Safety of Thread Lifting With APTOS and Energy-Based Technologies Under Artificial Intelligence-Guided High-Frequency Ultrasound

Background Suspension threads composed of poly-L-lactic acid (PLLA) and polycaprolactone (PCL) are widely used for nonsurgical facial rejuvenation. Accurate placement within the superficial musculoaponeurotic system (SMAS) is essential to reduce risks and optimize outcomes. Real-time high-frequency ultrasound with artificial intelligence (AI) may assist procedural accuracy. The safety of combining thread lifting with energy-based technologies, performed on the same day, remains underreported. Objective The objective of the study was to evaluate the overall safety of APTOS PLLA/PCL threads (APTOS Excellence Visage®; APTOS LLC, Tbilisi, Georgia) placed under AI-guided high-frequency ultrasound, with or without the use of energy-based modalities on the same day, in a real-world aesthetic practice. Methods This retrospective, single-center observational study included 246 patients who underwent facial thread lifting with APTOS Excellence Visage sutures under real-time ultrasound guidance. A portion of the patients received same-day energy-based treatments (linear focused ultrasound, monopolar radiofrequency, or CO₂ laser). Safety outcomes were assessed over 180 days. All patients were analyzed as a single cohort. Results The overall incidence of adverse events was below 5%, with no serious or irreversible complications. Reported events included self-limited postoperative pain (4.1%), ecchymosis (2.0%), hematomas (0.8%), and granulomas (1.6%). No cases of infection, thread extrusion, allergic reaction, or thread removal were observed. Ultrasound guidance confirmed accurate SMAS-plane placement in all procedures. Conclusions Thread lifting with PLLA/PCL sutures demonstrated a favorable safety profile when performed under AI-assisted ultrasound guidance. The use of real-time imaging enhanced anatomical precision. The combination of threads with same-day energy-based modalities was also safe, with no increase in complication rates.