Painless, effortless, safe!

Dr Indu Ballani, MD Dermatology, and Clinical and Aesthetic Dermatologist, New Delhi, elaborates on the technique that makes the PCLA procedure painless, effortless, and safe.

Thread procedures have gained popularity in the last few years due to it being office-based, minimally invasive and non-surgical. Recently, the fourth generation of threads, which are (Poly L-lactide-co-caprolactone) have been introduced in India.

These PCLA double needle bi-directional threads have barbs in the opposite direction to achieve good traction. There is also a central smooth area in between to facilitate gripping of the threads in the tissues. To understand the safety and ease of insertion of these threads, it is essential to have a thorough knowledge and detailed understanding of the anatomy. There are four layers and one plane that form the facial soft tissue structure: 1) Skin; 2) Subcutaneous layer; 3) SMAS-composed of muscle fibre, fat, and superficial facial fascia; 4) Plane containing retaining ligaments and space; and 5) Periosteum and deep fascia.

The double needle absorbable barbed threads are mainly inserted into the subcutaneous layer for re-positioning of the fat-pads. The absorbability of the threads is a requisite feature for minimum long-term complications as it has been seen that non-absorbable threads cause accumulation of undesirable material, which may trigger complications. The small barbs that are distributed regularly along the threads enable better and efficient grasping of surrounding soft tissues.

The barbs on both the threads are in a convergent bi-directional pattern with a central smooth part. This allows to pull the tissues around the central part. At each end of the thread, there is a straight triangular needle that is 100 mm long for the 12 cm, and 150 mm long for the 23 cm. These allow for the insertion of threads in both direction with precision, and the triangular shape of the needle allows it to traverse through the tissue allowing it to create angulations between the caudal and cranial portions of the thread that increases its lifting actions and tissue suspension.

The first step for insertion of the thread requires planning of the path so that a desired lift is achieved with re-positioning of tissue and anchoring at proper points.

The technique

There are different defined techniques for different indications on the face. The injector first chooses a particular technique and draws the insertion path with entry and exit points, sometimes there may be an intermediate point. Two safety lines are also drawn: The first from the upper margin of the tragus to the lateral canthus and the second from the medial canthus to the Modiolus. The areas outside this have a higher risk of damage to bigger vessels or nerve branches, hence requiring greater injecting skills.

The procedure, although non-surgical, requires adequate sterility by good disinfection to reduce the risk of infection. The next step is to inject 0.3/0.5 CC of lidocaine + adrenaline (1:100000) at the entry and exit points. Further, an opening is created by inserting an 18G needle vertically. Through this opening, one of the two needles is then inserted vertically till it reaches the subcutaneous layer, after which, it is slid parallel to the skin. Once it is in the correct layer, the same depth is maintained for the entire length of the needle. This layer is safe for insertion as there are no major vessels here. After taking out both needles from the exit points, excess thread is cut, and the tissue repositioned. Since this is a minimally invasive procedure, the after care is also simple like in the case of any other injectable procedures where the patient is counselled for swelling or hematomas, which may sometimes occur post the procedure.

More than 90 per cent patient satisfaction after one month has been observed as per available clinical research data and a background of 10 years of research on safety efficacy and tolerability makes thread lift a promising procedure to look forward to.