Dr Hotaki’s permanent lifting:
how the internal support framework works

Why I call this structure a support framework

By a support framework, I mean the configuration of the implant and its fixation that I create within the tissues. It is not a ready-made rigid component installed in the same way for every patient.

The method uses a smooth permanent implant without barbs. In describing my system, its position, configuration and relationship to the selected fixation areas are important. The support structure distributes the load between these areas.

A permanent material alone does not explain the result. The entire system matters: tissue assessment, the choice of repositioning directions, the support configuration and verification of the implant’s actual position.

How this mechanism differs from absorbable barbed threads

Patients often group different interventions under the name “thread lifting”. This generalisation obscures differences in materials and support mechanisms.

With absorbable barbed threads, engagement with the tissues is part of the support mechanism, and the material undergoes biodegradation over time. In my method, a smooth permanent implant is used to construct a different support configuration. I do not rely on barbs as the tissue-holding mechanism.

This comparison concerns absorbable barbed threads specifically, rather than every existing thread-based technique. Materials, construction, fixation methods and indications can differ between techniques.

When discussing two procedures, it is therefore more useful to compare their specific mechanisms than just their names: what material remains in the tissues, how support is provided and how the doctor verifies the structure’s position.

Why a permanent implant does not mean an unchanging face

The word “permanent” in the description of my method refers to the permanent nature of the implant used. It should not be understood as a promise that the face will stop changing.

Age-related changes, the condition of the skin and soft tissues, weight fluctuations and each patient’s baseline characteristics remain relevant. A permanent support does not cancel these processes.

The duration and extent of the clinical result should therefore be discussed separately from the properties of the material. Results should be assessed using documented observations of individual patients, with the time since the procedure stated.

Where planning begins: SAFA

Before constructing a support framework, it is necessary to identify the problem to be addressed. A visible contour change may combine tissue displacement, volume characteristics, skin condition and pre-existing asymmetry.

SAFA, my Standardised Aesthetic Facial Assessment system, helps structure this assessment. I consider tissue position, proportions, asymmetry and the nature of the changes before choosing an intervention.

This analysis is also needed to identify limitations. A support structure should not be considered a universal answer to every aesthetic concern. In some cases, a different approach or a decision not to intervene is required.

Read more about SAFA

How UPS connects assessment with the support structure

After assessment, the next question is: how can the identified changes be translated into an individual plan?

Within my system, UPS — the Universal Positioning System — supports this task. SAFA concerns assessment, while UPS concerns subsequent planning of positioning and repositioning directions.

Even when two patients describe superficially similar concerns, tissue position, the extent of asymmetry and baseline proportions may differ. The same movement and support pattern should therefore not automatically be transferred from one face to another.

This is where the two parts of the method meet: the individual plan defines the task, and the internal support structure serves to implement it.

What the doctor needs to verify

A change in the external contour does not reveal every detail of the implant’s position. In my training programme, planning is connected with the study of topographical anatomy, cadaveric practice and ultrasound verification.

These stages allow us to examine the relationship between anatomical structures, the selected trajectory and the implant’s actual position. Ultrasound verification is part of the verification system, but it does not replace anatomical knowledge, clinical judgement or patient follow-up.

The technical details of placement cannot be communicated through a general article. Here I explain the principle of the method; learning to perform it requires in-person training and practical preparation.

What matters during a consultation

Patients need an explanation not only of how the implant works, but also of whether this approach is appropriate for them. The discussion covers baseline changes, the intended correction, limitations, alternatives, possible adverse events and subsequent follow-up.

The minimally invasive nature of the intervention does not mean an absence of risk. A decision is made following individual assessment and discussion, and the same result is not guaranteed for every patient.

In my permanent lifting method, the material, SAFA assessment, UPS planning and verification of the structure’s position are regarded as connected parts of one clinical system.

For doctors wishing to study this system:face lift training programme.

Author: Dr Nur Hotaki.