Synergistic Effects of Thread Lifting, Autologous Fat Grafting, and Multi-Modal Laser Therapy in Facial Rejuvenation

Abstract Background Facial aging is a multifactorial process involving tissue descent, volume depletion, and dermal degeneration. Minimally invasive modalities like thread lifting, autologous fat grafting, and laser treatments address different aging components. However, their synergistic impact remains underexplored. Objectives The aim of the author of this study is to assess the clinical efficacy and histologic rationale of combining permanent thread lifting, autologous fat grafting, and nonablative laser therapy for comprehensive facial rejuvenation. Methods In this retrospective study, a total of 65 female patients (aged 31-60, Fitzpatrick skin types II-IV) treated from January 2022 to January 2023 were included. Patients were divided into 3 groups: thread lifting alone (Group 1), thread + laser (Group 2), and thread + laser + fat grafting (Group 3). Evaluations were performed at 12 months by a plastic surgeon, a dermatologist, and the patients themselves using a 5-point Likert-scale assessing skin texture, fine wrinkles, lift effect, and overall satisfaction. Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction were utilized, alongside cumulative link regression models. Results Significant group differences were observed in skin texture (P = .00013) and overall satisfaction (P = .00421). Post hoc comparisons revealed that Groups 2 and 3 outperformed Group 1 in skin texture (P = .0155 and P = .0003, respectively). Fine wrinkle improvement was notable in Group 3 (P = .0239 vs Group 1). Ordinal logistic regression confirmed significant improvement with laser therapy per dermatologist ratings (odds ratio = 2.10, P = .019), with a favorable trend observed for fat grafting. Cliff's δ and Hodges–Lehmann estimates showed progressively larger improvements with increasing treatment complexity. Conclusions Combining thread lifting, autologous fat grafting, and laser therapy may provide superior aesthetic outcomes to thread lifting ± laser therapy alone. This is likely the result of the synergistic effects on mechanical lift, volume restoration, and dermal remodeling. These findings support an integrative treatment paradigm for nonsurgical facial rejuvenation and justify further prospective validation with histologic endpoints. Level of Evidence: 3 (Therapeutic)