First the Vampire – Now The Puppet Facelift

Do you have clients bemoaning early-to-moderate sagging of face and neck but they aren’t ready for, or don’t want surgery? Are injectables not giving them the desired lift?

We’ve seen the Vampire Facial (as made famous by Kim Kardashian), so what are women now doing to turn back the clock without going under the knife?

Earning its nickname from the use of strings, or threads, to lift and volumise the cheeks and lower face, the Puppet Facelift is proving popular, especially to reduce the first signs of ageing.

‘The Puppet Facelift has been gaining popularity at a rapid rate, particularly with women in their 30s,” says Dr Sarah Tonks, who treats many a celebrity at her medi-spa, Omniya, in London’s chic Knightsbridge.

The so-called “lunchtime” procedure – but a medical procedure – uses bio-compatible re-absorbable threads to strategically lift sagging areas of the face and neck and stimulate collage and elastin production to naturally restore volume and shapeliness to the face/neck.

It involves the insertion of suture threads under the skin, to a depth of above 5mm. This is done after the administration of a small amount of local anaesthetic.

The threads are inserted into the skin using a fine needle, (into the subcutaneous layer), through an entry point which is in the middle of the line that the thread is intended to lay upon.

This enables the insertion of the thread in each half, appropriate to the orientation of the cones. The threads can then be compressed and massaged into an elevated place to obtain the lifting effect.

The thread is secured in place by the bi-directional cones. Placement patterns can include straight lines, and V or U shaped angles. The ends of the suture threads that are not fully inserted are cut off.

Therefore, no incision or cuts are necessary. You will simply have two or three entry/exit points for the needle on each side of your face, depending on what lifting technique is being used to achieve your desired result.

Cosmetic nurse practitioner Katherine Millar-Shannon (left), owner of Duquessa Skin Sanctuary in Melbourne and Sydney, talks to SPA+CLINIC about the Puppet Lift.

S+C: Does the Puppet Lift differ from thread lifts available over the past decade?

KMS: The Silhouette Soft “Puppet” facial threads are a minimally invasive solution that delivers a great option to patients for whom a facelift surgery is not their preferred approach.

While threads used for re-positioning of facial tissues have been commercially available since approximately 2002 they have evolved massively.

Originally threads were made from non-absorbable suture material with small “barbs” cut into them. These barbs had the propensity to not only weaken the thread but to peel off and migrate – sometimes even extruding out of the skin.

Many of these “barbed” style of threads have been updated to be made out of absorbable materials but are still faced with the issue of potential weakening of the thread and the associated “prickling” or “tingling” of the sharp barbs under the skin.

There is also the issue that these small “barbs” are limited to the amount of tissue they can re-position.

Silhouette Soft differs in that it is the only range of “threads” that rely on small bi-directional cones to effectively reposition the subdermal tissue and facial skin to a more lifted and youthful position.

Furthermore Silhouette Soft consists of these small absorbable cones (glycol lactide) and absorbable suture material (poly lactic acid PLLA) – a known collagen stimulator.

Therefore, over time, the implanted sutures and cones also stimulate your own collagen for natural and long lasting results. At the time of writing this Silhouette Soft is the only TGA registered bi-directional, absorbable facial thread on the market for non-invasive facial contouring and lifting.

S+C: What does the procedure involve?

KMS: This is an in-clinic procedure that does not require stitches or bandaging. Threads are anchored along your jawline, cheeks, neck or brow and gently pulled to give a lift effect. Tiny cones on the thread anchor themselves to the tissue and provide support and a lift to the area treated. The dissolvable threads work to deeply support and tighten the underlying tissue to mimic the results of a facelift.

Silhouette Soft threads also help the body to produce collagen in the areas that they are placed resulting in firmer skin (and many patients report improvement in skin texture and even-ness). You will see a gentle but noticeable lift that will improve the appearance of sagging or loose jowls, cheeks and/or brow. We can also combine this Thread Lift with dermal fillers to combat volume loss.

S+C: What is the thread material comprised of?

Silhouette Soft is made of a polylactic acid re-absorbable suture (thread), and moulded cones made of lactide/ glycolide.

S+C: Is there much swelling/bruising etc after the procedure?

KMS: Possible Adverse effects may consist of the following:

Like all procedures of this type there are possible side effects, although not everyone experiences them. Possible adverse events include infection, minimal acute inflammatory tissue reaction, pain, swelling and oedema.

S+C: How much discomfort is involved and what numbing/pain relief is required

Before the procedure injections of local anaesthetic (and adrenaline) – not sure of your audience here but this may be too much info for standard patients?? are injected into the areas that will be treated. Minimal discomfort is felt throughout the procedure.

S+C: When do results become obvious?

KMS: Silhouette Soft has a double action in one treatment- A lifting Action for instant yet discreet results and 2., A Secondary Regenerating Action for gradual and natural results.

As soon as the treatment is carried out, the practitioner is able to redefine the focused area by compressing the tissue and lifting the skin thanks to the bidirectional cones.

By reabsorbing, the polylactic acid acts in the subcutaneous tissue and stimulates fibroblasts activation and collagen production, therefore restoring the shapeliness to the face.  Somewhere in here I would be using the term “refreshed” ie. Providing a refreshed appearance.

S+C: How many treatments are generally required (obviously depending on a person’s age, extent of ageing “symptoms”, skin quality etc)?

KMS: The cost and treatment numbers vary on the number of threads required for an optimal result. Many will require a minimum of 2-3 threads per each side of the face for best results. Extra threads can be added after initial swelling etc has subsided.

S+C: How long do results last?

KMS: The visible effects of the Silhouette Soft treatment can last up to 12-18 months. Some people will enjoy longer lasting benefits, depending on their body’s response to the threads and their collagen production capabilities.


  • Sculptra Aesthetic is FDA-approved and has been used worldwide since 1999. It contains a synthetic material calledpoly-L-lactic acid, which is a biocompatible, biodegradable substance that is gradually and naturally absorbed by the body and commonly found in dissolvable stitches. While immediate volumising results are seen, this is temporary due to the fluid injected but will give the patient an idea of results to eventually expect. The effects of Sculptra are gradual over weeks and months, as the formula stimulates new production of the skin’s own collagen and elastin to create the desired volumising effects. Optimum results are usually seen at six months.