Over the past decade, facial rejuvenation procedures using surgical lifting through excision of redundant skin have been considered the gold standard [1,2]. However, surgical facial rejuvenation procedures may still produce postoperative complications such as infection, skin necrosis, hematoma, seroma, and damage to the branches of the facial nerve. Disadvantages also include visible scars and a prolonged recovery time [3,4]. Patients are therefore in need of minimally invasive facial rejuvenation techniques with lower morbidity and relatively rapid wound healing [3]. This has led to the introduction of novel nonsurgical facial rejuvenation procedures with volumizing effects. However, the disadvantages of these procedures include increased facial volume, unnatural contour, and a visible shift of the center of gravity to the lower third of the face [2,4-6]. Ablative or non-ablative resurfacing techniques are effective in improving the skin surface, but their disadvantages include a lack of sufficient lifting of the underlying ptotic tissues [7,8].

Facial rejuvenation techniques involving thread lifts are performed by passing sutures under the facial skin to treat sagging and facial flaccidity, and their advantages include a relatively short recovery time and relatively small incisions [6,9]. As such, facial rejuvenation techniques using threads are considered an alternative to conventional rhytidectomy procedures [10,11]. Their efficacy, safety, and durability therefore deserve special attention from four standpoints: (1) treatment effects, (2) sustainability, (3) in vivo safety, and (4) the risk of serious adverse events, such as intraoperative damage to the facial nerve [6].

Mint Lift (HansBiomed Co., Ltd., Seoul, Korea) is a violet-colored, absorbable polydioxanone monofilament thread with a wire length of 43 cm and a United States Pharmacopeia size of 0. Classified as a class IV medical device, its properties include transparency visible during the first postoperative month, bidirectional helical barbs that providing strong initial skin anchorage, and a lack of attachment of the yarn to the needle. It is initially inserted using a curved needle (5/8) and then later using an 18-gauge blunt cannula, for which a disposable external trocar is concomitantly used [9,12].

Given this background, we describe the short-term safety of a facial rejuvenation technique using the Mint Lift in patients with mild-to-moderate facial skin sagging.

Over the past several years, there have been marked changes in facial rejuvenation techniques using absorbable thread lifts with polydioxanone threads [13-16].

Thread lifts are used for nonsurgical facial tightening. Ideal requirements for threads used in these procedures include biological inertness, lack of tissue reaction, ease of handling, ease of knotting, lack of bacterial growth, high tensile strength, ease of sterilization, lack of an allergic reaction, lack of carcinogenicity, and high absorbability [15-17]. High biodegradability in body fluids and high tensile strength are particularly essential features of thread lifts, because the material used for thread lifts should be strong, but also should easily dissolve at the same rate as that at which the tissue gains strength [18].

It is apparent that no single thread lift fulfills all of the above criteria. Plastic surgeons should therefore select the optimal thread lift based on the type of aesthetic procedure they plan to perform. This issue is also closely associated with a lack of consistent requirements for thread lifts when these tools are used to lift the skin [10,19]. Finally, the use of optimal thread lifts for aesthetic facial treatments is an essential factor for both obtaining good cosmetic results and avoiding complications [6,14,15,20-22].

In our series, only nonserious complications were encountered, such as ecchymosis, infection, thread extrusion, and skin dimpling, all of which spontaneously resolved. These results indicate that Mint Lift is a safer modality than other facial lifting procedures or surgical methods; this may be due to the simplicity of the procedure, the low risk of iatrogenic tissue injuries, and differential features of our techniques, such as the use of a specialized cannula and absorbable sutures, as well as variability in the depth of cannula insertion. The short-term safety of the Mint Lift has been documented previously. According to Baek et al. [12], only a few minor complications arose with no notable problems in a 24-week, prospective, single-center, single-arm, pre-post test design, open-label clinical study of 61 patients with deep nasolabial folds and lower facial drooping (three men and 58 women). Those complications included pustule formation, pain, swelling, a subjective feeling of tightness, and skin dimpling, although they were mostly self-limited. Thus, Baek et al. concluded that facial rejuvenation using the Mint Lift may be a favorable modality. Moreover, in a separate study, Bae et al. [23] reported no major complications such as thread exposure, alopecia, or parotid gland injury. Although five patients complained of ecchymosis for up to 3 weeks, they did not require treatment and returned to their daily lives within 1 week postoperatively.

Herein, we describe the safety of a facial rejuvenation technique using the Mint Lift with a review of previous published studies on this topic. However, further long-term follow-up studies are warranted to corroborate our results.