Introducing Thread Lifts to Your Aesthetic Practice

Dr Sarah Tonks discusses the uses of thread lifting and how clinics should adopt it
I have been a doctor in aesthetics for eight years and in the last couple of years I have been performing thread lifting. Recently there has been a big uptake in clients specifically requesting thread lifting because they believe it will give them a certain result.

It is a treatment that has had a big media push but there is a lack of knowledge about it in the public sphere, so it's important that we understand realistically what threads can and can't for our clients.
Often, what happens when people come in requesting threads is they end up getting a different treatment, because what they actually want in terms of outcome is something different from what threads can provide.

Case Studies

An example of one client who got fairly medium results from thread treatment, had two pairs of PLLA bidirectional cones. One was in the malar region and one was along the jawline. Two to three weeks after treatment, there was some improvement in the position of her cheek and there was a slight tightening along the jawline. This particular client was happy with the outcome, though best results appear a few months post procedure. I had a similar case where the results were better after two to three weeks, however I still felt that adding adjunctive treatments would give her an even better result.  When clients pay for a treatment they often want to see quick results so that is something to consider when planning the treatment and you may want to add adjuncts such as dermal filler at the time of treatment with a thread.

This treatment can also be performed with 4D barbs. 4D barbs are mounted on a cannula whereas the regular barbs are mounted on a long needle however they are both types of PDO threads. A colleague of mine uses PDO threads. Their client had two sets of 4D barbs in the cheek region as well as regular barbs. She had very good results but again, they could have been better with additional treatments. I think it is important to let the patient know what would give them improved results even if it means staging the treatment due to cost.

Another of my colleague's clients had some 31gauge monofilaments placed underneath the eye. He gained tightening underneath the eye and the results were good, but again, they could have been better if we had added some dermal filler in addition to this.

Where threads can really help is when filler is not appropriate. One of my clients was unhappy with the jowling and sagging in her face. However she had already had large amounts of filler placed elsewhere. Her cheeks were incredibly overfilled when she smiled and adding more filler to her face would have been very tricky without making her look more unnatural.

We can put some filler in the angle of the mandible but that would be it. She is a good example who could benefit from thread lifting alone as it literally gives a lift rather than volumisation.

I also have clients who are adverse to using fillers. They believe they will look unnatural or fake. For this type of clients thread lifting can be a nice alternative. I have done some monofilament PDO for clients like this, for skin tightness, and they have been pleased with the results. You can then also add some longer PLLA or PDO 4D barbs to further improve the results.

Combination treatments

Thread lifting is just another colour in our artist's pallet. It gives us more flexibility to treat more patients, so it is worth considering taking into your practice. Both PDO and PLLA threads can be used in slightly different ways, so it's worth considering both.

Using fillers and thread lifting combined can be very beneficial for clients. As an example, I had a client who was 51. She felt she looked tired and wanted to look a bit fresher. She had an eight point lift which was some derma filler placed in the malar region, in the pre auricular area of the cheek, and also in the marionette region.

It looked fine but after we did threads it looked even better. She had some monofilament threads placed underneath her eyes on both sides and a couple of bidirectional sutures. One was along the jawline in the 90 degree pattern and then another one was in the malar region. I have recently changed how I am using these longer PLLA threads to insert them in a U shape rather than a V or a 90 degree angle, and I'm getting much better results.

The results were very good but if she hadn't had the fillers done initially she would still not have got enough volume in her face for it to truly be a good natural result.

We need to consider that using threads is not as straightforward as using fillers. After patients have dermal fillers they can often go straight back to work or on holiday. However, with thread lifting you can sometimes get some bruising, asymmetry or rippling in the skin immediately afterwards. This means that people are sometimes uncomfortable going out in public. I advise clients that they really will need a minimum of two weeks before they start to feel normal again.

You can use thread lifting in patients who have previously undergone a facelift. Sometimes, after ten years or so, people feel like they need a little lift again and thread lifting is useful for this.

A patient of mine, who had undergone a facelift, had some bidirectional PLLA in the same region but we also did a little PDO as well. This consisted of a couple of barbs in the mid-face, just along the zygoma. She also had some cross linked derma filler placed in the vertical lip lines in the upper lip. She was very happy with the results and her jawline looked a lot tighter.

Using thread lifting

If a client comes in for treatment and I feel like they could benefit from both threads and fillers, I'm often happy to do this in one go. The rhetoric of aesthetics is to take things slowly, but if it is somebody I've seen before and they are happy to proceed, I'm happy to do it, as long as I can see them a few weeks afterwards and do any tweaking that we might need to do.

I will often inject dermal filler first as it might be used for structure. For example I might do the malar region with dermal filler, and then use a cannula and volumise the angle of the mandible to give a little bit more structure. I will then put some threads in afterwards.

I have also found no issues with placing the thread directly through the area where we have placed the dermal filler. Once this is done, they may well need to have some tweaking or adjustment after two to three weeks. The PDO threads are very good for this. If you have used the long PLLA before and the patient has a little bit of asymmetry on one side, you can add in a couple of PDO barbs on that particular side and it will be corrected.

If they are having botulinum toxin treatment I will do the thread lifting in a different treatment session. Botulinum toxin and the dermal fillers will come first and a couple of weeks later we'll do any tweaks and add the threads in afterwards.

With threads you get an improvement in the skin quality and texture in a way that you don't just using derma fillers. So we are giving the patient a more global enhancement rather than just spot treating. I believe this has a long term future in our industry but we need to understand what the patient needs and not just what they want, because they may not understand the benefits and issues of the treatments available to them.


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