Thread Types

Thread Types

Thread Types Explained

Before deciding on what type of thread to use, you will need to first consider the treatment indications and what you are trying to achieve.

What Are Screw Threads?

Screw threads have one or two intertwined threads around the needle, and they provide a good volume restoration to any sunken areas of the skin. The production of collagen around the threads and their barbs will help to restore volume and improve the skin texture and elasticity resulting in a natural aesthetics outcome.

What are Mono threads ?

Deemed to be the least invasive of all the thread types. Mono Threads are smooth without barbs and are anchored to a point on the face or scalp. They mainly tighten the skin and provide a small amount of lift & collagen stimulation

Mono threads tighten the skin but without significant lifting; therefore, they have to be used in combination with cog threads for an overall improvement in face tightening as well as skin rejuvenation. Threads can also be added to the cheek area to create volume.

What are PDO Threads?

PDO is an acronym for polydioxanone, which is a colourless, biodegradable polymer. They are made from a strong synthetic monofilament fibre that consists of one or two twisted fibre threads which dissolve in tissue after a certain time. The polydioxanone material is used in plastic surgery, gynaecology, cardiology and traumatology. PDO sutures have been used in medicine for over 30 years.

PDO threads are used within the face and body to create volume treat wrinkles, improve skin quality, reduce pore size and reduce skin laxity. This effective treatment can be performed with minimum downtime.

History of PDO Threads

The earliest reports of surgical facial rejuvenation go back as far as 1911, but the use of midface suspensions for facial augmentation is a more modern practice, dating back to 1998. Early threads utilised non-absorbable materials and, despite their performance, these did not gain popularity due to their permanence. With the introduction of dissolvable PDO materials in 2011, thread lifts began to get more attention for their sustainable results.

What is Polydioxanone?

Polydioxanone is the material used in PDO threads and in the preparation of surgical sutures. It is degraded by hydrolysis (water), and the by-products are excreted in the urine, with the remainder being eliminated by digestion or exhaled as carbon dioxide.

Depending upon the size of the PDO suture used, the biomaterial is completely reabsorbed in 6 months and can be seen as a ‘foreign body reaction’ in the tissue in the vicinity of the implant. This is the exact reaction we want to see from aesthetic PDO threads, as collagen builds up around the thread and creates a lifting effect. This is caused by triggering the body to produce fibroblasts to create more collagen in the targeted area.

The principal mode of action of polydioxanone in the dermis was originally thought to be wholly reliant on this creation of new collagen by a foreign body reaction, which promoted would healing through tissue contraction. It was later identified that subcutaneous tissue fibroblasts were able to remodel the cells and increase protein synthesis, restructures and strengthens the extracellular matrix modification, and potentially promotes tissue growth.

The underlying mechanisms that define the regenerative changes that take place in the dermis and subcutis from polydioxanone threads included neo-collagenases from a foreign body reaction, microcirculation stimulation, increased metabolism, lipolysis, muscle relaxation and increased tissue adhesion.

Studies have shown that increasing the density of threads, placed either in multi-layers or close apposition, creates a denser structural supporting framework.

Ageing causes loss of facial fat, especially around the cheeks, eye area, jowls and the neck. The elastic fibres in the skin become thinner, which result in a loss of facial elasticity. These two ageing processes result in wrinkles and sagging skin due to the skins’ scaffolding’ not being able to provide much support. Thread lifts or suture lifts involve the use of threads made from materials used in surgery to close wounds.

When threads are placed under the skin, they tighten and lift loose or sagging skin in various areas of the face or body to reduce the effects of gravity and ageing. There are three main types of threads currently available:

  • Polydioxanone (PDO)
  • Polylactic acid (PLA)
  • Polycaprolactone (PCA)

PDO threads come in three main types, mono, cog and screw threads.

What are Barbed Cogs Threads?

Principally the same as PDO, Barbed cogs have multidirectional barbs which fix and support the skin tissue in various directions and are excellent for non-surgical face and neck lift treatments.

The procedure uses dissolvable PDO Cog threads to lift and tighten the skin by stimulating new collaged production thereby reducing wrinkles & tightening skin,

Cog threads have barbs which hook onto the skin to provide support and help to lift the sagging skin tissue, which increases the efficacy of the thread.

History of Barbed Cogs

The role of superficial muscular-aponeurotic system in facial tissue support provides a scientific foundation for facial tissue lift and fixation at a deep plane to skin and subcutaneous fat of the face and neck. The concept of barbed thread procedure was initiated many years ago for knotless wound closure and tendon repair by multiple authors.

However, Dr Sulamanidze a plastic surgeon, is considered as a pioneer in introducing bio directional barbed threads creating the highly regarded ‘APTOS’ technique in facial aesthetics.

Ever since, the combination of threads (varying in shapes and sizes) has been introduced for acquiring both skin tightening and a more advanced soft tissue lift, where longer barbed threads are used to allow a stronger fixation point.

Barbed Cogs

Barbed cogs are used for non-surgical face and neck lifts, as well as a facial rejuvenation and wrinkle reducing. This procedure uses the dissolvable PDO thread material  that has been used in medicine for many years-mainly in surgery, in the skin. PDO threads also stimulates the production of elastin and hyaluronic acid in the skin vital for creating youthful looking skin.

The process also creates self-stimulation of our own skin cells. Generally, there is minimal interruption in daily life, even right after the procedure, and no worries about removal as the threads will be fully dissolvable in the body after 2-6 months. The PDO material is biodegradable and biocompatible, and the effects of the treatment should last approximately 2-3 years & cumulative results are observed with repeated treatments.

Barbed cogs are a new and effective medical technique for lifting and tightening the skin of the face and neck. This treatment contours the face and stimulates the production of collagen. The lifting effect is complete 6 months after treatment when new collagen & fibroblast form around the thread.

Barbed cogs have the potential to re define facial contours and induce collaged production. The treatment forms part of an integrated support structure for the tissue of the face by encouraging natural collagen synthesis with immediate results that peak at 6 months and last much longer than dermal fillers. Results can also be maximised with other selected aesthetic procedures that encourage thickening of the dermis.

Barbed cogs have a revolutionary embedding suture and ligature thread, resulting in two times greater anchoring and tensile strength than cut thread offers an effective facial lifting.

To achieve a great lift with an improvement in facial tightening and rejuvenation, barbed threads should be used. The barbs act as cogs to clasp the skin and create tension in the thread, which lifts and suspends the facial area. Collagen is then formed around the threads and the cogs, resulting in an increased effect. The cogs must have a length that will enable them to hook onto the skin tissue and maintain the lift required. If they are too long, they will be too flexible, and they will not be capable of lifting the skin tissue. If the barbs are too short, on the other hand, then they will not be able to hook onto the skin tissue in the first instance.

Barb density is another factor to consider. Threads with a low barb density will not be able to lift the same amount of tissue as threads with a high barb density and not result in the desired lift. Low barb density threads will be less effective at lifting larger volumes or heavier tissue and restrict you to working with small amounts of soft tissue. A thread will need some smooth areas as well in order to ensure that there is adequate anchoring and to avoid puckering of the skin.

The angle of the barb is also vital in the amount of hold that is achieved. If the angle is too small, then the lift will be weak; if the angle is too big on the other hand, then this may dig into the thread, causing it to break. The length of the base of the barb should be equal to the thickness of the thread. The spatial distribution of the barbs along the thread will also vary, and the more contact that there is between the barbs and the facial tissue, the better they will hold.

Some threads may have barbs at different angles to achieve a more 360-degree lift. Some may have cones that maximise tissue contact, while others have barbs lined up in one line only.

Threads can be either mono-directional or bi-directional.

To achieve effective lifting of the skin tissue, the bi-directional threads are ideal as they provide immediate anchoring to the tissue, and the thread will be unable to move either way due to the two-way direction of the barbs. Some mono-directional threads are anchored on both ends at fixed points to enhance stability.

PDO threads last for up to 6 months in the skin. PLA threads last around 12 months, and PCA threads can last in the tissue from 12-15 months.

The longer the thread lasts, the more collagen that will be built up, and the end result will be better and longer-lasting.

PDO threads are better for repositioning and revitalising the skin tissue but will not provide a lift; therefore, it is more suited to a younger client.

PLA threads provide some lifting but are only suitable for clients that require moderate lifting.

PCA threads will provide some lifting and are suitable for clients that require a small to moderate amount of lift.

Recap

Mono Threads

Mono threads are smooth threads that do not have any barbs. They are often used in the face to create a mesh/net-like scaffold under the skin for tightening. Skin tightening usually improves after collagen starts to form around the threads. Treatment areas include; neck, forehead and under eyes.

Around 10-30 mono threads are used for each treatment area. In order to sustain a ‘lift’, the threads are attached to an ‘anchoring point’ of the scalp or face,

Screw Threads

To create a V-shape lift, screw threads help to reverse sunken areas and give the face a non-surgical face-lift. When two threads are intertwined, the method is known as a ‘multi-screw’.

Screw threads can come in the form of one or two threads intertwined together around the inserting needle. Using a screw thread has a great effect on creating volume in sunken areas of skin. Multi-screw threads have a stronger effect and used for general face-lifting.

Cog / Barbed Threads 

Cog threads are essentially mono threads with barbs that hook to the underside of the skin. These barbs form a support structure that lifts the sagging tissue. Unlike mono-threads, cog threads do not require an anchoring point. Collagen will form around the threads and their barbs. Cog threads are the best choice for jawline lifting and slimming.

Choosing the Right Thread

29g 30mm Smooth Mono PDO thread -Main thread uses include:

  • Vermilion border
  • All over the face and body for rejuvenation and volume
  • Use for acne scarring
  • Cross hatch technique to replace lost collagen

29g 30mm Mini smooth Mono thread

  • Cupids bow -Gives a defined peak
  • Vermilion border
  • Scars and acne scarring
  • As these are Mini threads you can use these on any area but you will need to insert more
  • Crosshatch- mesh work technique

29g 40mm

  • Necklace line
  • Submental area -tightens the fatty area
  • Arm creases
  • Crepey skin
  • Decolletage- Stimulates collagen

These threads need the right distance to be used as they are longer

29g 50mm

  • Cheek
  • Body
  • Abdomen
  • Stretch marks -Tightens skin and stimulates collagen

Ensure you check the working distance for the thread to be able to fit correctly

27g 60mm

  • Stomach area
  • Tightens the skin and produces collagen
  • Gauge is bigger so causes more trauma in the area to produce more collagen

29g 40mm twisted thread

  • Blunt
  • Thread is twisted round the needle so may need a little more push
  • Good for producing lots of collagen
  • Severe acne scars
  • Breaks up scar tissue
  • Deep wrinkles, 11s
  • Necklace
  • Submental area -Breaks up tissue to stimulate collagen production

Lifting threads do just that -They lift tissue as our faces age we lose bone structure and fat pads

Arte 19g 100mm

  • Blunt thread -one of the strongest threads
  • Small triangles are engineered into the thread to catch the underlying tissue and lift
  • Great for individuals who have lost weight and have that heavy facial look
  • Butt lifting
  • Breast lifting

19g 100mm Barb star

  • Laser cut into the threads giving strong tissue lift
  • Jawline
  • Facial lift from mouth to temple area

19g 90mm Barb star

  • Has a sharp tip
  • Great for jawline
  • Butt lifting
  • Breast lifting

Indications for Thread Treatments In The Face

  • Horizontal and vertical forehead wrinkles
  • Forehead lift
  • Lowered outer eyebrow ends
  • Flaccid tissue, sagging eyebrows
  • Lower eyelid-bags under the eyes
  • Cheeks
  • Nasolabial Folds
  • Marionette furrow
  • Sagging cheeks and area under the lower jaw
  • Skin furrow on the cheek
  • Creased cheeks

Face lifting using the action mechanism of Barbed cogs

Barbed cogs threads work in two ways, firstly physical notching on the threads surface can create an instant mechanical lifting action. Secondly, their presence triggers the body’s own physiological responses to produce collagen. Once the threads are inserted under the skin, they induce a local inflammatory response as the body’s natural defence mechanisms kick in, in response to a foreign object. As the threads naturally reabsorbed into biological fluids via dissolution, they stimulate the production of procollagen molecules as well as inducing a reactive fibrosis surrounding them, which maintains the lifting outcome beyond their resorption.

The Purpose behind insertion of Barbed cogs under the skin

Collagen is produced by fibroblasts. A mature and active fibroblast has the ability to product around 3.5 million procollagen macromolecules a day. This collagen forms up to 90% of the skin and is organised into large fibre bundles thus creating a 3d natural structure. As we age the process of callogenesis dramatically slows down and components of the extra cellular matrix e.g. elastin, glycosaminoglycans as well as promoting targeted lipolysis of fatty deposits. The aim of PDO thread insertion is to firstly create local microtrauma, which is followed by traumatic inflammation and its associated increase in blood supply. By day 3 fibroblasts begin to produce procollagen protein filaments which go on to form fibres of immature collagen and the stary of new connective tissue. He next stage is collagen maturation here by collagen fibres form bundles and cross linking occurs over several months. The result is synthesis of bands of fibrous connective tissue that act as a strengthening scaffold helping prevent facial ptosis

Through the use of barbed cogs, it is possible to create a strong intradermal as well as subdermal grid that induces bio stimulation, tissue support, progressive retraction of the skin as well as partial reshaping of tissues. PDO therapy resulting in regeneration of connective tissue and an increase in oxygenation to the tissue. By activating reparative and regenerative processes within the papillary dermis the PDO thread insertion process indirectly results in functional and aesthetic improvements. Polydioxanone as a biomaterial is quite revolutionary, possessing antimicrobial and bio stimulating properties in addition to being resorbable. The degradation of the threads is prompt and starts within 15 days of insertion and takes approximately 180-200 days to complete. Hydrolysis of the PDO polymer occurs breaking the threads down into carbon dioxide and water.

SO If a client needs tissue lifting, then PDO monofilament threads would not be suitable as they are placed superficially, are completely smooth and without barbs. While they produce a regenerative effect that can visibly improve the skin’s appearance, they do not provide any amount of tissue lifting.