PDO threads as the new treatment in biostimulationa and suspention of the sagging tissues_part one
Authors: Dr. Ivona Igerc
The purpose of this article is to introduce my experience regarding implantation of PDO threads as a good way to face lifting therapies in the very early stage of aging as a prevention therapy , as well as trying to treat middle and lower facial sagging due to the ligament flexibility and lack of skin elasticity resulting into sliding of malar fat pad.
Pdo threads allow us to create a strong intradermal and subdermal grind which helps biostimulation ,progressive retraction and support of tissue ,revascularization and partial tissue reshaping .In the same time if we use barbed clog threads we can acchivesuspention.As a result of PDO therapy,we have intercellular matrix and connective tissue regeneration,increase in tissue oxygenation and activation of reparative and regenerative proccesse in papillary dermis which is directly reflecting into aesthetic and functional improvements.
Important is to know limitations to thread lift therapies ,as well as when to decide on surgical corrections. Every practitioner is confronted with face aging either by deterioration of textures, or by ptosis. There are options how to rejuvenate and re contour the face –
Thtreading can be combined with dermal fillers and toxins and bring up results of amazing three dimensional volume replacement and lifting. Results obtained with thread lift ,especially in combination with other minimal invasive techniques ,are more natural and satisfying ,especially when we start the procedure right on time .
Until mid 90’s facelift surgery ,was the only solution to bring up the sagging skin and facial fat. It is a trublesome procedure, requiring hospitalization, global anesthesia and social downtime. In the mid 90’s appeared the first barbed tension threads Aptos (Dr. MarlenSulamanidze). Since then, several threads generations were born and are now commonly used.
Jowls ptosis is an essential phase of the facial aging from year of 45. Women are emotionally affected by that, and deeply upset with first signs of “face sagging” . Low jowls,as a result of the fat tissue ptosis, change dramatically face shape.The heart shape of the young face becomes the inverse heart shape. This tissue ptosis is exclusively fatty cutaneous. The fat pad is “sliding down “due to lack of elasticity of Bucco-maxillar ligaments on the left and right side.
Important is to keep in mind is that lower facial third is one of the most dynamic area of the face. The particularity of this lower area of the face is that it is submitted to major movements (chewing, smiling and speech). So, this dynamic has to be preserved. But this is also the part of the face ,where the release of tension must be in the absolute balance with suspension itself. Only on that way mimics can be obtained in the most natural way. To achieve the best possible aesthetic result we must obtain right mimics and no skin sagging.
Correction of fat pads ptosis must preserve the flexibility and mimics of the lower face. This is the right approach and methodology of semi surgical tread lift, and thread lift with surgical implantation,as well as temporary thread lift. Mid face is prompt to ptosis too.Our job in that region is usually easier as the mimics of the face is not so strong in that area.We must correct and reposition malar face pad and get the right convexity of the face from the profile site. Maximum point of mid face projection is different for Asian and Caucasian faces . Chinese ethnic groups reacquire more medial projection of the mid face. Caucasian and westernized faces need to get the highest point of malar projection by following the zygomaticarche ,more lateral positioned. This differences come out of the different skeletal anatomy ofmaxillar bone.
Anatomic characteristics of low jowls area.
The face area after 40, experience the “Newton law”. The malar fat pad is migrating caudal and medial and finishing into naso-labial area creating an unnatural accumulation of fat where it is normally not existing.. In the same time, the skin elasticity decreases. Ptosis of the face is a vertical process.
Surgical lift always provides scars and tissue traction is nearly always horizontal. Around ears is the most suitable place. Therefore, traction is almost horizontally. On the other hand, threads provide vertical ,horizontal, and semi vertical corrections. Traction depends on the way we define a problem. The beauty of the lower face lies in the “hockey stick” shape of mandibular bone. Lover jaw line should be clearly defined and outstanding.
“W” shape is not required and should be corrected. We can divide Threads into two categories :absorbableand non absorbable .Non absorbable –permanent threads are made of Nylon-which put in traction sometimes can cut tissues and Polypropylene –doesn’t create fibrosis ,doesn’t react with tissue and is easy removable.The second one is favorable solution. Non absorbable threads are made form different materials (polyglactin910,Poliglecaprone ,Polyglicolic Acid and Polydioxanone .
Polydioxanone (PDS and PDO)was the first antimicrobial and biostimulating monofilament for synthesis of biological tissue.It is prompt to degradation (H2O+CO2).Degradation starts after 15 days and is completed into 180-200 days via hydrolysis. The most important characteristics of PDO threads are bio stimulation, anti inflammatory properties and less capacity on foreign body inflammatory response and on that way the fibrosis, which brings to tissue bio restructuring ,is easy controlled.
The original insertion method for Pdo is based on 26-31G micro needle with thread of 6/0-8/0 micro threads, with temporary fibrosis, optimizing vascularization, no inflammatory response but a macrophage response through tissue biostimulaton with increase of temperature and oxygenation. There is no entrance hall required .
There are five main types of PDO micro
threads:
The purpose of this article is to introduce my experience regarding implantation of PDO threads as a good way to face lifting therapies in the very early stage of aging as a prevention therapy , as well as trying to treat middle and lower facial sagging due to the ligament flexibility and lack of skin elasticity resulting into sliding of malar fat pad.
Pdo threads allow us to create a strong intradermal and subdermal grind which helps biostimulation ,progressive retraction and support of tissue ,revascularization and partial tissue reshaping .In the same time if we use barbed clog threads we can acchivesuspention.As a result of PDO therapy,we have intercellular matrix and connective tissue regeneration,increase in tissue oxygenation and activation of reparative and regenerative proccesse in papillary dermis which is directly reflecting into aesthetic and functional improvements.
 |
| Photos before -patient in left and right lateral projection-sliding of malar fat pad in mid-face area due to lack of elasticity and prolapse of bucco-maxillar ligament. Naso-labial fold and Marionette line is visible, and mandibular line has aesthetically not ideal shape -shape of sigmoid curve |
Important is to know limitations to thread lift therapies ,as well as when to decide on surgical corrections. Every practitioner is confronted with face aging either by deterioration of textures, or by ptosis. There are options how to rejuvenate and re contour the face –
- surgical face lifts (permanent solution and two dimensional changes),
- tension threads-absorbable or not absorbable which ,semi surgical or surgical(permanent or temporary)
Thtreading can be combined with dermal fillers and toxins and bring up results of amazing three dimensional volume replacement and lifting. Results obtained with thread lift ,especially in combination with other minimal invasive techniques ,are more natural and satisfying ,especially when we start the procedure right on time .
 |
| Photos after- patient in left and right lateral projection- mid face thread lift has precisely defined zygomatic prominence and lover face thread lift is making mandibular line in the “hockey stick”shape ,.Our aim is to create straight line of the lower jaw. After thread lift we can spot the lifting effect by disappearance of Naso labial fold and Marionette line.Thats a straight prove the lift happened .Here we were sing just PDO threading. |
Until mid 90’s facelift surgery ,was the only solution to bring up the sagging skin and facial fat. It is a trublesome procedure, requiring hospitalization, global anesthesia and social downtime. In the mid 90’s appeared the first barbed tension threads Aptos (Dr. MarlenSulamanidze). Since then, several threads generations were born and are now commonly used.
Jowls ptosis is an essential phase of the facial aging from year of 45. Women are emotionally affected by that, and deeply upset with first signs of “face sagging” . Low jowls,as a result of the fat tissue ptosis, change dramatically face shape.The heart shape of the young face becomes the inverse heart shape. This tissue ptosis is exclusively fatty cutaneous. The fat pad is “sliding down “due to lack of elasticity of Bucco-maxillar ligaments on the left and right side.
 |
| Threading of the nose is used in order to lift the nose bridge and re-design it by making it straighter,higher and sharper. This is one among the most popular procedures in China. With short threads, specially designed for nose reshaping inserted into the cannula not to compromise the blood flow,we can moderate columella and all nasi too. |
Important is to keep in mind is that lower facial third is one of the most dynamic area of the face. The particularity of this lower area of the face is that it is submitted to major movements (chewing, smiling and speech). So, this dynamic has to be preserved. But this is also the part of the face ,where the release of tension must be in the absolute balance with suspension itself. Only on that way mimics can be obtained in the most natural way. To achieve the best possible aesthetic result we must obtain right mimics and no skin sagging.
Correction of fat pads ptosis must preserve the flexibility and mimics of the lower face. This is the right approach and methodology of semi surgical tread lift, and thread lift with surgical implantation,as well as temporary thread lift. Mid face is prompt to ptosis too.Our job in that region is usually easier as the mimics of the face is not so strong in that area.We must correct and reposition malar face pad and get the right convexity of the face from the profile site. Maximum point of mid face projection is different for Asian and Caucasian faces . Chinese ethnic groups reacquire more medial projection of the mid face. Caucasian and westernized faces need to get the highest point of malar projection by following the zygomaticarche ,more lateral positioned. This differences come out of the different skeletal anatomy ofmaxillar bone.
 |
| Threading of the nose is used in order to lift the nose bridge and re-design it by making it straighter,higher and sharper. This is one among the most popular procedures in China. With short threads, specially designed for nose reshaping inserted into the cannula not to compromise the blood flow,we can moderate columella and all nasi too. |
Anatomic characteristics of low jowls area.
The face area after 40, experience the “Newton law”. The malar fat pad is migrating caudal and medial and finishing into naso-labial area creating an unnatural accumulation of fat where it is normally not existing.. In the same time, the skin elasticity decreases. Ptosis of the face is a vertical process.
Surgical lift always provides scars and tissue traction is nearly always horizontal. Around ears is the most suitable place. Therefore, traction is almost horizontally. On the other hand, threads provide vertical ,horizontal, and semi vertical corrections. Traction depends on the way we define a problem. The beauty of the lower face lies in the “hockey stick” shape of mandibular bone. Lover jaw line should be clearly defined and outstanding.
“W” shape is not required and should be corrected. We can divide Threads into two categories :absorbableand non absorbable .Non absorbable –permanent threads are made of Nylon-which put in traction sometimes can cut tissues and Polypropylene –doesn’t create fibrosis ,doesn’t react with tissue and is easy removable.The second one is favorable solution. Non absorbable threads are made form different materials (polyglactin910,Poliglecaprone ,Polyglicolic Acid and Polydioxanone .
Polydioxanone (PDS and PDO)was the first antimicrobial and biostimulating monofilament for synthesis of biological tissue.It is prompt to degradation (H2O+CO2).Degradation starts after 15 days and is completed into 180-200 days via hydrolysis. The most important characteristics of PDO threads are bio stimulation, anti inflammatory properties and less capacity on foreign body inflammatory response and on that way the fibrosis, which brings to tissue bio restructuring ,is easy controlled.
The original insertion method for Pdo is based on 26-31G micro needle with thread of 6/0-8/0 micro threads, with temporary fibrosis, optimizing vascularization, no inflammatory response but a macrophage response through tissue biostimulaton with increase of temperature and oxygenation. There is no entrance hall required .
There are five main types of PDO micro
threads:
- 1)Pdo MONO- it is 6/0-8/0 thread insertead into the 26-31G needle which through technique of “Quilting inn” medium to deep dermis promotes the tissue remodeling The longitude varies from 12mm-60mm
- PDO SCREW- it is 5/0-8/0 micro thread in a micro needle from 26-31G with a spiral shape intoruduced into deep dermis and/or superficial sub dermis ,creating lines of bio stimulation and retraction along the traction vectors .this threads ar normally 25-60mm long
- PDO EMBOSSED THREAD-threads with microgrooves which allows the tissue to regrow into the thread .Position is mid to deep sub dermal level and they are 25-60 mm long .
- PDO COGS- are suspension barbed threads .They can be mono bi and three directional and 50-90 mm long. Their aim is to suspend the tissue by stimulating fibroblasts on collagen production along the thread axis.
- PDO mini cannulas- the straight or barbed threads can be used in delicate areas as under eyes or temporal, and intra vaginal due to insertion through blunt cannula .On that way the risk of hematoma diminishes. There are blunt cannulas for nose tip and neck (19 G X40 mm -4D ). The basic of positioning of Korean micro threads in a “zig-zag” or quilting way is creating self retaining system which produces light suspension and tissue re modeling.
- Khazanchi R, Aggarwal A, Johar M. Anatomy of ageing face. Indian J Plast Surg. 2007;40:223–9.
- Wu WT. Barbed sutures in facial rejuvenation. Aesthet Surg J. 2004;24:582–7. [PubMed]
- DeLorenzi C. Barbed sutures: Rationale and technique. Aesthet Surg J. 2006;26:223–9.
- Paul MD. Complications of barbed sutures. Aesthet Plast Surg. 2008;32:149. [PubMed]
- Sulamanidze M, Shiffman, Paikidze T, Sulamanidze G. Facial lifting with APTOS Threads. International Journal of Cosmetic Surgery and Aesthetic Dermatology. 2001;3:275–281.
- Sulamanidze M, Sulamanidze G. Lifting of soft tissues: old philosophy, new approach – a method of internal stitching
REFERENCES