Threadlifting: for or against?

What this procedure is has already been repeatedly written in the professional press and on the pages of online publications, and discussed at conferences and seminars.

The new technology of thread lifting was quickly picked up by cosmetologists, as it allows them to do what until recently was the prerogative of exclusively plastic surgeons. The profitable commercial component of this procedure and the demand among clients make specialists more often think about introducing the procedure into practice. Before using this technique and actively promoting it, it is important to find out its features, long-term consequences and once again weigh the pros and cons. To help understand this issue, two opinions of leading beauty industry experts on mesothreads are presented.

Threadlifting procedure

Scientists from South Korea invented threads made from polydioxanone (a suture material that has been used in surgery for three decades) for subcutaneous injection to prevent and correct age-related changes. According to manufacturers and distribution companies, thread lifting using mesothreads is a procedure for tightening and strengthening the skin using polydioxane absorbable threads, which are installed at different levels of the dermis. They create a 3D frame for the problem area, which is harmoniously integrated into the dermal matrix and does not cause discomfort. When carrying out the thread lifting procedure with mesothreads, you can achieve instant tissue lifting and remodeling of the contours of the face and body. The rejuvenation effect after the procedure is achieved by stimulating neocollagenogenesis in the deep layers of the dermis. Unlike other thread lifting techniques, thread lifting does not stretch the tissue. Classic mesothreads do not have notches and are inserted in the form of a mesh into the subcutaneous fat layer. Thin needles glide easily under the skin, causing minimal damage to the tissue. On the return stroke of the needle, the thread is separated from the guide and remains under the skin for 180–210 days.

Not a panacea, but one of the methods

Opinion of Vladlena Averina, dermatovenerologist at the Feofaniya Clinical Hospital, trainer at the Academy of Scientific Beauty training center, speaker at EMAA, DASIL, Face-2face, AMWC, AMEC (Ukraine, Kiev)

The thread lifting procedure came to us from Asia. And this is not surprising, because acupuncture and acupuncture are part of traditional oriental medicine. And during the thread lifting procedure, the correct tension vectors often pass through bioenergy points and meridians, thereby causing their stimulation.

The effects of mesotherapy, most hardware techniques, fillers, botulinum toxins have been studied for a long time and quite well. At the same time, the demand for anti-aging procedures is growing, the market is developing rapidly, so it is not surprising that the new method - mesothreads - quickly found its adherents among doctors and patients. The procedure has gained great popularity in the CIS countries. At the European congresses (F2F, AMEC) held this fall, there were also reports from French colleagues on complex correction, which included mesothreads.

Terminology and evidence base

First of all, let's understand the terms. The words “mesotherapy” and “mesothreads” have one common prefix – “meso”. This means that manipulations are carried out in the dermis-hypodermis. The thickness of the threads used for the procedure is 30–26 G, so the damaging effect is small. Also, the rules of mesotherapy can be applied to this method - “little, rarely, in the right place.” Perhaps this is why among our specialists these threads are called “mesothreads”. Although the Korean school involves working not only at the level of subcutaneous fat, but also muscles, as well as introducing a large number of threads (150–200 pieces) in one procedure, repeating sessions 2–3 times in a short period of time. So the name “mesothread”, in my opinion, is not entirely correct, but there is no other name yet.

The historical predecessors of mesothreads - gold threads, threads with notches, threads with cones - have other indications, effects, and installation methods.

Mesothread is a monofilament bioresorbable thread folded in half. One part of the thread is located inside the guide needle, the other is fixed on its surface using a special retainer made of polymer material. The guide needle is quite flexible, made of medical steel, has thin walls, and is ideally sharpened.
The material most often used to make threads is polydioxanone (PDO). Today there are a sufficient number of scientific articles in the field of surgery about the advantages of using this material. For more than 30 years, polydioxanone has been used for stitching tissues that require long-term fixation (skin, blood vessels, intestines). Monofilament PDO threads have high sliding ability, good strength characteristics, low irritation and a low risk of infectious complications (compared to multifilament ones).

In vitro experimental studies have shown that in tissues the thread causes a foreign body reaction, accompanied by massive macrophage infiltration. Fibroblasts line up along the periphery. Gradually, the thread is replaced by fibrous connective tissue, which then undergoes complete or partial involution. This means that in place of the thread, over time, the original tissue is restored or partially replaced by scar tissue.

Bioresorption of PDO threads in tissues occurs on the 60–90th day. A collagen matrix is formed around the threads, which explains the duration of the effect. Depending on age, hormonal status, and metabolism, the amount of collagen formed varies. Accordingly, the duration of the effect will vary from one to two years.

The most controversial point in this situation is the quality of the formed collagen. I would really like to believe that collagen of the first type, that is, the most “correct” one, is formed around the thread. Otherwise, this will mean that we are intensely stimulating the development of scar tissue. At the moment, no one has carried out either electron microscopy or immunohistochemical analysis in our country. Therefore, the evidence base for this method remains an open question. The only thing we can rely on in vivo is ultrasound examination of tissues performed before and two months after the introduction of threads. It shows the formation of fibrous structures at the location of the threads.

Korean development scientists, of course, carried out histological studies, as a result of which neocollagenogenesis and increased vascular and cellular proliferation are clearly visible. But, as we know, the Caucasian and Mongoloid types have a number of their own characteristics, so not all methods and correction options are equally good for us.

Complex correction protocol

In my practice, I use complex correction, which includes the thread lifting technique. Schematically, the complex correction looks like this:

1. Mesotherapy, boosters, peelings, hardware techniques (microcurrents, fractional photothermolysis, HydraFacial, IR, RF).
2. Mesothreads, 3-4 week break.
3. Botulinum toxins, 2-week break.
4. Fillers.

Why are mesothreads used first and then hyaluronic acid fillers? The lifting and restructuring effects of mesothreads change and sometimes simplify the filler correction plan, often allowing the use of fewer fillers. If thread lifting with mesothreads was preceded by 3-4 weeks of filler injection, then tissue swelling at the site of complex correction can last up to five days. Also, with large volumes of fillers, thread migration is possible, especially if the thread passes deep and enters the area where the filler is located.

Fillers and mesothreads can be combined in one procedure, provided that the correction zones are different.

In case of an undesirable result after the injection of botulinum toxin - slight ptosis of the eyebrows, asymmetry - it is possible to correct these conditions using threads.

You can also successfully combine thread lifting and plasma lifting procedures - they are both effective and potentiate the effect of each other. PDGF (platelet-derived growth factor) initiates the healing of connective tissue, the formation of a collagen matrix, accelerates mitogenesis, angiogenesis, macrophage activation, and the secretion of growth factors. The targets are fibroblasts, muscle fibers, chondrocytes, osteoblasts, and mesenchymal stem cells. Two procedures are performed in one session. First, blood is drawn from the patient's vein. While the blood is centrifuged, mesothreads are introduced. When they are installed, before removing the guide needle from the tissue, 0.1 ml of the drug is injected into it with a syringe.

Adequacy and rationality

Considering the mechanism of action of the threads, I believe that placing a large number of them (for example, 70–100 threads in the face area) is not justified. Financially for a doctor, yes, it’s justified. But for the client... If you correctly assess the patient’s condition, draw up an adequate comprehensive treatment plan, choose tension vectors, taking into account Langer’s lines, reference points, areas of special facial mobility, then you can get by with a small number of threads. After all, we work with many patients for a long time and they trust us. And if in a year or a year and a half after 100 threads in the face area we get extensive fibrosis, then we will have to eliminate the consequences.

Doctors using this method are pioneers, because now the accumulation and exchange of clinical experience is just underway, and a scientific base is being formed.
I am a big supporter of this correction method, but I want to say that this is one method, not a panacea. A rational, thoughtful attitude is the key to the success of any harmonious correction.

Five “yes” and five “no” to mesothreads

Opinion of Evgeniy Shagov, chief physician, co-owner of the aesthetic medicine center Anti Age Clinic, member of ESLD, AAAAM (Ukraine, Donetsk)

Before deciding to put an innovative technology into practice in aesthetic medicine, critical questions need to be asked. Honest answers allow us to objectively assess the rationality and, most importantly, the safety of its use in everyday practice. Among the innovative technologies that have caused a lot of noise today, of course, are the notorious mesothreads.

In this article I will try to briefly formulate my own list of answers to the questions on the basis of which I made the decision to use mesothreads in my medical practice.

Five yes

1. Are mesothreads certified in Ukraine?

– Yes, but as a suture (!) material.

2. Are there today therapeutic technologies for lifting soft tissues and skin that are more effective and safe than mesothreads?

– Yes, this is ultrasonic SMAS lifting, RF technology, CO2 laser, etc.

3. Are there possible complications and unwanted side effects when working with mesothreads?

- Yes, they are possible. In my practice, I have accumulated sufficient experience in the rehabilitation treatment of patients with complications that arose after this procedure was performed by doctors practicing the mesothread lifting technique. Complications can be caused by both execution errors and an unpredictable allergic reaction of tissues to the suture material. Moreover, the frequency of complications from mesothreads is significantly higher than from preparations of the same hyaluronic acid.

4. Does it seem strange to me that, while in the CIS countries and Asia there is a debate about the adequacy of this method, in the mature markets of the USA and Western Europe this technique is completely absent?

– Yes, and, in my opinion, this situation resembles a large-scale clinical experiment in vivo.

5. Do I think that every patient undergoing this technique should be informed in advance that he is a participant in such research?

– Yes, and this is unconditional from both a clinical and moral and ethical point of view!

Five no's

1. Are mesothreads used in leading clinics in Western Europe and the USA?

– No, they do not apply.

2. Is the technology for using mesothreads for lifting purposes certified in Ukraine?

– No, it is not certified.

3. Are there standardized studies that confirm the claimed effectiveness of mesothreads in terms of lifting and improving skin structure?

- No, they don’t exist.

4. Do I consider it correct to use suture material in order to improve the structure of the skin and the metabolic processes occurring in it, through uncontrolled aseptic inflammation and the development of fibrosis?

– No, to improve the structure of the skin and activate metabolic processes in it, there are less “barbaric” technologies, such as biorevitalization, PRP therapy, laser technologies, chemical peels, skin care aimed at preserving Marchionini’s hydrolipid mantle, etc.

By publishing this series of questions and answering them competently and honestly, I believe I was able to help my colleagues concerned about the responsible approach to the practice of aesthetic rejuvenation make decisions. For the rest of the audience, I will briefly summarize the above by answering the last question:

5. Do I use mesothreads in my practice?

- No, I don’t use it.

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Of course, the above opinions of experts are their point of view. Drawing your own conclusions and forming your own opinion is the task of every competent professional.

First published: KOSMETIK international journal, No. 4/2013, pp. 58-61