This is what I read on the internet some other day. Today this applies to men as well as women as both seem to have been bitten by “look your best” bug. Ageing and fat (specially the sudden loss of fat), are responsible for sagging skin. Gravity and pregnancy also contribute to further sagging of the skin.

Wrinkles, jowls and double chin are the consequences of facial skin sagging and extra folds of skin at the elbows, knees, abdominal overhanging (on all sides) and sagging breast are contributed by ageing of the body skin.

Reduction in elastin, collagen and glycose amino glycans of the skin contribute to genetically programmed ageing of the skin. These effects are enhanced by extrinsic factors such as UV radiation, temperature variation ( I think AC is the biggest culprit), gravity, wind or excess humidity, pollution, vices (drinking & smoking), poor nutrition and mental stress (that we doctors have in abundance). Hence we are left with a loose, wrinkly and dry skin in the respective order as we marinate….oops! I mean mature (that’s a graceful word we have found for ageing!). Pigmentary alterations also do occur as an ageing process but it is out of the scope of this article.

While a host of surgical and non surgical procedures are available for skin lifting, the choice of treatment actually depends upon the extent of damage done. While filler treatment is reserved for early sagging and surgical resection for pretty advanced stage, moderate amount of sagging of the skin is the ideal stage for introduction of PDO threads in the skin.

Polydioxanone (PDO) filament is a synthetic absorbable suture which is prepared from polyester, poly(p-dioxanone). PDO is a colourless, crystalline, bio-absorbable polymer that was developed specifically for wound-closure sutures. As a suture, it exhibits high flexibility, higher retention strength, slower-absorption rate and lower-inflammatory response rate when compared to Vicryl (poly(glycolic-co-lactic acid)) and Dexon (poly(glycolic acid)). PDO is non-antigenic in nature. It carries no risk of bacterial colonization/ infection. The monofilament suture typically loses 50% of its initial breaking strength after 3 weeks and is completely absorbed within 6 months, making it most suitable for tissue engineering rather than wound closure [17,18]. These characteristics of PDO enable it to stimulate production of collagen and fibroblasts in response to its implantation. Thus PDO brings about skin tightening and scar resurfacing. PDO also increases the blood flow around the threaded areas, which result in skin rejuvenation.

PDO is degraded by hydrolysis, and the end products are mainly excreted in urine.

Packaging

PDO threads are generally available in a pack of 10 needles. The thread is pre-inserted into the needle (21 G) in the 80:20 ratio, that is 80% inside the needle and 20% outside the needle. The needle tip is specially developed with a back cut-end to prevent direct trauma to the blood vessels and other delicate structures reducing the chances of haematoma along the thread length. There are different types of PDO threads available for a variety of indications and various sizes such as 30mm, 50mm, 60 or 70mm and 90 mm to fit and satisfy the dimensions of various body parts. The first two lengths or sometimes even higher lengths are used for face while bigger lengths are used for body for obvious reasons.

MECHANISM OF ACTION OF THREAD LIFT

The entire basis of the thread-lift technique is the foreign body cutaneous response to the presence of PDO threads within the skin.

Pre-procedure counselling and preparing the patient

A detailed consultation, pre-treatment photographs in various positions informed written consent are all carried out prior to the procedure. Detailed history regarding any other medical complaints should be recorded. Blood pressure and sugar levels should be documented.  Due precaution and prudence should be exercised in case the patient is suffering from any medical illness. Patients using anti-coagulants should be advised to stop using them at least 10 days before the procedure, only after being permitted by their treating physician.

Procedure

A topical anaesthetic cream is applied 30 mins–1 hour before the procedure. The procedure could be carried out in a medical office or in a day surgery. Rigorous sterility measures should be undertaken. The skin should be stretched by the surgeon’s left hand (for a right-handed surgeon) to make it taut. The right hand of the surgeon pierces the skin with the needle tip. While piercing the skin with the needle tip, the needle should be kept as parallel to the skin as possible. After a give way feeling, the needle should be glided straight inside the skin. A vigilant eye should always be kept on the needle tip through the skin to reduce the chances of damaging internal structures. The entire length of the needle should be inserted till the hub of the needle touches the skin.

Few more such needles should be inserted parallel to the first needle in a given area before withdrawing any of the inserted needles. This helps as a reference for the next needle. It also reduces the time for the procedure.

These needles should, however, be removed before inserting the perpendicular needles to form a mesh of threads to prevent damage to the skin. The inserted needles are swiftly removed one by one. Even while removing other needles, firm pressure with a gauze piece should be maintained on the site of already withdrawn needles. Firm pressure should be maintained for around 10 mins to achieve good haemostasis. The same procedure is repeated in a perpendicular direction to create a mesh for significant neo-collagenesis.

The number of threads required depends upon the indication trying to use as many as possible. A face generally needs 50 to 60 threads for a great results and additional 20 to 30 threads for neck.

An antibiotic and anti-inflammatory therapy is required for 10 days. It is very important to not to stress the operated area by restricting the muscle movement underneath.Patient may resume a moderate physical activity 25 days after and a more intense activity such as swimming 45 days after the procedure. In case any other body part is treated, movement should be restricted for a couple of days accordingly.

Results

The positive benefits of this treatment appear in two phases. As a part of the early changes, rejuvenation effects are noticed after 1 or 2 months. The complexion improves and pigmentation reduces. By 3 months-time, patients experience up to 40% of tissue tightening which is manifested as slight blunting of the static wrinkles or shallowing of the scars The increment of naturally-produced hyaluronic acid, collagen and elastin and the fibrosis induced by the particular and specific shape of the threads starts optimizing the results by 6-months duration. One sitting may lead to 80% improvement in the concern for which the treatment is done. Additional improvement can be aimed by undergoing another thread-lift procedure as early as 2 months after the initial treatment.

Complications are minimal and restricted to infection, haematoma, peeping threads or inflammatory papules at insertion sites. Peeping threads should be cut and mild steroid settles the papules.

Thread lift, according to me, is a great and simple tool in our hand to achieve gratifying results…..and thank God that the 10 mins dryer thing doesn’t work for our skin!

PN: For additional information on thread lift, please refer to Chapter 15 Non-Surgical Facelift authored by me in the upcoming book, Cosmetic Dermatology, A practical and Evidence-based Approach.