Silhouette Soft. Am I better off with fillers?

I am 38 years old and have been advised to have silhouette soft threads by my doctor. She said I'm the perfect candidate. She did not specify how many threads but I think one or two per side. I've been reading a lot into it and most reviews are quite negative. I have some premature jowl sagging which and the begging of marionette lines. Any advice is welcome! Am I better off with fillers? Can you feel the thread after recovery? I heard that you can't open your mouth wide... is that permanent?

Doctor Answers 11


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Thank you for your question. Which one is better for you depends on your symptoms of facial aging and your cosmetic goals. Silhouette InstaLift™ is a minimally invasive procedure that is able to target the deeper layers of skin on a patient’s face and neck. This new target area makes the procedure stand out from existing procedures that treat the surface or outer layers of the skin, such as wrinkles, brown spots or lost volume. An aged appearance is usually caused by a patient's deeper layers, so targeting that area allows us to get better natural results. InstaLift also has absorbable lifting sutures that tighten the skin and stimulate collagen as they dissolve over time. Fillers on the other hand have different benefits. For more information, I recommend getting a in person consultation with a board-certified dermatologist.

New York Dermatologic Surgeon
3.8 out of 5 stars 17 reviews

Silhouette Sutures Versus Fillers

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Silhouette sutures are indicated to provide a lifting effect to the mid-face in patients with mild to moderate facial folds. These resorbable sutures are fit with bidirectional cones, and are made of a collagen stimulating material, providing both an instant and gradual lift. While you are advised to avoid excessive facial movement and certain activities for the first 2-4 weeks (dental work, facial aesthetic treatment, high impact sports, etc.), these restrictions are not permanent. When placed at the proper depth, you should not be able to feel the Silhouette sutures after placement

Silhouette is not necessarily meant to take the place of filler, rather they can work together to create the most natural, rejuvenated look possible. There are different benefits to each procedure, however whether you are better suited for either Silhouette or filler alone could only be assessed through an evaluation. While they work best together, speaking very generally, if you are just noticing the beginning signs of “sagging,” Silhouette may provide you with the improvement you’re looking for; if you have significant volume loss, fillers may make more sense for you. As always, be sure to seek out the treatment of a board certified Dermatologist for the best outcome. Best of luck!

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.6 out of 5 stars 23 reviews

Silhouette Soft | Thread vs fillers

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Dear LidaR,

Thank you for your question. 

The key to improving a saggy face lies in the FILL and LIFT approach. In the absence of pictures, here is the general rule.

Jowls are the downward migration of your medial cheek fat pads. 

Treatment is a 3 step process.

1. Fillers to restore areas of lost volume. In your case, the cheeks, marionette lines and the pre jowl sulcus.

2. Threads to lift your saggy jowls

3. Review in a month's time with a focus on global rejuvenation

What is the key to looking youthful?

The key to youth is to reposition, re-volumise and restore lost tissue. By firming, lifting and tightening skin, by adding volume where it has been lost, and by holding tissue together, we can achieve a DREAMLIFT. It all starts from the top, so we fill from top down. When we were younger, we had an inverted triangle face shape. As we age, our midface sags the most, resulting in the formation of jowls, and changing our face shape into a square. So the key here is to lift, while maintaining a natural, youthful you.

I hope this is helpful to you.

Daniel Chang, MBBS
Singapore Physician

Fillers and Silhouette

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Fillers and Silhouette Soft are totally different things. Fillers give you a volume restoration on areas where you need or have lost volume. Silhouette Soft on the other hand, lifts the sagging skin. However both can work complimentary to each other but one cannot replace the other. For the premature jowl sagging & marionette line, Silhouette soft is my treatment of choice because it has excellent results.

Rajat Gupta, MD
India Plastic Surgeon

Thread Lift for Lower Face

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Thank you for your question.  It would be useful to provide some photos to see if you would benefit.  The threads are useful for the lower face for treatment of jowls and marionette lines in the right candidate.  Your surgeon should be able to identify if you would be a suitable candidate.

Reza Nassab, FRCS (Plast)
Manchester Plastic Surgeon
5.0 out of 5 stars 22 reviews

Silhouette Soft or fillers

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Silhouette Soft is the perfect treatment for skin laxity. Laxity occurs through natural ageing and is the result of deflation of fat compartments in the mid face leading to a gradual decent of the skin downwards and forwards. This results in an increase in naso-labial folds, marionette lines and jowls. To correct this a filler can be placed to restore the loss of volume and to lift the folds. The best treatment depends on the amount of laxity. As a 38 year-old the laxity should be mild and Silhouette Soft could be perfect. But fillers will give an improvement. Sometimes the ideal treatment is to do both!

The threads cannot be felt once in position in the subcutaneous tissues. The skin will feel tighter along the path of the threads at first and for about one weeks post treatment it is important not to overdo facial expressions but you can still open your mouth. Usually, one week after treatment everything will have settled completely. Finally it is important to add that there is an initial lift, but the results improve over the subsequent 2-34 months as collagen is stimulated.

I hope this is helpful. Best wishes

Silhouette versus fillers

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Hi there,

Photos would greatly assist, and naturally I can only give you my general opinion as I have not seen you for a thorough assessment.  In terms of the Silhouette Soft treatment guidelines, it is now considered best practice to place at least three threads per side.  We have had some evolution in the use of Silhouette over the past 4 or so years, with different schools of thought at different times.  It is now considered more reasonable to place more threads, and three are considered adequate to get a good result.  Naturally this is dependent on the patient also.  Silhouette are relatively effective for  repositioning lax tissue in patients in the 30-55 age group who have mild to moderate skin laxity and good skin condition.  Patient selection is key.  

Unfortunately when the correct situation is not chosen, the patient will get less than ideal results, with no result being the most commonly reported adverse event.  I consider Silhouette Soft to be a relatively weak anti-aging tool on its own.  However, I do use it in combination with fillers regularly.  Putting the volume back to the face with fillers can surely produce more dramatic results, but it you are looking for a very subtle, natural result then Silhouette could be an option for you.

Hope this helps!


MJ x

Silhouette Instalift and other non-surgical options

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Thank you for your question.  Dermal fillers are a great way to help soften the early signs of aging.  The Silhouette Instalift procedure is another great way to lift some of the 'sagging' tissues associated with the aging process.  I will often use both approaches as they work synergistically together.    Which to start first?  It depends on patient assessment and aesthetic goals of the patient (a photo would be helpful).   If, for example, the marionette lines or jowls are mild, then either Instalift sutures or dermal fillers may be all you need.  For patients with a more pronounced presentation, then a combined approach may yield the best results.  I would visit with a board certified plastic surgeon with experience in non-surgical facial rejuvenation in your area to discuss your options in more detail

Texture, tone and volume to give the very best results.

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A photo will be great, a face to face examination is Gold standard. To answer your question, fillers can help with jowls, the art is to trick the eye to elongate your jawline. A good specialist can achieve this with fillers in the correct areas. Sure, silhouette threads can achieve this as well, it really depends on your anatomy. I think that a combination of improving skin tone (threads) followed by volume replacement (fillers) will give the very best, but also the most natural results. Dr Davin Lim. Brisbane .Australia. 

Silhouette InstaLift or Fillers

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Dear LidaR:

This is a tough question without photos. An in-person consultation by a well-qualified, talented and Board Certified Plastic Surgeon is your best bet.

  • The Silhouette InstaLift (SIL) made of collagen stimulating dissolving suture with anchoring cones is inserted under the skin to mechanically lift, reposition and over many months stimulate tightening of the soft tissues of the face, neck, brow and now other areas of the body such as arms, thighs and breasts.
  • Fillers provide volume expansion or projection.

So, it depends on what your needs are.

My analogy is that with aging and skin / soft tissue laxity, the youthful smooth seas of the temple developed a “giant” wave at the cheek followed by a submalar hollow before hitting the shore along the mandible. Aging gives rise to 5 smaller waves and troughs at the lateral canthus, naso-jugal fold, nasolabial fold, lateral commissure/marionette fold and the neck fold.

  • The SIL acts in “harpooning” the soft tissues and reeling them back up toward the temple.
  • Fillers are used to fill the troughs or project the wave height.

Both can be used simultaneously. Adjunctive procedures include: 

  • Sculptra to create more collagen tightening under the skin and 
  • retinoids/chemical peels to tighten the skin from above.  

Both SIL and fillers need some time for adjustment. When injected artfully a reversal of the skin waves occurs. For fillers 2 days to 2 weeks maybe needed to settle and feel normal. SIL will required time to properly anchor, settle and start the collagen building process; my patients need 5 days to 3 weeks before they feel fully back to normal including yawning, opening their mouth widely and turning your head so as not to “pop” the anchors and lose the lift. Many of my patients have undergone prior facial procedures or have heavier tissues and need many more than 1-2 sutures per facial side. I like the lift and stimulation achieved with 4-5 facial sutures, 2 brow sutures and 3-4 neck sutures per side.

This is a lot to understand. Please consult carefully so you understand what is best for you. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.