Combinations, for best results!

Dr Maya Vedamurthy, Director, RSV Skin Clinic, and Senior Consultant, Apollo Hospitals, Chennai, has been using the fourth-generation threads since Relife’s Definisse threads were introduced into the India market. She elaborates on how these can be best used in combination with other treatments.

An ageing face has a combination of several defects. One, they have descent of fat pad, ie, fat pads move away from the place they need to be in, leading to hollowness, and a sagging skin. For instance, the jowl fat, the submental fat, all descend downwards, creating hollowness in the place they ought to be. This fat needs to be trans-positioned and pushed back. This is not always achievable with just fillers and the energy-based devices, and at times, there is a need for more tensile strength to pull the skin and push the fat to the place where it was. This is where combination treatments come in.

The fourth-generation threads – PCLA 12 cm and 23 cm – have a dual effect, and this is what makes it different from the other generation of threads. It lifts as well as rejuvenates the skin, helps in collagen formation, and revitalises the skin. The lifting and the repositioning are much better with this group of threads.

Combination treatments

When the fourth-generation threads are used in combination with other treatments, the fat is repositioned, as well as this also results into an improvement in the skin texture. The need is that of a holistic approach – the lifting effect, improved skin quality, minimising the pores by producing skin tightening, and giving a glow to the skin. It has other effects in addition to lifting because it revitalises the skin.

There are different combination treatments for different indications. For the hollowness and mid-face sagging, fillers can be used first because it is on a deeper plane that is on the bone. However, once the lost volume has been replaced, there will be excess skin sagging over it. Hence, either fillers can be done first, followed by threads; or fillers can be followed by an energy-based device such as HIFU (highintensity focused ultrasound) that tightens the SMAS. Then again, we have loose over hanging skin for which threads can be opted for. At times, aesthetic practitioners would also want to do resurfacing to give a glow to the skin and then tighten it. For this, there are several combinations and all of them can be done on the same day because they act at different levels. Threads is only in the subcutaneous plane. The fillers are much deeper, and the energybased devices work at a SMAS level. Sometimes, you may also opt for radiofrequency to tighten the skin.

The fourth-generation threads can be used in combination with PDO threads as well. While the fourth-generation threads can be used for lifting the skin, PDO threads help in rejuvenation. These can be used as free-floating threads, and can be placed in the subcutaneous fat.

However, aesthetic physicians must be conscious about not using these threads on extremely obese patients as well as in the case of excessive laxity. Usually, the ideal age for this treatment is about 30 to 60 years. However, at times, much older people request for it and their skin has too much of sagging and wrinkling because of which this treatment will not make a huge difference. When there is a heavy face, the threads really cannot lift it, and sometimes the skin is thin and cannot hold the thread. These would be two typical scenarios where the candidate should not be considered for the thread lift.

With the option of using the PCLA fourthgeneration threads, the choice can be made on the basis of the technique that will be used. The anchoring points in these threads are much superior as compared to what was used earlier. The technique is good, it is simple, the needles are fine and easy moving, and the threads are fine too. The side-effects are less, tensile strength is more, and the patients are happy with the results.

When used in combination treatments, these prove to be cost-effective as well as offer gratifying results.