The History of Thread Lifting
Introduced in the late 1990s, PDO threads were initially designed mainly to lift ptotic facial tissues; but over the years, variations of the original design such as mono, screw/tornado, and cog were developed and used. These variations involved the placement of threads along a planned trajectory and these threads are then pulled to lift the skin, secured and trimmed at the entry point.
At its initial stage, thread lifting was viewed with a degree of suspicion amongst some medical aesthetic practitioners due to the high incidence of post-operative complications. However, as technology and techniques continue to advance, new suture and variations have become increasingly available, and if one were to review the available literatures regarding threads, it should be noted that although early data showed inconsistent results and early relapses, recent findings have provided clear evidences of the effectiveness and safety of thread lift.
Today, new devices, thread variations, materials, designs and techniques are continuously being developed and the indications for each technique are further refined, thereby resulting in significantly lower incidences of complications in the initial stages. In fact, the evolution of thread lifting has progressed so much that aside from the popularly known PDO threads, the market has now availed new threads such as PLLA and PCL.
In the last 3-5 years, a growing trend shows that patients today are actively seeking non-surgical procedures, including thread lifts. This proves that when performed correctly with the right threads and techniques, previous thread lifting associated complications can be greatly reduced, minimised and prevented.
Types of Threads - Mono vs. Screw/Tornado vs. Cog
While threads have made significant progress since its introduction, there are fundamentally 3 types of threads - they are, Mono, Screw/Tornado and Cog.
Mono: Mono threads are smooth threads without barbs. These thread type are usually placed into the face in a mesh-like fashion for skin tightening effects by improving and stimulating collagen formation around the thread.Mono threads are often used on neck lines, neck sagginess, forehead and under eyes. These threads are designed to be attached to an “anchoring point” under the skin. Although effective in the stimulation of collagen production and synthesis, mono threads are generally effective only for tightening of the skin but not lift.
Screw/Tornado: Screw threads are sometimes known as Tornado threads. They are often in the form of single or double threads intertwined together around the inserting needle. These threads have a great effect on volumizing sunken areas of the skin. Naturally, the intertwining threads have a stronger effect over the singular threads and are usually used for general face-lifting.
Cog: Cog threads are essentially mono threads, but with barbs deigned to hook to the underside of the skin. These barbs are usually either cut or molded as part of the thread and purposed as a support structure to lift sagging tissues. Unlike smooth mono threads, cog threads do not require anchoring points. In the case of cog threads, collagen formation will occur around both the threads and their barbs; making it most effective for jawline lifting and slimming.
PDO vs PLLA vs PCL
Generally, thread lifts are performed primarily to tighten skin, with its secondary effect to shape and contour the face. In recent years, the use of threads have progressive moved beyond the face, on to other body areas such as arms, thighs, abdomen and even buttocks.The basic of thread is that they can, and are, usually made of one of the 3 different types of materials:
Polydioxanone (PDO), Poly-L-Lactic Acid (PLLA) and Polycaprolactone (PCL).Polydioxanone (PDO): Most commonly used for stitching suture in surgeries, the effects of polydioxanone (PDO) threads can last between 6 to 12 months. With the threads complete dissolved and absorbed by the by skin after 6 months, it helps to stimulate the production and synthesis of collagen in the skin for up to 12 months.The functions of PDO has been known to cause changes in the dermis and many studies have shown that it is effective in improving pores and fine wrinkles. Furthermore, it is able to foster collagen formation in the dermal matrix to increase thickness of the papillary dermis. PDO threads can also induce tissue changes by placing them into the subcutaneous layer, as PMN cells, including eosinophile, are gathered making granulation tissues around the thread after insertion. It has been observed in some studies that there is an abundant of newly made collagenous connective tissue in the formed granulation tissues. Some studies have also shown that these newly made collagenous connective tissues converge into the pre-existing fibrous connective tissue creating a “merging effect”. Through this effect, it causes an inflammatory reaction to the surrounding area where the thread is inserted, and by effect of mechanotransduction, it will spread as waves to the surrounding tissues. In the granulation tissues newly made near the threads, fibroblast and myofibroblasts have also been reportedly observed. This shows that PDO threads can effectively improve the elasticity of the skin in the area of the procedure and by the effect of myofibroblasts, tighten the skin. Lastly, fat cells have also been observed to have denatured by the granulation tissues in the area of treatment, proving that PDO threads, if used correctly, can be very effective in face shaping, contouring and rejuvenation procedures.
Poly-L-Lactic Acid (PLLA): Another material often chosen for surgical sutures is the Poly-L-Lactic Acid (PLLA). The PLLA has been observed to be even more effective at simulating collagen production than PDO. This material has a lifetime of two years or more, and once dissolved, the PLLA breaks down into harmless ordinary substances like lactate, glucose, carbon dioxide and water. Some times used an alternative to fillers and botulinum toxin, PLLA can function as a volumizer and is able to stimualte the production of Type 1 and Type 3 collagen. One benefit of using PLLA over PDO threads is that it causes almost no or very small amount of inflammatory reaction to the surrounding tissues, yet delivering similar, if not better results.
Polycaprolactone (PCL): Although not as commonly used or as popular as the PDO and PLLA, polucaprolactone (PCL) threads is one that can last up to more than 2 years. This is because, the chemical bonds and structure in PCL are stronger and more complex, hence it takes a much longer time to be dissolved completely. The slower rate of degradation of the PCL threads also makes it ideal to be inserted to the surrounding tissues over an extended time; achieving a longer lasting result. PCL is also known to be very potent at stimulating collagen production as compared to PDO or PLLA. Once dissolved, the material breaks down into nontoxic ordinary substances and even after the thread has dissolved, collagen production can last for up to one year.Future of Thread LiftThe pace of which thread lift procedures is evolving suggests that it is expected to continuously progress and advance in the near future, and similarly, the demand for shorter, quicker, more effective and innovative procedures should expect to move in linear. Hence, it has become inevitable for a practitioner to be equipped with the latest and most advance tools, skills and techniques to deliver better and longer lasting results in patients.