Tissue repositioning with threads

Dr. Pankaj Chaturvedi, MD Dermatology, Hair Transplant Surgeon and Founder of MedLinks Clinic, Delhi, elaborates on soft tissue repositioning and facial lifting with fourth generation threads, and the importance of facial marking and assessment.

Ageing brings about various changes in the facial structure such as volume loss, laxity of skin and drooping of facial fat compartments. Owing to these unavoidable changes, the facial appearance becomes undesirable with time.

Fourth generation threads are advanced threads that help in repositioning of tissues, which have moved from their conventional position.

Furthermore, the material of PCLA threads (Poly- L-Lactic Acid and Caprolactone) is so advanced that it stimulates Collagen 1 and Collagen 3 synthesis. Even after the threads get dissolved, there is a mesh of collagen that stays in that area and supports the tissue to a certain extent. They have long lasting effects.

Facial assessment is important to understand the primary pathology – whether it is volume loss or tissue sagging or a combination of both. It is also imperative to see the skin’s elasticity and thickness. For instance, if the patient is skinny and has volume loss on the face, a thread lift will not bring about any considerable change as the main role of thread lift is not volumisation, but tissue repositioning. The aesthetic medicine practitioner may have to consider additional treatments post the facial assessment.

There are different techniques of tissue repositioning, and hence, it is important to do proper markings. Incorrect markings may lead to suboptimal results.

Based on facial assessment and markings, the outcome of the treatment can be predetermined to a certain extent. During assessment, the doctor judges the laxity by lifting the area and seeing how much repositioning can be done with the thread. It is more or less predictable and the same must be conveyed to the patient to avoid unrealistic expectations.

Asymmetries are not uncommon in thread lifts. However, what is seen instantly post-procedure of a thread lift is not the final outcome. Initially the skin is lifted and collected. But there is a little inflammation too, which takes 7 to 10 days to resolve. Most patients say that they see an asymmetry. Here, it becomes important to explain to them that it will resolve with time and the final outcome will be visible after six weeks.

Procedural protocol

Check the history of the patient thoroughly including medication, and rule out infections and other disorders. Since the procedure is cosmetic in nature, one should bear in mind that if the patient has an illness which is reactive in nature then it should be treated as a contraindication and such minimally invasive treatments should be avoided.

Since the thread will stay in the skin for a year, it is important that the patients are suitably educated about it. During the procedure, sterilisation is important. Hair should be carefully considered and handled in the treatment area because the thread has to go inside and, if a hair goes inside with the entry or intermediate points, it can cause an infection. Keeping the treatment area and equipment sterilised is also extremely important.