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. I want to summarize what I have already written on threads in the chapter one .
Pdo threads allow us to create a strong intradermal and subdermalgrind which helps bio stimulation, progressive retraction and support of tissue, revascularization and partial tissue reshaping. In the same time if we use barbed clog threads we can achieve suspension. As a result of PDO therapy,we have intercellular matrix and connective tissue regeneration, increase in tissue oxygenation and activation of reparative and regenerative processes in papillary dermis which is directly reflecting into aesthetic and functional improvements.

The most commonly used threads are resorbable PDO threads. There are five main types of PDO micro threads:
All threads we can be divided into two main categories: resorbable and non resorbable.
The most commonly used threads are resorbable PDO threads.
There are five main types of PDO micro threads:
PDO Mono

PDO Screw

PDO Embossed Thread

PDO Cogs

PDO Mini Cannulas

PDO treads ,are used on six different ways and six treatment protocols could be applied (procedures how for thread insertion).The PDO thread insertion protocols , are not antagonistic to traditional face lifting ,but in synergy with it.
Synergy is also obtained with all other minimal invasive aesthetic procedures in reconstruction of the face , bio stimulation and regenerative medicine

1) HA-PDO Traction-Threads are used in combination with dermal fillers, allows us to achieve slightly visible but progressive suspension effect , without stiches and incisions in the case of minor facial ptosis(mid face ,lower face)

2) PDO Soft Lift when patients need greater traction and stability we need to fix the threads with a suture point into the fascia through minor incisions usually hidden in the hair

3) PDO Suspension Lift- We do reshaping of the face and neck with barbed threads Multi barbed threads are fixated into the muscular facial fascia –SMAS

4) Bio Stimulation And Rejuvenation With PDO Threads We want to create the subcutaneous grid which is stimulating collagen production

5) PDO Bio Stimulation Combining Different Therapies Of Bio Revitalization Dermal or sub dermal grind of threads is combined with other medical devices for bio stimulations- active substances or/and autologous connective micro grafts are injected to promote bio stimulation of the patient tissues

6) PDO Threads And Therapy The patients seeking for pain relief ,muscle contraction relief ,edema relief, cellulitis relief ,stretch marks-estrias can be treated with PDO threads. We can use treads to combine all treatments based on TCM (traditional Chinese Medicine ) and meridians

7) Thermal Treatments And PDO Threads Prolonging the benefits of thermal results therapies by completing the thermal cycle methods of bio stimultion by inserting the PDO threads

PATIENT SELECTION (positive selection)

Our ideal patient is:

• Patient’s DOB 40 - 75 years old, with 
small or medium tissue ptosis.
A good way to evaluate ptosis ,is to tract the skin in the temporal area and observes how many lines do appear. More than 3 is a bad indication.
• Patient with no chronic disease, or immuno- compromised
• Cooperative patient who understands the benefits and therapy limits
• Dysmorphophobia should 
be detected and avoid.
• Patient who too young for surgical lifting 
or doesn’t want it.
• Patient whose facial tissues are either, not too thick , or, not too 
thin.
• Patient has enough fat tissue for anchorageof the thread, 
but not too heavy weight to support.
• Patient is anticoagulant treatment free, has no allergy or allergy intolerance on any substance of thread which is going to be inserted

PRE TREATMENT PATIENT PREPARATION:

1. Before – After photography must be taken (front, semi profile- left and right, profile- left and right)
2. Patient has to sign an informed consent.
3. Patients anamnesis must be completed –medical history (medical, surgical and allergies)
4. Pre treatment medication -prescription -Arnica or Etamsylate 3 days before procedure to limit hematoma’s risk
5. Antiseptic shampoo treatment -on the night prior /or and morning prior (Povidone iodine)thread insertion into the scalp or into the hair line
6. Antibiotic prescription two days before the treatment and lasting for three days /or beginning of antibiotics on the treatment day and two days after procedure (Amoxiciline+clavulinate) –for semi permanent and permanent threads

POST CARE PATIENT INSTRUCTIONS:

• No facial massage for 2 weeks,
• Soft cleaning of the face and neck
• Sleeping on the back for a week ,face side up

PATIENT TREATMENT PREPARATION

1. Asepsis-shaving the area if there is hair in the thread insertion area (semi surgical and surgical or semi permanent and permanent threads)
2. Disinfection with pivadone iodine on the area of treatment and chlorehexidine
3. Anesthesia :lidcaine 1-2%of adrenaline (2.5 ccfor each thread if we have surgical permanent threads)
4. 30 G needles 40 mm to avoid risk of hematomas

RECALL OF THE PATIENT:

• After 8 days from the procedure
• After 1 month from the first recall

We do want to control every step of postoperative healing

POSSIBLE COMPLICATIONSTHAT MIGHT OCCURE ;

1. INTRA OPERATIVE HEMATOMA (just press and wait),
2. OEDEMA (from 1 hour to 1 week)
3. TEMPORAL PAIN (conventional analgetics are sufficient) –Usuallyoccurs due to surgical implantation of threads
4. INFLAMMATION (conventional anti inflammatory medication)
5. VISIBILITY OF THREAD : into period of 8 days post.op. we can still unhook some thread traction points ,and obtain correction with dermal fillers.
6. SEPSIS rear complication, we have to eliminate and take out threads and prescribe antibiotics.

That is usually due to bad quality materials of which threads are made , or aseptic way of work.
Mostly happening with surgical threads ,not a common complication of PDO micro threads.

CONCLUSION: Thread lifting and bio stimulation, is a perfect therapy which is applied to young and middle aged patients, with medium facial sagging, who seak for soft face lift without no “ down time”.
Threading can be combined with different therapies ,as intradermal fillers , toxins,regenerative therapies and treatments of bio stimulation like amino acid precursors. Results are enhanced,rejuvenated and lifted facial tissues. This is the best way to an instant,natural and organic 3D Facial Lift and Face Recon touring ,without any prolonged “Down time” and serious complications.








REFERENCES

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