Threads in aesthetic medicine

• Facial aging

  • Dynamic, cumulative effects of time on the skin, soft tissues, and deep structural components of the face
  • Complex synergy of skin textural changes and loss of facial volumes
  • Reflects the combined effects of gravity, progressive bone absorption, decreased tissue elasticity, and redistribution of facial volumes
• Types of threads

  • Absorbable (Polydioxanone (PDO), poly-L-lactic acid (PLLA), polycaprolactone (PCL))
  • Non-absorbable (polypropylene)
• Thread structures

  • Smooth threads (for biostimulation, lack anchoring mechanism)
  • Non-smooth threads (for tissue repositioning and secondary biostimulation, have barbs for anchoring)
• Non-smooth thread types

  • Unidirectional barbed threads (all barbs in 1 direction)
  • Bidirectional barbed threads (barbs in opposite directions for major traction)
• Ideal candidate for thread lift

  • Between 30-60 years of age
  • Minimal or moderate signs of ageing
  • Normal or thick skin and trophic or hypertrophic superficial fat
  • Compliance to the aftercare indication and availability for follow-up
• Thread facial rejuvenation

  • Convenient and less invasive alternative to traditional facelift procedures
  • Tailored for individuals encountering early signs of aging, like mild to moderate facial sagging
  • Affix threads to the skin tissue, gently pulling them back to elevate and reposition facial tissues
  • Stimulate collagen production in the dermis, enhancing skin tone and elasticity

  
• Contraindications

  • Recognisable personality disorders
  • Previous injection of non-absorbable filler in the same treatment area
  • Unrealistic patient expectations
  • Anticoagulant therapy/bleeding disorders
  • Use of illegal medication/substance abuse
  • Intolerance for or allergic to lidocaine or epinephrine
  • Moderate-to-severe acne/rosacea
  • Intolerance for or allergic to PLL and/or PCL
  • Immunologically compromising diseases
  • Facial and/or scalp eczema or psoriasis
  • Local or systemic infection
  • History of keloids or hypertrophic scarring
  • Acne/rosacea at or near the thread entry/exit points
  • Uncontrolled diabetes
  • Pregnancy, breastfeeding
  • Use of blood thinners
• Thread Lift Pre-Treatment Instruction

  • Avoid any kind of pressure or tension on the face for 12 hours
  • Do not make exaggerated facial expressions for about 2-3 weeks. Avoid aggressive or prolonged chewing, wide yawning, or smiling too large for up to 1 month
  • Sleep in supine position with no pressure on the cheek area for first few days
  • Do not massage the treatment area or receive deep facial massage for the next 2 months
  • No strenuous exercise for 4 weeks
  • If possible, do not smoke or consume alcoholic beverages (includes wine) for 1-2 weeks
• Thread Lift Post-Treatment Instruction

  • Management of pain can be achieved with mild analgesics
  • Short-term antibiotic therapy may be beneficial (eg, amoxicillin for 5 days)
  • A routine follow-up is scheduled 1 week after the procedure
  • Gradual healing occurs and fibrotic scar tissue builds up around the threads which keep the soft tissue in place
• Facial Anatomy

  • Supra SMAS plane = subcutaneous tissue
  • Subcutaneous tissue = superficial fat compartments
• The techniques

  • Entry point is created with 18G needle vertically perforating the entire thickness of skin
  • Insert the cannula vertically in full depth of skin and subsequently glide the threads perpendicular to the skin layer in constant depth in order to reduce dimpling
• Techniques

  • Molding Cog /Double Cog PDO
  • Cog PDO
  • U-Cog PDO
• Common side effects

  • Ecchymoses, small hematomas
  • Edema, slight inflammation
  • Neural pain or parasthesia after thread lift insertion
  • Tiny temporary skin irregularities
  • Temporary asymmetries
• Common complications of thread lift

  • Dimpling at the entry
  • Skin ripples / irregularities along the route of thread
  • Visible threads
  • Threads migration
  • Bruising
  • Vascular compromise