Asymmetrical Correction of Facial Rotation Using Unilateral Thread Insertion

Facial asymmetry, particularly rotational asymmetry, represents a significant aesthetic concern that impacts facial harmony and perceived attractiveness. Traditional approaches to facial rejuvenation often employ symmetrical interventions, which may fail to address the underlying rotational patterns. This study investigates the efficacy of asymmetrical thread lifting using JETEMA threads (Epiticon, Bi-thread, JETEMA, Korea) for correction of facial rotation.

To evaluate the effectiveness of standardised unilateral thread placement in the nasolabial fold area for correction of facial rotational asymmetry and establish a consistent approach for treatment of clockwise facial rotation patterns.

Forty-five patients (32 females, 13 males; mean age 41.3 years) presenting with facial rotation were treated with asymmetrical insertion of JETEMA threads. Two threads were inserted using a reverse technique on the affected side of the face (left side for clockwise rotation, right side for counter-clockwise rotation) targeting the nasolabial fold area. Assessment of facial rotation was conducted using standardised photography and a newly-developed 4-point Facial Rotation Grading Scale (FRGS) before treatment and at 6-month follow-up. Patient satisfaction and improvements in rotation grade were evaluated.

Improvement in facial symmetry was observed in 89% of patients (40/45) at the 6-month follow-up based on the study-specific Facial Rotation Grading Scale (FRGS). All severe cases (Grade 3, n = 11) improved to mild rotation (Grade 1), while most moderate cases (Grade 2, n = 26) improved to Grade 1, with the exception of 5 patients. Patient satisfaction scores averaged 8.3/10. These findings should be interpreted with caution due to the use of a non-validated assessment scale and the absence of objective measurement tools.

Unilateral thread lifting using a standardised reverse technique may represent a promising minimally invasive approach for correction of facial rotational asymmetry. However, given the methodological limitations, including the use of a non-validated grading system and short-term follow-up, further studies incorporating validated assessment tools and objective measurements are required.

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