “absorbable or not”; what matters is the shape of the thread and how it is placed.
Lifting threads carry barbs, and those barbs catch tissue that has come down, pull it up and hold it in place. Cog threads are the typical example, and Aptos is also a barbed thread. Separate filling threads exist that add a little volume rather than pull.
Even among barbed threads the differences are large. The pulling strength and the resulting shape change with the length of the thread, whether the barbs point one way or both ways, and whether threads are inserted one line at a time or crossed several times inside the face. That is why comparing thread names and counts alone almost never works.
How does an Aptos thread lift work? What is the thread made of?
An Aptos thread lift places a long, barbed, absorbable thread under the skin and, along directions marked in advance, uses the barbs to catch tissue that has come down and move it up. The one I mainly use is an Aptos thread called EVHA, which contains hyaluronic acid, and each strand is about 19cm long. This long thread crosses several times inside the face and supports the tissue across a surface rather than at a point.
The material is often described as a “PLLA thread”, but strictly speaking it is not a thread made of PLLA alone. A clinical study of the Aptos EVHA thread describes it as a copolymer thread of L-lactide and caprolactone with hyaluronic acid added. Threads of this kind are reported to break down slowly and lead to collagen forming around them.
So the effect of Aptos is two things layered together. One is the force of the barbs pulling the tissue up, so the lift is visible right after treatment. The other is the collagen that forms around the thread and holds that shape. The thread does eventually dissolve completely, but once the tissue has been pulled up properly, the effect does not stop one day; it fades gradually. How long Aptos results last is covered in How long does an Aptos thread lift last?.
How are cog threads and Aptos different?
Cog threads and Aptos are both absorbable barbed threads, yet their structure is completely different. Aptos threads are much longer and cross about three times inside the face, so one Aptos thread does almost the same work as three cog threads. That is why you should not compare a number of cog threads with a number of Aptos threads by the count alone.
This difference is also why I started using Aptos. When I used to place cog threads one line at a time, the shape right after treatment looked just right, but there was not enough strength, and in many cases things came down a little over time. After switching to Aptos, which pulls by crossing several times, both the pulling strength and how well it holds clearly improved, and it has become my favorite thread lift these days. Pulling hard on a thread anchored in only one direction can create a dimple where the skin sinks in, so I use Aptos, which lifts across a surface and holds more firmly.
So I see Aptos as a stronger treatment, with higher tensile strength than other thread lifts. If a strong lift is needed, I choose Aptos; if you would rather go lighter, another absorbable thread.
How is the Aptos thread count decided? How many threads are used?
Aptos usually takes 4–6 threads for one area, such as the jawline or double chin. The jowls, the corners of the mouth and the nasolabial folds are often lifted at the same time, so for the whole face it is about 10 threads in most cases. This is the standard I have worked with, and within it I decide the number by how much tissue has come down and how heavy it is, and whether the sagging is only along the jawline or extends up to the cheeks. Since one Aptos thread does close to the work of three cog threads, you do not need as many Aptos threads as the cog-thread count you may have heard elsewhere.
The pulling direction matters as much as the number of threads. If the direction is wrong, the cheekbones can look much more prominent. I pull toward the back of the face, close to the hairline. This can make that spot look slightly swollen and larger for the first few days, but it settles quickly. If there is almost no sagging, there is no need to count threads at all, because I do not recommend Aptos in that case.
In many cases the treatment does not end with the threads. Even when the threads pull up the deeper side, if the subcutaneous fat layer above has stretched, the result is not complete, so we almost always combine a thread lift with lipolysis injections.
How long does Aptos take, and what about anesthesia and pain?
An Aptos treatment takes about 30–60 minutes. Anesthesia can be local anesthetic injections, or numbing cream can also be used. The anesthetic injection hurts briefly, and while the threads go in there is almost no pain; mostly you feel a pulling sensation.
The lift is visible right after treatment, and the shape settles naturally over 1–2 weeks. After 2–3 days daily life is not much of an inconvenience, but for 2–3 weeks you should not open your mouth wide or massage your face. How long swelling and bruising last, and the warning signs, are covered separately in Thread lift side effects and failure.
How are Aptos and Ultherapy different?
Aptos and Ultherapy do different jobs. Aptos uses threads to catch tissue that has already come down and move it up directly, while HIFU (ultrasound) lifting such as Ultherapy, or radiofrequency (RF) lifting, heats the inside of the skin to work on firmness and the surface. Sagging is often explained as a problem of the deep supporting structure and fine lines as a problem of the shallow layers, but layers cannot be neatly divided by words, so I decide by looking at the face. That said, if the tissue has stretched too much or is too heavy, the force of the threads alone may not be enough, and in that case we often use another lifting treatment to reduce fat or raise surface firmness at the same time. The difference between Ultherapy and Thermage is in How are Ultherapy and Thermage different, and which should come first?.
Whether your face is one that needs pulling up, or one that needs reducing or filling, can be looked at together at the in-person consultation after reading the visit guide.