Two years’ outcome of thread lifting with absorbable barbed PDO threads: Innovative score for objective and subjective assessment

Background: Thread-lifting rejuvenation procedures have evolved again, with the development of absorbable threads. Although they have gained popularity among plastic surgeons and dermatologists, very few articles have been written in literature about absorbable threads. This study aims to evaluate two years’ outcome of thread lifting using absorbable barbed threads for facial rejuvenation. Methods: Prospective comparative stud both objectively and subjectively and follow-up assessment for 24 months. Results: Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting from 3–10 mm and high degree of patients’ satisfaction with less incidence rate of complications, about 4.8%. Augmented results are obtained when thread lifting is combined with other lifting and rejuvenation modalities. Conclusion: Significant facial rejuvenation is achieved by thread lifting and highly augmented results are observed when they are combined with Botox, fillers, and/or platelet rich plasma (PRP) rejuvenations.     

Improving mandibular contour: A pilot study for indication of PPLA traction thread use

Background: The request for less-aggressive procedures to improve mandibular contour is increasing. Several kinds of threads have been used for this purpose. Nevertheless, PLLA (poly-L-Lactic acid) traction thread procedure has not been previously described. Aim: To investigate the role of PLLA traction threads in improving mandibular contour. Methods: Twenty women were enrolled in the study. They were differentially classified for skin laxity. Patients were treated in a single session with two PLLA traction threads per side. Specific post-procedure instructions were given to patients, and complications occurred after the procedures were estimated. A Fisher’s t-test was performed to identify criteria related to longevity of results. Results: We found longevity of results to be associated with younger age (p = 0.001), absence of severe skin laxity of jawline and neck (p = 0.001), and aesthetic satisfaction (p = 0.024). Edema, swelling, and temporary skin contour irregularities were found in most cases (N = 16; 80%), whereas paresthesia resolving without sequelae in 2–4 weeks was found in two cases (10%). Conclusions: Our results show that selected patients, younger than 51 and showing a mild-moderate degree of skin laxity of jawline and neck angle represent ideal candidates for PLLA traction thread treatment. Further studies will be performed to confirm our results.     

Is it possible to obtain long-lasting results with thread lift in the brow region? Introduction of a new suspension technique and evaluation of 50 patients

Background

Eyebrow region is a dynamic region, and it has a thinner skin prone to wrinkles and sagging. Descended brows could be repositioned immediately with fewer complications by the use of the threads. Despite all its advantages, the main drawback of absorbable thread lift is its short duration of lifting effect.

Aims

This report aims to describe our thread lift technique we have implemented to counteract the descent of the brows and evaluate our results in 50 patients.

Patients/Methods

A retrospective chart review was carried out over a period of 1 year from September 2019 to 2020 for the patients who underwent thread lifting for eyebrows in a private clinic in Ankara. Complications after the procedure, durability of the results, global esthetic improvement scale (GAIS) score, and patient satisfaction survey scores were recorded.

Results

The study group was composed of 50 female patients with a median age of 34 years. The median duration of the procedure is 15 months. Nine (18%) patients experienced complications related to the procedure including ecchymosis, edema, erythema, skin dimpling, and pain. Three weeks after the procedure, the position of the eyebrows of eight (16%) patients were improved, 18 (36%) patients were much improved, and 24 (48%) patients were very much improved according to GAIS.

Conclusions

So far, the most disappointing feature of the threads was the poor long-term sustainability of the outcomes. Our thread lift technique for brows offers a significant improvement in the position of the eyebrows in a short time with decreased downtime. More importantly, it can be possible to improve the longevity of the results with this approach.     

A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation

Background. The use of visible or near infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths and thus compounding their distinct stimulation of cellular components is proposed.

Objective. To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin.

Methods. Thirty‐one subjects with facial rhytids received nine light therapy treatments using the Omnilux^TM LED system. The treatments combined wavelengths of 633 nm and 830 nm with fluences of 126 J/cm² and 66 J/cm² respectively. Improvements to the skin surface were evaluated at weeks 9 and 12 by profilometry performed on periorbital casts. Additional outcome measures included assessments of clinical photography and patient satisfaction scores.

Results. Key profilometry results Sq, Sa, Sp and St showed significant differences at week 12 follow‐up; 52% of subjects showed a 25%–50% improvement in photoaging scores by week 12; 81% of subjects reported a significant improvement in periorbital wrinkles on completion of follow‐up.

Conclusion. Omnilux^TM combination red and near infrared LED therapy represents an effective and acceptable method of photo rejuvenation. Further study to optimize the parameters of treatment is required.     

Clinical evaluation of non-ablative radiofrequency facial rejuvenation

OBJECTIVE: To evaluate the clinical efficacy of non-ablative cutaneous radiofrequency (RF) facial rejuvenation. DESIGN: Prospective study with longitudinal follow-up of a validation cohort set in an urban, private practice of an ambulatory facial plastic surgery center in southern California. METHODS: A consecutive sample was enrolled of 35 healthy adults with moderate facial aging, manifested by skin laxity, rhytids, and ptosis (brow, midface, jowls). Following intravenous sedation anesthesia, the study area was treated with 115-144 J/cm² using the non-ablative RF device (ThermaCool TC^TM). The main outcome measures were the objective measurement of brow height, investigator evaluation of skin parameters, a patient satisfaction questionnaire, and standardized photography, at fixed time intervals. RESULTS: At 12 weeks, a statistically significant increase in mean vertical brow height of 1.6-2.4 mm was observed in patients treated exclusively with the RF device (p<0.0001). All skin parameters (laxity, wrinkles, clarity, pore size) were improved. Complications and side effects were minimal. Patients were uniformly satisfied. CONCLUSIONS: The ThermaCool TC RF system represents a promising non-invasive method of obtaining moderate facial rejuvenation in the appropriately selected patient. Long-term results are pending.     

Effect of pdo facelift threads on facial skin tissues: An ultrasonographic analysis

Background

Recent studies demonstrate that PDO threads, after being introduced into the facial skin, provide benefits due to collagen formation around the thread and improved vascularization.

Aims

This work aims to report the ultrasound and photographic follow-up after the execution of the facelift thread technique, thus evaluating the anti-aging treatment that PDO threads will provide for human facial skin.

Methods

The facelift will be performed using PDO thread 18G cannulated Sculpt i- Thread FML 100 × 185 mm, and 29G PDO thread Needled Flat i-Thread 38 × 50 mm. A total of 10 patients were selected for the study; all of them had medium-grade facial ptosis and aged 40–50 years old. In order to control tissue changes after thread, insertion ultrasound measurements will be made with Philips ultrasound 12 MHz linear probe at maximum resolution, initial evaluations and control of 30, 60, 90, and 120 days, measuring the skin layers: epidermis\dermis and hypodermis. Photographic control was performed before and after 120 days of intrusion of the PDO threads.

Results

The formation of collagen around the PDO thread was evidenced through ultrasound images in all patients in this study, as well as improvement in the appearance of the skin and sagging, evaluated by photographic control.

Conclusions

We can define that the PDO threads used for the facelift are effective in the formation of collagen around the thread (observed through the increase in the dermal layer), and improvement of the condition of the anti-aging factor through sagging skin, vascularization and thinning of the superficial fat layer (observed through the reduction of the subcutaneous or hypodermis layer).     

Employing a teaching module improves patient satisfaction in facial rejuvenation

Background and objectives The purpose of this study was to determine whether a teaching module for facial rejuvenation improved patient satisfaction and enhanced practice growth in a cosmetic surgery office. An educational module was designed to review soft‐tissue anatomy and physiology, treatment options, and outcomes. Materials and methods During the initial office consultation, the module was utilized in group A (50 patients) but not in group B (50 patients). Satisfaction surveys were taken from all patients following the consultation. Patients from both groups who scheduled procedures were surveyed following completion of treatment. Results The surveys indicated a statistically significant higher level of satisfaction with the consultation, a better understanding of treatment options, and a greater percentage of treatment scheduling in group A patients (P < 0.05). Furthermore, patients in group A who underwent treatment indicated greater satisfaction with treatment outcome when compared to those treated patients in group B (P < 0.05). Conclusions We conclude that use of a well‐designed teaching module helps patients better understand the concepts behind facial rejuvenation and leads to increased procedure scheduling and greater patient satisfaction following treatment.     

Non-surgical rhinoplasty using filler,Botox, and thread remodeling: Retro analysis of 332 cases

Background: Non-surgical nasal job has been practiced and published with doubtful concerns about efficiency and safety among physicians and aesthetic surgeons. Aim: of the work to share our experiences in non-surgical rhinoplasty using filler, Botox, and thread with presentation of aesthetic and complication outcome. Patient and methods: Retrospective analysis of the aesthetic and complication outcomes and techniques for non-surgical remodeling rhinoplasty using fillers, Botox, and PDO absorbable threads in 332 cases. Results: Non-surgical nasal remodeling provides temporary correction of small nasal deformities with achieved satisfactory aesthetic outcome and very low incidence of complications.

Conclusion: Non-surgical nasal remodeling with injection precautions could work efficiently and safely in outpatient clinic with good temporary results up to 6 months.     

Evaluation of safety and efficacy of 980-nm diode laser-assisted lipolysis versus traditional liposuction for submental rejuvenation: A randomized clinical trial

Background: Submental fat accumulation and skin laxity is a frequent concern of cosmetic patients. Objective: The aim of this randomized prospective controlled clinical trial was to compare the efficacy and safety of laser-assisted lipolysis and liposuction in the submental rejuvenation. Material and methods: Thirty-six female adults were enrolled in this clinical trial and were categorized into two groups: group 1 underwent 980-nm diode laser with the power of 6–8 W and group 2 underwent traditional liposuction. Patients were evaluated with ultrasonography 2 weeks and 2 months after the procedures. Results: Ultrasonographic evaluation reported the significant reduction of fat thickness in each group compared with the baseline (p value < 0.001). At the 2 weeks and 2 months follow-up visit, fat thickness reduction was significantly higher in the lipolysis group (p value < 0.05). Overall patients’ satisfaction in lipolysis group was higher than liposuction with 11 (61%) of lipolysis patients being very satisfied in contrast to 10 (55.5%) of liposuction patients reporting “dissatisfied or neutral” results. Conclusion: Laser-assisted lipolysis using 980-nm diode is approved to be safe and effective for skin tightening and rejuvenation of the submental area and seems to be a better option than traditional techniques for treatment of this cosmetic problem.     

Clinical and histological evaluation of microneedle fractional radiofrequency treatment on facial fine lines and skin laxity in Koreans

Background

Facial wrinkles and sagging are the most visible signs of aging and can cause profound distress. Microneedle fractional radiofrequency (MFR) is a minimally invasive procedure, which utilizes both microneedling and radiofrequency energy to rejuvenate the skin.

Objective

To describe the safety and efficacy of a temperature-controlled MFR device on facial fine lines and laxity.

Patients and Methods

A retrospective chart & histology review was performed on individuals who received bipolar MFR for facial rejuvenation. A total of 15 Koreans with a median age of 46 years were included. All participants underwent a single treatment session. The results were assessed objectively using serial photography and subjectively based on the participants' satisfaction scores. Histologic changes before, immediately after MFR and at 4 months follow-up was examined. Complications were also recorded.

Results

Partially denatured collagen fibers and dermal shrinkage was observed immediately after MFR whereas an increase in elastin and collagen was noted at 4 months follow-up. 86.7% of recipients considered the results satisfactory. Consensus ratings by two independent dermatologists on the objective outcomes at 4-month follow-up were very much improved (53.3%), much improved (26.7%) and improved (20%). Treatment was well tolerated and did not cause any significant long-lasting discomfort.

Conclusion

Temperature-controlled bipolar MFR is a minimally invasive treatment option to consider for facial fine lines and laxity via neo-collagenesis and neo-elastogenesis. The procedure was safe and clinically effective.     

Effect of mesotherapy with nanochip in the treatment of facial rejuvenation

ABSTRACT

Objective: To observe the clinical effect of mesotherapy with nanochip for facial rejuvenation.

Methods: 24 volunteers with aging skin were treated with a polycomponent formulation – NCTF® BOOST 135 HA for 5 times (once weekly for 3 times and successively biweekly for 2 times). Photographs were taken by VISIA at baseline, and after 1, 4, 10 weeks, while global scores for photoaging (GSP), improvement scores, volunteers’ satisfaction, parameters describing the properties of the skin, and adverse effects were assessed during each follow-up period.

Results: Total 20 volunteers completed the treatment. Evaluation of the whole face showed that GSP, skin texture (ophthalmic wrinkles, dermal thickness, and intensity of collagen fibers of skin), and skin brightness (Lab value) significantly improved at 4 weeks compared to baseline, while the difference between 4 and 10 weeks was not statistically significant. No evident improvement was observed in pigmented spots, telangiectasia, skin tightening, trans-epidermal water loss (TEWL), and skin hydration. Slight erythema, pain was the most common side effect.

Conclusion: Mesotherapy with nanochip can improve skin texture and brightness, but the effect is not permanent. It is recommended that the treatment be used as a complementary method for patients with facial rejuvenation needs.     

Retrospective real-world study of Definisse threads for jaw line reshaping in Indian patients (REDEFINE JAW study)

Background

Thread lifting is a minimally invasive aesthetic procedure that lifts and realigns sagging tissue. Definisse double-needle threads are the latest fourth generation absorbable, monofilament, suspension barbed threads of synthetic origin with convergent bidirectional barbs. Definisse thread produces dual action; mechanical action gives a lifting effect and over a period, it promotes histological revitalizing action.

Objectives

To evaluate the real-world efficacy and safety of Definisse double-needle threads for lower facial lifting for jaw line reshaping in Indian patients.

Methods

This is an observational, retrospective study involving patients who underwent treatment for lower-face reshaping using Definisse double-needle 12 cm threads.

Results

Fifty patients with a mean age of 47.44 years were included in the study with an average follow-up of 5.14 months. All the patients have undergone Jawline Reshaping (JR) procedure, while 70% of patients also underwent Malar Reshaping (MR) technique simultaneously. Mean of Physician and Subject Global Aesthetic Improvement Scale (PGAIS and SGAIS) showed improvement immediately after the procedure (mean scores 2.82 and 2.7, respectively) and showed further improvement at the follow-up (3.72 and 3.58, respectively). Moreover, most of the patients immediately after the procedure rated the improvement in PGAIS and SGAIS as “much improved” compared to pre-procedure appearance (78% and 66%, respectively), while, at follow-up, 76% and 66% of the patients, respectively, rated “improved very much” compared to pre-procedure appearance.

Conclusion

Current study has demonstrated the effectiveness of the latest Definisse threads in Indian patients in performing tissue repositioning to provide a noticeable lifting effect. Procedure was also well tolerated and none of the patients developed serious complications.     

Experimental Investigation on the Tissue Response Induced by Face-Lifting Mesh Suspension Thread in Rats

BackgroundFace-lifting procedures are often performed to hide the effects of aging. Thread-lifting, a minimally invasive technique for the correction of facial aging, has become increasingly popular, and various materials for the procedure have been developed.ObjectiveThis study compared tissue responses to two types of threading sutures placed under rat skin: polypropylene (PP) monofilament mesh suspension thread (a novel face-lifting material) and polydioxanone (PDO) barbed thread.MethodsEight rats each were assigned to the PP monofilament mesh suspension, PDO barbed thread, and control groups. Tissue reactions were evaluated 28 days after subcutaneous loading of the materials.ResultsSignificant increases in tensile strength and the mean area occupied by collagen fibers were evident in skin loaded with PDO barbed thread and PP monofilament mesh suspension thread compared to control skin (p<0.05). Compared to sites loaded with PDO barbed thread, those loaded with PP monofilament mesh suspension thread showed a significant increase in the number of collagen fibers and a lower grade of inflammation (p<0.05).ConclusionPP monofilament mesh suspension thread has skin-rejuvenating effects comparable to those of PDO barbed thread, but induces a less severe inflammatory response. This indicates that it is a safe and effective material for use in thread-lifting procedures on aging skin.     

Clinical evaluation of non-ablative radiofrequency facial rejuvenation.

OBJECTIVE: To evaluate the clinical efficacy of non-ablative cutaneous radiofrequency (RF) facial rejuvenation. DESIGN: Prospective study with longitudinal follow-up of a validation cohort set in an urban, private practice of an ambulatory facial plastic surgery center in southern California. METHODS: A consecutive sample was enrolled of 35 healthy adults with moderate facial aging, manifested by skin laxity, rhytids, and ptosis (brow, midface, jowls). Following intravenous sedation anesthesia, the study area was treated with 115-144 J/cm2 using the non-ablative RF device (ThermaCool TC). The main outcome measures were the objective measurement of brow height, investigator evaluation of skin parameters, a patient satisfaction questionnaire, and standardized photography, at fixed time intervals. RESULTS: At 12 weeks, a statistically significant increase in mean vertical brow height of 1.6-2.4 mm was observed in patients treated exclusively with the RF device (p<0.0001). All skin parameters (laxity, wrinkles, clarity, pore size) were improved. Complications and side effects were minimal. Patients were uniformly satisfied. CONCLUSIONS: The ThermaCool TC RF system represents a promising non-invasive method of obtaining moderate facial rejuvenation in the appropriately selected patient. Long-term results are pending.     

The efficacy of conditioned media of adipose-derived stem cells combined with ablative carbon dioxide fractional resurfacing for atrophic acne scars and skin rejuvenation

Objective: To evaluate the effects of conditioned medium of adipose-derived stem cells (ADSC-CM) on efficacy and side effects after fractional carbon dioxide laser resurfacing (FxCR) when treating subjects with facial atrophic acne scars or with skin rejuvenation needs. Materials and methods: Twenty-two subjects were enrolled in the study and divided into two groups. Nine subjects were included in skin rejuvenation group and thirteen subjects were included in acne scar group, and all subjects underwent three sessions of FxCR. ADSC-CM was applied on FxCR site of one randomly selected face side. Evaluations were done at baseline, 1 week after first treatment, and 1 month after each treatment. The outcome assessments included subjective satisfaction scale; blinded clinical assessment; and the biophysical parameters of roughness, elasticity, skin hydration, transepidermal water loss (TEWL), and the erythema and melanin index. Biopsies taken from one subject in skin rejuvenation group were analyzed using hematoxylin and eosin, Masson's Trichrome, and Gomori's aldehyde fuchsin staining. Results: ADSC-CM combined with FxCR increased subject satisfaction, elasticity, skin hydration, and skin elasticity and decreased TEWL, roughness, and the melanin index in both acne scars and skin rejuvenation groups. Histologic analysis showed that ADSC-CM increased dermal collagen density, elastin density, and arranged them in order. Conclusion: ADSC-CM with FxCR is a good combination therapy for treating atrophic acne scars and skin rejuvenation.

Trial registration: JSPH2012-082 – Registered 14 Feb 2012     

Correction of nasolabial folds wrinkle using intraoral non-ablative Er:YAG laser

Background: The accentuated nasolabial folds (NLFs) is the most pronounced sign of aging. Non-ablative erbium:yttrium aluminum garnet laser (ER:YAG), Smooth mode was used for the treatment of mucosal tissue. It was reported that it is effective in facial rejuvenation.

Aim: To assess the safety and the effectiveness of intraoral ER:YAG Smooth mode laser in the treatment of NLFs wrinkle. Materials and methods: A total of 20 patients with different grades of NLFs wrinkle treated with 2940 nm Er:YAG laser intraorally. Six sessions were done every 2 weeks. The efficacy was assessed by two blinded dermatologists. Photographs were taken at the baseline, end of treatment and 6 months after the final session to document visible changes in NLFs wrinkle. The assessment was based on Modified Fitzpatrick Wrinkle Scale (MFWS) and by comparing the photographs. Patient’s self-assessment and patient’s satisfaction were used for assessment of final results and any side effects associated to treatment were observed. Results: There was significant reduction of the NLFs wrinkle. The MFWS was significantly improved 6 months after treatment compared to before treatment (p < 0.001). At the end of the follow-up period, there was improvement in overall appearance of the wrinkles. Patient’s self -assessment and satisfaction demonstrated better cosmetic outcomes. Conclusion: Intraoral Er:YAG laser is safe, painless, and effective treatment option for NLFs wrinkle.     

Comparative effects of various absorbable threads in a rat model

Background: Conventional procedures including botulinum toxin and filler injections have their limitations in improving deep wrinkles and decreasing tissue laxity, and possess the propensity for vascular accidents. Absorbable thread is a recently commercialized field, but there is little evidence on comparative superiority. Objectives: We observed the effects of polydiaxanone (PDO) threads with different number of strands in relation to collagen production and histopathology in a rat model. Materials and methods: Dorsal skin of rat was divided into five different compartments and four different PDO threads and monofilament poly-lactic acid (PLA) thread were inserted. Tissue samples were obtained at week 1, 2, and 12 after the procedure for histopathologic review and real-time PCR for quantification of collagen. Results: Multiple PDO filaments produced more collagen at 2 weeks. Single-stranded PLA thread insertion resulted in more Col1α1 levels than the double PDO thread and also showed the most Col1α3 production at week 2. The amount of collagen showed a sharp decline at week 12. Histologic evaluation showed retained threads surrounded by fibrous capsule-like structure at week 12. Conclusion: We were able to observe more collagen production in multiple stranded PDO threads compared to a single strand and that increasing number of threads leads to more collagen synthesis.     

Novel method for facial rejuvenation using Er:YAG laser equipped with a spatially modulated ablation module: An open prospective uncontrolled cohort study

Facial aging is a complex biological process that affects the skin and superficial musculoaponeurotic system (SMAS). A new technology (RecoSMA) for skin rejuvenation based on acoustic-interference method using Er:YAG laser (2936 nm) equipped with a special module SMA that targets both the dermis and SMAS was evaluated in an open-label prospective cohort study of 100 female patients treated for facial rejuvenation. Measure of clinical improvement included investigator-rated clinical photography using the Modified Fitzpatrick Wrinkle Scale, and ultrasound measurements in the dermis a week, 30 days and six months post treatment. All patients completed the study and no complications were noted. Improvements in skin tone and texture were noted in all participants and significant decrease in wrinkle depth was demonstrated at the six-month follow-up that was confirmed by ultrasound skin measurements. Data presented herein confirm the safety and efficacy of RecoSMA treatment for facial rejuvenation.     

Fractional carbon dioxide laser for facial rejuvenation: A prospective study to evaluate the efficacy and the safety

Background: The aim of this study was to evaluate the efficacy and safety of the fractional ablative carbon dioxide laser for facial rejuvenation. Materials and Methods: Twenty-nine female who have the complaint of facial aging were recruited for the study. Participants received a maximum of three laser treatment sessions with one-month intervals and were scored using a 5-point scale on seven categories for facial aging before and after the treatment by the physicians. Self-assessments by participants were done at the last month of follow-up period and 3 years after the last session. Results: Mean facial aging score before the treatment was 11,24 ± 4,30 and after the treatment was 10,51 ± 3,86 (p = 0.003). The decrease in the score was mild in 18 (62,1%) participants, whereas it was moderate in only 1 (3,4%) participant. None of the participants had significant or perfect improvement. When the seven categories were analyzed seperately, the only statistically significant alteration in the score was found in the skin tone category (p = 0.0001). Conclusion: Results show that rejuvenation with the fractional ablative carbon dioxide laser decreases mildly the symptoms of facial aging in more than half of the patients.