While the beauty industry suffered a slight decline early on in the pandemic, aesthetic practices quickly rebounded, witnessing an immense increase in inquiries for cosmetic treatments, including thread lifting procedures.
Thread lifts are popular with both practitioners and patients because, like injectables, they can be done in the office with local anesthetic. An increase in work-related teleconferences has driven consumers in search of anti-aging procedures to help them look their best and feel confident. Thread lifting treatments for the face are expected to experience the fastest growth rate during the forecast period, as they meet the demand for safe treatments with minimal recovery and maximum convenience.
To respond to the uptick in demand, product technology and innovation are driving the market forward with an expansion of the types of threads offered for improved versatility, efficacy and safety. Today, practitioners can find a variety of threads to help lift and tighten skin and stimulate collagen synthesis.
Polydioxanone (PDO) threads come in a variety of styles designed for customized results. Monofilament (mono) PDO threads are smooth threads used to tighten skin and fill in volume loss, while barbed threads can lift or re-drape skin and stimulate collagen production. PDO threads remain the most popular, thanks to technology like in-cannula threads designed for efficacy and patient comfort.
Poly-L-lactic acid threads (PLA, PLLA) can increase volume in sagging areas to restore facial shape while lifting and stimulating collagen synthesis. These threads are resorbable and act on the deeper layers of skin.
Polycaprolactone (PCA) threads are composed of synthetic caprolactone and are the latest technology in threads. They are bio-absorbable, mono-suspension threads that lift, tighten and provide the longest support structure for collagen production.
Continuous development in technology requires aesthetic physicians to keep up with trends and advances to determine the best outcome for patients. Jan Balczun, MD, a board-certified facial plastic surgeon (Recklinghausen, Germany) with an interest in nonsurgical rejuvenation procedures, said, in his experience PDO threads have come a long way.
“When thread lifting became popular in Europe, the strength of PDO threads was not sufficient for the needs of the patients,” he began. “For stronger lifting effects I had to switch to PLLA threads, but the management of these threads was more complicated. You had to take precautions due to sterility reasons and because threads were delivered without cannulas, the procedure was trickier, which meant more stress for the patient.”
With the recent advancements in PDO threads, Dr. Balczun now uses only PDO threads in his practice. “The biodegradability is far better than with other threads, and over time, the PDO threads grew stronger and took on a lot of indications from PLLA threads. In addition, the handling of PDO threads is a lot easier, as most of the threads are delivered already inside a cannula. This means less stress for the patient, faster results and less complications.”
Thread Lifting for Facial Rejuvenation
Neurotoxins and fillers are popular cosmetic treatments for facial rejuvenation that achieve fast results with no downtime. Now, thanks to the advancements in technology, thread lifting can be added to a physician’s armamentarium of minimally invasive rejuvenation therapies.
Thread lifting is quickly becoming a preferred method to address mild to moderate skin laxity of the face and neck. According to Omotara Sulyman-Scott, MD, a facial plastic surgeon and founder of That Face in Chicago, Ill., thread lifting may provide better results than other non-invasive rejuvenation treatments.
“Thread lifting is meant to reposition the soft tissue of the face,” she pointed out. “A more contoured jaw line and reduction of sagging skin is achieved by pulling up the cheeks, reducing jowls and tightening or pulling the neck in laterally. It can also open up the eyes by lifting the brow.”
Facial plastic surgeon, Vincent McGinniss, DO (Findlay, Ohio), shared one of his reliable protocols that serves as a foundation for a midfacelift. “Good entry points are chosen and include one a few millimeters anterior to the hair-bearing temple and another just anterior
to the tragus, he stated. “Other great options include the jaw angle, the mastoid region, and regions anterior to the sternocleidomastoid muscle, to name a few. These points make sense because some of these regions are used as anchoring points in traditional facelift surgery. The barbed threads come in a variety of sizes and the 19-gauge are my workhorse thread,” he added.
Dr. McGinniss clarified that certain indications require customized treatments and realistic expectations must be explained to the patient. “Additional lifts to the cheek, jowl, submental region, and neck will often require threads to be placed at the additional entry points mentioned above. The more lift needed, the more threads that will be required.”
Thread choice is critical to achieve the desired, customized effect. “Threads can provide a natural facelift and barbed threads are best to grasp, lift and suspend sagging tissue,”
Dr. Balczun explained. “Basic and screwed threads are used for tissue rejuvenation, decreased laxity and to smooth small wrinkles.”
Dr. McGinniss explained how he incorporates these rejuvenation treatments in his practice. “I sometimes combine thread lifts with other therapies such as radiofrequency (RF) or ultrasound devices, platelet-rich plasma/fibrin, fillers and neurotoxins to customize treatments.” Choosing the right treatment depends on the patient and the desired outcome.
He reiterated that communication with the patient is key. “When choosing between fillers and threads, I like to tell my patients that fillers can fill, and threads can lift,” he noted. “The claim that fillers can lift is debatable. I feel that if we place enough filler in one location, the tissues could re-drape around it to some extent; however, if significant lift is needed, a large bolus of filler in a particular location may re-drape the tissues, but likely in a very unnatural way.
“Threads do a nice job of lifting the tissues that have descended from age and gravity,” Dr. McGinniss continued. “The descended volume of tissue is grabbed by the barbs of the thread and moved upward to create a more youthful appearance.”
While thread lifts can re-drape and tighten skin, Dr. Sulyman-Scott emphasized that thread lift candidates must be chosen carefully. “In some patients with thin skin, thread lifting to tighten may result in bunching up of the skin at the thread injection location, so if you are pulling the face up and laterally towards the ears, you can have excess skin bunched up in that area, which is not cosmetically appealing.
“Furthermore, when skin is very thin, the threads become visible or palpable where the patients can actually feel the threads underneath the surface of the skin,” she added.
MedyGlobal America (Glenvar Heights, Fla.) is a boutique PDO thread company for healthcare professionals. The company recently patented 360°, three-dimensional helical barbed threads with advanced technology for attachment points that deliver improved support of sur-rounding tissue without manual twisting.
With a focus on reliable results, MedyGlobal America has been raising the standards of PDO thread performance via technology advances such as small production, contaminant-resistant fiber construction and high tensile strength. They offer monofilament screw threads with PDO inlays for greater support, mesh threads to address deep wrinkles and nasolabial folds, as well as RHINO threads specifically for the nasal area.
PDO Max® (Liverpool, N.Y.) is a trusted provider of PDO threads and one of the few companies with a PDO thread-in-cannula device fully cleared by the FDA. The company provides over 20 varieties of threads, and recently launched a numbing cannula with lidocaine, designed to pre-tunnel and numb treatment areas.
According to Dr. McGinniss, the future of PDO Max holds more exciting advancements. “Consistent with PDO Max’s passion for sharing knowledge in this field, we are going to start a cadaver course next year focusing on teaching relevant anatomic nuances critical to mastery of precise, effective and safe PDO placement.”
JJ Medical (Rancho Cucamonga, Calif.) is the North American representative and distributor for BioSun PDO Threads. BioSun supplies the threads while JJ Medical offers ongoing sup-port and pop ups for newly trained injectors, as well as in-clinic trainers.
JJ Medical is fully committed to safety and innovation. The company’s goal is to provide products that are safe and easy to use with a commitment to additional training sessions when new technologies are developed. Informative, hands-on training helps practitioners gain, and continue to develop, the appropriate skills to achieve immediate, natural looking results.
VIOLA Threads (Brea, Calif.) provide medical aesthetic practitioners with various types of fully biodegradable threads that come in dif-ferent shapes, sizes and even materials.
Consisting of dyed PDO, VIOLA threads are indicated for use in soft tissue approximation, where the use of absorbable sutures is appropriate. The complete prod-uct line includes both cutting-type (Cobra) and molded-type (Molding) threads to perform all types of thread lifting treatments for both begin-ners and advanced users.
Today’s aesthetic physician and cosmetic practitioners have the benefit of advanced technology at their fingertips. As Dr. McGinniss eloquently stated, “Continued growth in our understanding of threads in vivo is what drives us to apply cut-ting edge technology in practice in order to offer world class treatment options for our pa-tients that are safe and effective.”
1. Market research. Giving Intelligence Teams an AI-powered advantage. (n.d.). Retrieved November 12, 2021, from https://www.reportlinker.com/p06028479/Aesthetic-Threads-Market-Growth-Trends-COVID-19-Impact-and-Forecast.html.