What are threads exactly?
There are a few different types of thread that are popular in the US market. PDO threads are biodegradable absorbable sutures made from a polymer that is comparable to a complex sugar. The threads made of poly-L-lactic acid (like Sculptra) and also made of absorbable polymers, which signal collagen growth and tissue renewal, are less popular.
They are known as “threads” in the aesthetic field, but have been used in surgery for decades under the name “sutures”. That’s right – these cosmetic reinforcement sutures are made from the same materials surgeons use to seal lung and heart tissue.
The cosmetic use of sutures from plastic surgery gained prominence in the late 90s and early 2000s when sutures were used to hang damaged cheek tissue and shortly afterwards permanent sutures were used to lift the face, but resistance served as more of a problem than a solution, and it has been recognized that the absorbable sutures pose fewer risks, are more aesthetically pleasing, and can be placed and adjusted according to the patient’s aging process.
Nowadays, sutures are used to lift sagging brows, contour the midface, and tone the jaw area that becomes prone to jowling. The popularity in the aesthetic medicine industry is growing daily.
What types of threads are there and how do you know which one is right for you?
PDO and PLLA threads are the two main types of threads used by vendors in the United States, with PDO being the most widely used. They are both biostimulators that strengthen skin and tissue and build collagen, but PDO sutures are typically made in a greater variety and more flexible and customizable forms than the PLLA sutures, which are typically and can be placed deeper in the tissue and more risks with pits and granulomas.
I prefer to use PDO sutures on my patients and there are many different profiles of PDO sutures within that framework. There are smooth threads to build up a skin thickening, twisted or cyclone-like threads to induce increased skin thickening, there are spiked or serrated threads intended for lifting, and within the range of barbed threads there are unidirectional and bidirectional threads depending on the support needed to hold the towels up and hang them up.
Think of it this way: if your concern is to lift your face and tighten your jaw, then most likely you will need the barbed sutures. If your concern is more the thinning and sagging of the skin, you will most likely need the smooth or cyclone threads, possibly in combination with a lift, depending on the area.
How do threads work? Can you explain your technique / process?
Threads are considered biostimulators in the sense that they signal our body to respond and essentially heal itself. The threads (both lifting and thickening) are placed in a specific layout or pattern in the middle to deep dermis tissue to induce collagen by increasing fibroblast activity. When the threads are absorbed, your collagen takes the place of the thread.
If, for example, lung tissue is sewn with PDO, the thread does not stay there permanently, but encourages the surrounding lung tissue to take its place and hold it. Signaling the body that some regeneration needs to take place is a brilliant process.
Today you are known for your thread technology and you took over the process early on. How long have you been threading and why did you want to offer this process and be an expert on it?
I’ve been working with threads for four years now. When I started learning about threads about eight years ago, it initially felt like we weren’t done with the science and techniques. There were many complications I’d heard about and the training I received didn’t leave me confident of the results, but three years ago we now have very delicate threads with stronger barbs, better techniques, and the science is more refined, like we can learn from our Asian counterparts who have worked aggressively with threads for the past decade.
I have invested a lot of time and money to be trained not only by western vendors but also by South Korean aesthetic vendors who are much more experienced and have a gentler approach to major transformations.
Threads have been an important part of my practice as previously I could make a face bulkier and smoother using fillers and neuromodulators, but I was unable to lift a face without adding fullness in certain areas. Threads give me a way to tighten and treat thin skin without making a face look heavier or puffy in any way, and patients love that.