Threads offer plastics surgeons yet another non-surgical way to lift, refresh and rejuvenate the skin.

Dr Pagkalos inserts the treads beneath the surface of the skin to stimulate collagen production, tighten the skin and provide some degree of immediate lift. Although there is a lot of hype and marketing about how quick, easy and effective the procedure is, complications can happen and the results vary vastly according to the doctor, the quality of threads used and patient selection.

There are two main types of threads:

  • Threads that improve skin quality
  • Threads that mechanically hook into the skin and lift sagging tissues

Threads that improve skin quality

This type of threads acts as a regenerative stimulant that ultimately improves skin properties such as thickness, elasticity and turgidity. The use of threads have progressively moved beyond the face on to other areas such as arms, thighs, abdomen and buttocks.

Dr Pagkalos strategically inserts threads into the skin creating a dense net which acts as a matrix for newly formed connective tissue. As a result, skin in the treatment area becomes thicker and firmer, attributes found in younger skins.

Composition of threads

Threads are made of 3 different types of materials:

PDO (Polydioxanone), PLLA (Poly-L-Lactic Acid) and PCL (Polycaprolactone).

PDO threads are made from the same material as PDS absorbable sutures used in surgery. The effects of PDOs can last between six to 12 months and threads are completely dissolved and absorbed after 6 months. PDOs make changes in the dermis that improve the appearance of pores and fine wrinkles, while, at the same time, foster collagen formation in the dermal matrix to increase thickness of the papillary dermis.

Studies have shown that newly made collagenous connective tissue converges into the pre-existing fibrous connective tissue creating a “merging effect”. This effect causes an inflammatory reaction to the surrounding area and through mechanotransduction the inflammatory reaction spreads as waves to the adjacent tissues, enhancing the extent of the results.

Last but not least, studies have shown that newly formatted granulation tissue cause denaturation of fat cells which, in turn, make PDOs very effective in facial shape enhancing when properly placed.

PLLA threads is another material often used in surgical sutures. PLLAs are even more effective in stimulating collagen production. PLLA threads have a lifetime of two years and once dissolved they break down into harmless, common substances like lactate, glucose, carbon dioxide and water.

Having volumising properties PLLAs are also used as an alternative to filers and although the degree of inflammatory reaction is lower than PDOs, they manage to deliver similar, if not better results.

PCL threads, although not as commonly used as PDOs or PLLAs, can last more than 2 years! This is due to their chemical bonds and structure which is stronger and more complex. PCLs need much more time to be completely dissolved and therefore produce a longer lasting result.

The structure of threads.

Mono-threads were the first type of threads used in cosmetic medicine. Mono-threads are smooth, usually thin threads without barbs. They are effortlessly inserted inside the skin, the procedure is almost pain-free and the results are generally satisfactory.

Trying to enchase threads efficacy, researchers came with the idea of using multiple threads intertwined together around the inserting needle. That idea gave birth to the screw/tornado threads which extend the area available for granulation tissue formation and greatly improve the outcomes of Thread Lift.

Cog threads are nowadays the top-of-the-line threads used in skin quality improvement. Originally used as “lifting” threads, Cogs nowadays represent the optimal solution for skin tightening. In this case, the barbs once designed to hook to the underside of the skin and lift the face upwards, now act as an added stimuli for collagen production. Inserted in a net forming manner under the superficial skin layers, Cogs lead to the formation of a strong connective tissue matrix with impressive outcomes to difficult areas such as the mouth corners and the jawline. Although being a relatively painful treatment and requiring a skilled plastic surgeon to properly insert them, Cogs are gradually gain trust among patients and surgeons around the world.

Who is a good candidate for a Thread lift?

Thread treatment can practically be beneficial for all patients with skin laxity caused by age and/or weight loss. Ideal candidates are however patients under 65 years old, non smokers, with mild to moderate skin laxity and a healthy lifestyle.

Threads are also used as a very effective precaution measure for patients on a weight loss program that are afraid of having a loose skin after hitting their weight goals.

Although media have raised patients’ expectations a lot, Thread lift is nothing more than another non surgical approach to skin tightening. Threads may not work miracles but they manage a decent degree of skin tightness and also provide a solid foundation for subsequent fillers injection. Studies have show that best results are achieved through a combination of threads, hyaluronic acid and modern mesotherapies.

The future of Thread lift

Having reached the limits of structural evolution, research labs around the world are now focusing in adding new substances to the chemical composition of threads in order to enhance effectiveness and duration of results. Gold is gaining popularity among plastic surgeons due to its unique attributes. When integrated to threads, gold causes a delayed release of ions to the skin which has both immediate and long term results. Gold ions reflect light, making skin look brighter, while, at the same time, gold’s anti-inflammatory properties result in a healthier, youthful and fresh skin.

Threads that mechanically lift the skin

This type of threads relies in the mechanical attributes of cones or bars incorporated to the threads that support and lift the face.

Patient selection is however essential. Ideal candidates are relatively young pattens, non smokers with a mild to moderate sagging, who want their faces to look good for as long as possible before opting for a surgical intervention.

The lift is instant but patient’s compliance is crucial in order to maintain the results.

Furthermore, pulling the skin creates folds that look and feel ugly. Although this folds are planned to be concealed into hair, there is still cases that this can not be properly done. Plastic surgeons have to keep a balance between pulling the skin and being able to hide the folds produced.

Dr Pagkalos uses a variety of Lifting threads such as Silhouette Soft®, Aptos® and Dual Arm threads.