Infection Following Thread Lift in a Patient Who Refuses Thread Removal

Patient description

Female
60 years old
No relevant medical history

Case description

Dear colleagues,

I would like to seek your advice regarding a 60-year-old female patient who developed an infection after a thread lift procedure. The patient had previously undergone thread lifts and filler injections without complications.

This time, one week after the procedure, she presented with inflammation in the left parotid region accompanied by trismus, which was initially interpreted as parotid trauma. Treatment included local cold compresses and NSAIDs, resulting in symptom resolution within approximately four days.

At a scheduled follow-up visit, two and a half months after the procedure, to evaluate further treatment options, she reported a lesion in the left preauricular region, near the initial thread insertion site which she stated began 48 hours prior to the consultation. She denied pain, discharge, or other accompanying symptoms. On physical examination, a round, erythematous lesion with liquid content was observed, accompanied by an indurated tract extending toward the ipsilateral gonial region.

The lesion was interpreted as a post-procedural infection. Empiric treatment with Amoxicillin and Trimethoprim-Sulfamethoxazole (TMS) was initiated, and a soft tissue ultrasound of the region was requested.

Ultrasound findings (day 4 of antibiotic treatment) revealed:

• A linear, homogeneous, hyperechoic structure consistent with facial suture material (thread), surrounded by anechoic liquid within a fistulous tract.
• The tract measured 30 mm in length and 9.4 mm in transverse diameter.
• The thread extended in a cephalocaudal direction from the subcutaneous tissue to the middle third of the masseter muscle.
• Increased echogenicity and thickening of the subcutaneous tissue were noted, along with enhanced microvascularization, indicating active diffuse edema and inflammation.

At day six of antibiotic treatment, the patient contacted me very concerned after receiving the ultrasound report. The medical imaging specialist had suggested that the thread should be removed. However, the patient noted that the surface lesion had resolved, she was asymptomatic, and the induration previously palpable was no longer evident. She expressed her satisfaction with the aesthetic result of the thread lift and her strong reluctance to undergo the removal procedure and subsequent reinsertion of a new thread.

I would like to inquire if any of you have experience managing thread infections and whether you have ever opted for an expectant approach, avoiding thread removal while completing the antibiotic regimen.

Your insights and recommendations would be greatly appreciated.

Thank you in advance for your guidance.