Kanishka Ramchandani of Aesthetic Medicine, in association with Relife, a Menarini Group Company, delves deeper into the efficacy of fourth generation threads, giving insights about patient selection based on age and other relevant factors.

Kanishka Ramchandani

Aesthetic treatments have undergone a definitive change in the post-pandemic era, thanks to the sociological factors that have come into play. As per the Aesthetic Threads Market Growth, Trends, COVID-19 Impact and Forecast (2021 - 2026) 1 report by Reportlinker. com, ‘plastic surgeons have received a surge in inquiries for cosmetic procedures since the coronavirus lockdown was lifted, with workers desperate to look good on Zoom calls.’

According to the International Society of Aesthetic Plastic Surgery (ISAPS) 2019 report 2 , around 80,304 procedures of facial rejuvenation and 7,488 facelift procedures were performed in 2019 in India. These numbers have grown significantly since then. Considering the consumer bent of mind towards minimally invasive or non-invasive procedures, threadlifts are one of the fastest-growing cosmetic procedures in major markets such as North America and Asia. They are significantly growing in popularity for facial rejuvenation.

In our feature titled Definite Lift (in the Aesthetic Medicine July-August 2021 edition), we explored the reach of the fourth generationthreads in India and the gaps in popular aesthetic treatments that these threads are going to fill. In this edition, we go further into the workings of fourth generation threads to discuss patient selection, pre-procedure preparation and age-related treatments.

A new generation steps in!

Although the fourth generation threads have become the popular choice of treatment for aesthetic medicine practitioners for minimally invasive facial rejuvenation, it requires thorough patient analysis and pre-procedure examination to determine if all related factors are conducive to the treatment. Therefore, it is important to note 3:

1. Which patients may benefit from treatment with suspension threads?

2. Which superficial fat compartments must be treated and lifted?

An inappropriate correction will likely result in partial or no improvements in the patient’s defects.

Ideal candidate

• Between 30-60 years of age.

• Minimal or moderate signs of ageing (although even patients with severe ageing may demonstrate a slight improvement after treatment).

• Normal or thick skin and atrophic or

hypertrophic superficial fat.

Once the ideal candidate is determined, practitioners need to understand which type of thread is to be used. This will depend on the age of the patient, the treatment area and the desired result.

Practitioners need to take into account contraindications before suggesting or starting the thread lift treatments. Some of the absolute contraindications include4:

• Recognisable personality disorders

• Previous injection of non-absorbable filler in the same treatment area anticoagulant therapy/bleeding disorders

• Use of illegal medication/substance abuse

• Intolerance for or allergic to lidocaine or epinephrine

• Moderate-to-severe acne/rosacea

• Intolerance for or allergic to PLLA and/or PCL

(Poly-L-Lactic Acid and Caprolactone)

• Immunologically compromising diseases†

• Facial and/or scalp eczema or psoriasis

• Local or systemic infection

• History of keloids or hypertrophic scarring

• Acne/rosacea at or near the thread entry/ exit points

• Uncontrolled diabetes

• Pregnancy, breastfeeding

• Use of blood thinners

Thread lifts are not suitable for patients with excessively saggy skin. Threads may not be suitable if the skin is aged, thick or damaged, but still it is important to remember that thread lift, especially PCA, represents an option for those who cannot tolerate surgical lifting or narcosis. Patients with good soft tissue volume, less facial fat and a small amount of skin to be lifted will benefit the most from thread lifts. 5

For a practitioner, it is a must to walk the patient through the entire procedure and explain in detail the pre and post treatment precautions. The patient is advised to be off alcohol and tobacco and other relevant medications that may lead to excessive bleeding or bruising of the skin, at least five days prior to the treatment. It is ideal to explain to them potential complications and the recovery timeline. While the exact course of treatment may vary, depending on how the doctor prefers to do it, it is a lunch-time procedure conducted in a sanitized procedure room under local anesthesia. Practitioners may additionally prescribe antibiotics and analgesics for better post-procedure outcomes.

References: 1 and 2 :https://www.globenewswire.com/news-release/2021/02/26/2183301/0/en/Aesthetic-Threads-Market-Growth-Trends-COVID-19-Impact-and-Forecast-2021-2026.htm3: Menarini DN 12cm pdf 4 and 5: Wong V, Rafiq N, Kalyan R, et al. Hanging by a thread: choosing the right thread for the right patient.J DermatCosmetol. 2017;1(4):86-88. https://medcraveonline.com/JDC/hanging-by-a-thread-choosing-the-right-thread-for-the-right-patient.html