The midface (malar fat pad), commonly known as the apple cheek, is the visual focal point of the mid-facial region — located in the zygomatic area, from beneath the eyes to the nasal sides, composed of the malar fat pad and overlying skin. Full apple cheeks are a hallmark of youthful faces — providing mid-face volume, sweet smiles, and an overall youthful appearance. However, the midface is also one of the earliest areas to show sagging — typically beginning in the late 30s as the malar fat pad gradually descends under gravity. Midface sagging affects the face in multiple ways: (1) Deepened nasolabial folds — as the malar fat pad descends, its lower edge compresses the nasolabial area, deepening and lengthening nasolabial folds. (2) Flattened midface — after descent, the zygomatic area loses fullness, making the midface appear flat and aged frontally. (3) Tear trough appearance — as the malar fat pad’s upper edge descends, support under the orbital area decreases, deepening tear troughs. (4) Blurred facial contours — midface descent reduces cheek definition, with side profile sagging. Rappoel Dermatology near Gangnam Station, Seoul, uses APTOS bidirectional barbed threads — a non-surgical method for precise midface elevation, instantly restoring youthful, full midface contours.
Technical Advantages of APTOS Midface Thread Lift
- APTOS bidirectional barbed thread unique design: APTOS is a PDO (polydioxanone) bidirectional barbed thread developed by Russian company APTOS — the thread surface has bidirectionally distributed micro-barbs that grip tissue in two directions after insertion. This bidirectional design allows the thread to simultaneously grip superiorly (temporal fascia) and inferiorly (malar fat pad), forming bidirectional anchoring — distributed lifting force that resists loosening
- Non-surgical instant lift: APTOS thread lifting uses specialized guide needles to implant barbed threads in the subcutaneous layer — barbs grip the descended malar fat pad, and the physician lifts the thread to reposition the midface to its youthful position. Immediate restoration of midface fullness and nasolabial fold reduction — without surgical incision or general anesthesia
- Simultaneous collagen neogenesis stimulation: APTOS PDO threads stimulate local collagen and fibrous tissue proliferation as they gradually degrade over 6-9 months — this new tissue continues providing support after the threads dissolve, maintaining the lifting effect for 1-2 years
- Natural results without stiffness: APTOS thread lifting repositions the subcutaneous fat pad — without altering facial expression muscle function. Patients can make normal expressions (smiling, speaking) without appearing stiff or pulled. This is a key advantage over traditional facelift surgery
- Adjustable and supplementable: Unsatisfactory results can be enhanced with additional threads. After threads fully absorb, treatment can be repeated to maintain results
Lifting Strategies for Different Midface Sagging Types
- Early midface sagging (30s-40s): Mild nasolabial fold deepening, slight midface fullness decrease. Strategy: 2-3 APTOS threads per side, focusing on malar fat pad upper edge. Combined with HA filler for enhanced fullness
- Moderate midface sagging (40s-50s): Noticeable nasolabial fold deepening, midface flattening, tear trough appearing. Strategy: 3-4 APTOS threads per side, lifting from malar lower edge to temporal fascia. Combined with Rejuran PDRN for skin quality
- Severe midface sagging (50+): Deep nasolabial folds, obvious midface descent, cheek laxity. Strategy: 4-6 APTOS threads per side, multi-directional threading (upward + diagonal), forming mesh-like lifting. May need combined full-face threading (forehead + midface + jawline)
- Asymmetric sagging: Different left-right midface descent. Strategy: more threads on the more descended side (1-2 extra), symmetric lifting for consistent bilateral results
- Midface + overall facial sagging: Strategy: full-face threading plan — forehead lift (improving brow ptosis + eye area) + midface lift (improving nasolabial folds + apple cheeks) + jawline lift (improving jaw contour), comprehensive one-session elevation
Rappoel APTOS Midface Thread Lift Treatment Protocol
- Facial assessment and plan design (20 min): Frontal and side evaluation of malar position and nasolabial fold depth → assess facial symmetry → evaluate skin elasticity and thickness → communicate expectations with patient → mark threading paths and entry points → establish thread count and specifications
- Disinfection and local anesthesia (15 min): Full facial povidone-iodine preparation → lidocaine local anesthesia at entry points and threading paths → wait 5-10 minutes for anesthesia effect
- Thread implantation and lifting (30-40 min): APTOS specialized guide needle entry from temporal area → advance along designed path in subcutaneous layer to midface area → withdraw guide needle leaving APTOS thread → gently lift thread to reposition malar fat pad → adjust lifting force for natural results → 2-4 threads per side
- Immediate assessment and adjustment (10 min): Frontal and side confirmation of lifting effect → patient smiles and speaks to confirm natural expression → immediate adjustment for any asymmetry → trim exposed thread ends → gentle pressure for hemostasis
- Post-care guidance (5 min): Post-care instructions (avoid laughing and wide mouth opening for 1 week, avoid side sleeping for 2 weeks, avoid facial massage for 1 month, avoid strenuous exercise for 2 weeks) → schedule 2-week follow-up
The entire APTOS midface thread lift takes about 60-70 minutes, with immediate midface elevation and nasolabial fold improvement visible, more natural results after 1-2 weeks of swelling resolution, lasting 1-2 years. Located 3 minutes from Gangnam Station Exit 10, with seamless English and Chinese consultation.
Frequently Asked Questions
How long does APTOS midface thread lift last?
APTOS midface thread lift duration: (1) Immediate lifting effect — visible malar elevation and nasolabial fold reduction immediately post-procedure, from physical thread lifting. (2) Collagen proliferation phase — 1-3 months post-procedure, thread-stimulated collagen neogenesis peaks, further consolidating the lifting effect. (3) Maintenance phase — APTOS PDO threads gradually degrade and absorb over 6-9 months, but new collagen tissue continues providing support, with overall results lasting 1-2 years. Factors: age (younger skin has stronger collagen proliferation for longer results), thread count (more threads provide more collagen stimulation), skin elasticity (better elasticity maintains lifting longer). Rappoel recommends: 12-18 month assessment after initial treatment; supplemental treatment when results diminish. Regular maintenance extends results — each thread lift accumulates collagen proliferation on the previous foundation.
Which is better for midface: thread lift or HA filler?
They work through different mechanisms and can complement each other: (1) Thread lift — physically repositions the descended malar fat pad to its youthful position, suitable for those with descended but normal-volume midface. Pros: instant lifting, simultaneously improves nasolabial folds, lasts 1-2 years. Cons: doesn’t increase midface volume. (2) HA filler — injects large-molecule HA to increase midface volume and fullness, suitable for those with insufficient midface volume (flat). Pros: instant fullness increase, lasts 12-18 months. Cons: doesn’t lift descended tissue. (3) Combined — thread lift + HA is the optimal approach: thread lift repositions descended fat pad (restoring position), HA filler increases volume (restoring fullness), synergistically achieving both position + volume improvement. Rappoel recommends: thread lift first (restore position), assess after 2 weeks for HA supplementation (add volume).
Is midface thread lift painful? How long is recovery?
APTOS thread lift pain and recovery: (1) Pain — very mild after local anesthesia, with needle prick sensation during anesthetic injection (about 5-10 seconds) and pulling/stretching sensation during thread placement but no pain. Completed under local anesthesia without general anesthesia needed. (2) Recovery — facial swelling most prominent at 1-3 days post-procedure (especially midface and temporal areas), with possible mild bruising. Swelling reduces 70-80% by 1 week, with near-normal appearance by 2 weeks. Facial sensation may feel slightly different (tightness) during the first month as threads stabilize in tissue. (3) Precautions — avoid laughing and wide mouth opening for 1 week (prevent thread displacement), avoid side sleeping for 2 weeks (prevent asymmetry), avoid facial massage and beauty treatments for 1 month, avoid strenuous exercise for 2 weeks. Rappoel provides post-treatment ice packs and recovery masks for swelling reduction, with most patients able to work and socialize after 1 week.
What is the difference between APTOS and other thread lift brands?
APTOS is a pioneer in thread lifting — main differences from other brands: (1) Brand history — APTOS was invented by Russian plastic surgeon Marlen Sulamanidze in 1998, the earliest barbed thread technology patent holder with over 20 years of clinical experience. (2) Thread design — APTOS uses a unique bidirectional barb design (barbs distributed in two directions), providing stronger grip and more even force distribution compared to unidirectional barbed threads. Other brands like Silhouette Soft use bidirectional cone structures; Ulthera is not threading but ultrasound. (3) Material — APTOS uses PDO (polydioxanone), absorbing in 6-9 months with excellent biocompatibility. Other brands may use PLA/PLLA or different materials. (4) Certification — APTOS has CE and Korean KFDA certification. Rappoel chose APTOS for its long clinical history, mature thread design, and proven safety. Rappoel holds the APTOS 2026 Q1 Vanguard Certificate (global outstanding partner certification).
Can midface thread lift be combined with Thermage?
Yes, with required time intervals: (1) Complementary effects — thread lift physically repositions descended malar fat pad (restoring position), Thermage FLX uses RF heating to tighten loose dermal skin (firming skin). One addresses position, the other addresses texture, with strong complementarity. (2) Time interval — not recommended on the same day (heat may affect thread stability). Recommended: Thermage FLX full-face tightening first, then APTOS thread lift 4-6 weeks later. This way Thermage first tightens the skin to provide a better foundation for threading, and thread lift on tightened skin achieves better lifting. (3) Combination advantage — Thermage improves overall facial skin laxity (fine lines, pores, overall tightness), thread lift focuses on midface and nasolabial fold lifting. Together they achieve comprehensive overall + localized anti-aging. Rappoel’s full-face anti-aging comprehensive plan frequently uses the Thermage + thread lift combination — the most cost-effective non-surgical anti-aging approach.
Sagging midface and deep nasolabial folds aging you? Rappoel APTOS midface thread lift — instant youthful cheek restoration!
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