Thread lifting procedure: preparation and implementation

2019-12-04

The thread lifting procedure and practical recommendations for increasing the effectiveness and preventing complications of the thread facelift method.

Anna Ogurtsova, Ph.D., dermatovenerologist of the highest category, certified specialist in thread technologies, current member of the Ukrainian Association of Dermatovenereologists and Cosmetologists (UAVDVK) (Ukraine)

The article highlights the main algorithms for the correct pathogenetic preparation of patients for a thread lift: the advantages of threads that provide the possibility of retraction and fixation of the tightened tissues at reference points are highlighted, the importance of identifying and eliminating all conditions and conditions that affect not only the course of the procedure and rehabilitation, but also reducing the effectiveness of the procedure in the long-term postoperative period, as well as increasing the risk of complications.

Introduction to the problem

Continuing the topic of age-related involutional ptosis of the soft tissues of the face, popularly covered in the literature through the prism of the physiology of aging, in this article I would like to pay special attention to the issue of strategy and an integrated approach to solving this problem.

Involutional changes, sagging, sagging skin and soft tissues of visible parts of the body are quite significant not only aesthetic, but also social problems in the life of any modern person. The influence of these appearance defects on the quality of social life is especially clearly visible at the age of over 40, when a person has already reached certain heights in financial and personal terms. It is no secret that it is during this period that a person’s appearance (tight figure, flawless skin, general grooming and confidence in one’s irresistibility) to some extent becomes an attribute of one’s status, proof of success.

Modern dermatocosmetology offers a huge range of effective procedures and rejuvenation methods to stop the manifestations of age. But sooner or later there comes a time when even they are powerless against the progressive gravitational ptosis of the skin.

Just five years ago, the only effective solution to this problem was plastic surgery. None of the previously existing methods in cosmetology gave us the opportunity to provide effective retraction and reliable fixation of sagging tissues. But now dermatocosmetologists have the opportunity to safely and effectively tighten and fix sagging tissues using threads on an outpatient basis.

Cosmetology was waiting for the advent of thread technologies, so thread lifting in the practice of a cosmetologist opened a completely new era of practical possibilities and aesthetic results.

Almost without exception, all methods of thread rejuvenation in their various modifications quickly gained enormous popularity both among aesthetic medicine doctors and among older patients with manifestations of skin ptosis.

Of greatest interest in terms of the effectiveness and kinetic validity of tissue tightening are threads made of absorbable intact material with microprotrusions along the entire length, which have the ability to force tissue displacement and fixation in reference zones. These thread rejuvenation techniques allow dosed and multidirectional tightening of different areas of the face, which indicates the most predictable result for different initial patient data. It is this type of thread and all the methods of their implantation that bring dermatocosmetologists closest to plastic surgery in terms of lifting effectiveness. However, unlike it, thread lift methods are much simpler to perform, are less traumatic and do not require long-term rehabilitation.

It is important to remember that, even with extensive experience in performing thread lifting, the doctor should never simplify his attitude towards these technologies and discount the possible risks of their side effects and dangerous complications.

Therefore, in order to achieve a beautiful aesthetic result and patient satisfaction, specialists must comply with the following conditions before each new procedure:

• take into account the effectiveness of previously carried out similar manipulations;

• analyze all the nuances of the history of tissue reaction to any invasion;

• carry out proper pathogenetic preparation of the patient for threadlifting;

• correctly understand the essence of a thread lift, choose a specific method correctly, and perform the operation delicately;

• Constantly improve your technique for performing thread lifts.

Only such a careful approach to thread rejuvenation methods disciplines the doctor, allows him to increase efficiency, improve his skills in the future and prevent complications.

Patient management algorithm

Today, aesthetic medicine has acquired a pronounced commercial character, and quite often specialists, pursuing financial gain, carry out a thread lifting procedure as soon as the patient has agreed to it, without preparing his body in general and the skin in particular. This means preparation not only psychological and financial. It is strictly necessary to analyze indications, contraindications, identify and eliminate all conditions and conditions that can affect not only the course of the procedure and rehabilitation, but also reduce the effectiveness and reliability of the procedure in the long-term postoperative period. In other words, a pathogenetically substantiated approach to planning a thread lift is required.

Neglecting the correct preparation of the patient for thread lifting leads to a decrease in the effectiveness of the lift, frequent complications and a rapid relapse of ptosis of the corrected tissues.

To achieve the expected aesthetic result, before planning thread techniques, it is necessary to perform the following stages of pathogenetic preparation of patients for the procedure:

• individual analysis of the pathogenesis of skin ptosis and its regenerative potential, the severity of subcutaneous fatty tissue;

• analysis of the pathogenesis of decreased effectiveness of thread lifting and relapse of soft tissue ptosis;

• identification and elimination of objective and subjective factors that reduce the effectiveness and duration of the effect of thread lifting;

• studying the pathogenesis of post-traumatic processes in the skin and the duration of these changes;

• analysis and statistics of the main causes and mechanism of development of thread lift complications.

Knowing the typical pathogenetic reactions in tissues before and after implantation of threads, we will not succumb to the false sense of randomness of post-traumatic reactions and will be able to individually implement a full range of measures that will protect against complications, reduce rehabilitation and eliminate factors that reduce performance.

Analysis of the pathogenesis of skin and soft tissue ptosis

As you know, sagging and flabbiness of the skin is one of the most typical and problematic attributes of its aging and is a consequence of a whole cascade of age-related involutional changes in the body and skin. Therefore, the elimination of ptosis will be the more successful the more thoroughly in preparation for thread lifting we think through the improvement or (if possible) elimination of the disturbances in the processes in the skin that accompany ptosis.

The pathogenesis of ptosis is caused by the following micro- and macroscopic processes (not only in the skin, but also in the body as a whole):

• hormonal aging of the skin against the background of a gradual decrease in estrogen levels;

• decreased production of somatotropic hormone with changes in protein metabolism and insufficient synthesis of structural proteins;

• neurovegetative dysfunction in the body;

• macro- and microcirculatory disorders in the skin and soft tissues with impaired oxygenation and venous stagnation;

• disturbance of carbohydrate and fat metabolism in the body with the accumulation of peroxidation and glycation products in the skin;

• stratification of the skin-fat compartments on the face with the manifestation of their gravity, weakening of the connection between the layers of the skin-fat flap;

• weakening and sagging of the facial muscle frame.

It should be noted that gravitational ptosis of soft tissues and sagging skin are very interconnected and aggravate each other. Sagging and wrinkling of the skin significantly reduces the effectiveness of thread lifting and requires additional external procedures to improve the situation.

Systemic and topical tissue preparation

Correction of involutional disorders in the skin accompanying ptosis should precede thread lifting and be comprehensive.

Stage 1. Systemic therapy:

• normalization (tendency towards normalization) of hormonal levels for persons over 45 years of age (“Klimapin”);

• elimination of microcirculatory disorders and hypoxia of the skin and soft tissues (oral administration of the drugs Detralex, Venoton);

• angioprotective effect, reducing vascular fragility (“Ascorutin”);

• strengthening antioxidant protection in the skin (omega-3, -6);

• strengthening the immune system and anti-inflammatory resource of the skin;

• correction of neurovegetative dysfunction (B vitamins);

• stimulation of metabolic processes (“Venoton”).

Stage 2. Topical therapy:

• local injection creation of favorable conditions for the activation of fibroblasts and the synthesis of structural proteins;

• injection restoration of the intercellular space and optimal hydration of the matrix;

• improving blood circulation and metabolic processes in the skin;

• venotonic effect.

Pathogenesis of decreased effectiveness of thread lift

In my practice, I have noted a number of reasons that reduce the effectiveness of the method. They can be systematized and combined into two groups:

• objective, or organic (depending on the doctor or patient);

• subjective, or physiological (the nature of pathophysiological changes in the skin itself) (Table 1).

Table 1. Factors that reduce the effectiveness and duration of the tightening effect

In the process of working with patients, ways to correct conditions that reduce the effectiveness of lifting were identified.

Firstly, it is necessary to prevent factors determined by the qualifications of the doctor:

• a clear understanding of the topographic anatomy of skin-fat packets and reference points on the face;

• the direction of tissue retraction should counteract the main vectors of gravity of the muscles and fat compartments (from bottom to top, from the center outwards);

• the threads should be positioned strictly hypodermally;

• if possible, do not grab more than two fat packets;

• carrying out lipolysis or liposuction in areas with pronounced excess fat.

Secondly, it is necessary to create favorable conditions for implantation of threads, to prevent recurrence of sagging skin (at least four weeks before the thread lifting procedure and at least two weeks after):

• intradermal injection revitalization and reconstruction of the dermis (plasmolifting, hyaluronic therapy, peptides, vitamins, antioxidants, microelements);

• contour plastic surgery using preparations based on hyaluronic acid using the vector lifting method;

• signal regeneration using peelings;

• hardware cosmetology (microcurrent, RF).

Speaking about the technique, it should be noted that fat compartments on the face have different involutional dynamics in patients with different morphotypes of aging (Fig. 1). Therefore, before performing the procedure, you need to remember the topographic anatomy, carefully consider the type and trajectory of the threads in order to, if possible, capture the most massive fat packets in the correction area.

At the same time, we must remember that it is impossible to effectively lift and fix three or more fat bags at one fixation point. This is too heavy a “burden” for one reference zone, and in this case a rapid relapse and subsidence of the lifted skin-fat flap is inevitable.

Rice. 1. Topography of the location of fatty compartments
parts on the face. The compartments have
different involutional dynamics in patients
products with different morphotypes of aging. Top-
lower third of the person: central compartment,
middle compartment, upper orbital
ny compartment. Middle third of face: but-
labial, medial buccal, median
buccal, lateral temporobuccal, late-
ral orbital, lower orbital,
mandibular

Pathogenesis of complications and ways to prevent them

Thread lifting is classified as a minimally invasive procedure that damages the integrity of the skin, so undesirable events accompanying tissue injury are considered natural. Moreover, in most cases they are the same for different types of threads.

First of all, such situations are usually divided into complications and temporary phenomena. Their occurrence depends on many reasons - both common to invasive procedures and specific to thread techniques. And if the general causes are quite well covered in the literature, then many specific factors of complications (related primarily to the design of the threads, the peculiarities of their insertion, the nuances of facial anatomy) due to the novelty of the technologies, are sometimes very vague for novice specialists.

To understand what undesirable consequences of the procedure are caused by these factors specific to thread techniques and how to minimize the risks, you first need to understand what problems a cosmetologist solves when using threads (Table 2).

Table 2. Complications of thread rejuvenation methods

Proper preparation for a thread lift is the key to preventing many complications. Its essence is to analyze the pathogenesis of post-traumatic disorders in soft tissues and to create maximum conditions before and after the procedure: firstly, to eliminate undesirable persistent consequences (infection, extensive hematomas, asymmetry, trauma to the underlying tissues), secondly, to reduce minimum expected temporary post-traumatic effects (aseptic inflammation, in addition to compliance with asepsis and antisepsis).

We must take care to prevent infection in the case of large volumes of intervention, the skin is prone to inflammation (in history and with hygienic negligence of patients), in case of microcirculation disorders, if there is hyperemia, swelling, small hematomas, unevenness, pain.

Strictly speaking, the key to preventing complications during thread lifting are three points:

• doctor's qualification level;

• compliance with the technique of the operation (it is different for each type of thread);

• strict implementation of recommendations after the intervention.

Pathogenetic preparation for the lifting procedure

So, during preparation for the procedure, you need to take into account all the causes and mechanisms for the development of complications. This includes:

• taking anamnesis;

• identification of indications and contraindications for thread lifting;

• advanced training in knowledge of anatomy and topographic anatomy of facial tissues;

• differentiated application of techniques depending on the structure and thickness of the skin of different areas of the face;

• prescribing drugs in prophylactic dosages to improve blood clotting (if there is a history of bleeding and increased fragility of blood vessels);

• prescribing a bandage for a large volume of intervention in the lower third of the face, in the area of the chin diaphragm (for postural drainage of tissue from transudate);

• sanitation of foci of chronic infection of the ENT organs and oral cavity;

• prescribing drugs from the fluoroquinolone group in the early post-manipulation period for at least three days;

• prescription of drainage, venotonic, angioprotective drugs;

• prescription of NSAIDs (nimesil and nimesulide group) for at least three days after the intervention;

• creating optimal conditions for the long-term postoperative period;

• explaining to the patient all the nuances of the procedure and the postoperative period, the risks of complications, the importance of immediate treatment at the slightest hint of the development of complications;

• observation of the patient and contact with him throughout the entire period of rehabilitation.

Photo 1. Patient O., 62 years old: A) before the procedure; C) 3 days after installation Aptos Thread 2G – mental zone, Aptos Needle 2G – submental
zone, Light lift Spring – “puppet wrinkles”; C) 14 days after the procedure

Photo 2. Patient Yu., 43 years old: A) before the procedure; C) immediately after placing Light lift Thread 2G – buccal-zygomatic zone, Light lift Thread 2G – mental
zone; C) one month after the procedure

The thread lifting technique with tissue fixation at reference points using notches and loops has become a breakthrough in the field of aesthetic medicine. It has achieved high popularity among patients due to the simplicity, relative painlessness of the process and the duration of the effect, which is actually comparable to plastic methods of skin tightening. The desire to look perfect, total busyness and reluctance to go under the knife have made thread lifting a popular service. This trend places high demands on dermatocosmetologists and requires an even more competent and balanced approach to thread lifting techniques. Only a pathogenetic approach to the problem of correcting age-related skin changes guarantees an impeccable aesthetic result, meets patients’ expectations and increases the effectiveness of thread rejuvenation.

First published in Les Nouvelles Esthetiques 2015/№2