Episode 9: PDO Threadlift

PDO threadlifts use sutures (PDO threads) to help give a subtle lift to the skin.
Kane and Dr. Saluja will go through:

1.  What is a PDO threadlift?
2.  What are the differences between lifting threads and smooth threads?
3.  Who would be the ideal candidate for a PDO threadlift?
4.  What is the recovery like?

Listen to the podcast to answer these questions.

Thank you for your listenership!

Transcript

Hi everyone. I hope you're well. Thank you so much for joining in on another episode of Just Laser It and all things Cosmetic Kane. How are you doing?

I'm doing wonderful. Thank you. The days are getting a little bit lighter.  I get to take the dogs out for a walk when I get home with a little bit of light still, so it's nice.

I do love this. My favorite months in Charlotte are March, April and May. I love when the dog woods are in bloom. I just love these days. Although we're not there yet

It's still pretty cold. That's right. Okay, so we're going to do something different today. So today, instead of talking about lasers or toxins or fillers, we’re going to talk about a different subset of injectables and that what we're going to talk about are PDO threads.

Kane, you know that I didn't embrace them really until about two years ago.

I'm going to give the backstory of this. And, and so, you know, when I did my fellowship, so remember I'm an ophthalmologist first, and then I went back and I did a cosmetic dermatology fellowship out in San Diego with Dr. Mitch Goldman. And in his practice, one of his partners, Dr. Kimberly Butterwick. was certainly a preeminent thread lifter. She was known nationally for her thread lifts. And the type of thread lifts that she did were contour threads. That was what existed back then.

And her results were beautiful. I loved her results. But contour threads began to spread, like wildfire as far as procedures being done. And there were some issues that could come up with contour threads. They did not dissolve, which you would think that that would be a good thing, but , they could lead into issues and. I don't know. I just walked out thinking that I'm not sure that I want to bring this to my practice when I started, my aesthetic

I know you'll get more into it with the PDO side, but what were you trying to achieve back then?

1.      A subtle lift

2.      Without extra volume added

That's what we were trying to do with threads.

Threads are made of suture material.

There are two main types
   Lifting threads (which have tiny cogs or teeth on them) which help to both lift and build collagen

  Smooth threads: primarily only build collagen

In 2013, threads started to change a little bit and  PDO threads (polydiaxanone) threads came to the market.

They are different than the older Contour threads (which no longer exist) in that they were now dissolvable. At about nine months or so, these threads begin to dissolve while building collagen around it. Now, it's not to say that the contour threads didn't build collagen, but these PDO threads had some robust collagen building.

I still kind of poo-pooed them a little. And it wasn't till about, probably four or five years ago that patients really started asking, hey, are you doing these thread lifts? And I told them, no. Then finally I said, you know what? I'm going to go and get trained with the masters of threads so that I have a better answer as to why I am not doing them.

When I went to go do them, I actually kind of liked them. Remember Kane, my first one that I came back from in Connecticut, and I was. Just amazed at what they could do.

Well, I mean, and maybe you should talk about this for a minute, is the technology has changed dramatically from what they were to what, e even still, just from a year or two ago to where they are now. They're, they're continually evolving.

They really are. So let me go into two different aspects of threads. There are two basic threads. There's, there are lifting threads and there are smooth threads. These are two subcategories of threads, and so these lifting threads have got tiny little micro extensions on them, or you can kind of think of tiny little hooks on them that when you place them in your face or your neck area and you pull upward, it's pulling the tissue up. Well, these tiny little teeth used to only be in one direction. Now they're doing multi-directional threads. They're, they're doing tighter helical, so they're really getting more cogs or these little teeth in per thread to give more strength to it.

Does that make sense? It does, it's too hard to like to go into technique and describing technique on this podcast, but, but with all these evolving technologies, I would imagine that the techniques are also evolving as well, along with it

You have to stay up to the, with the cutting edge, because there are new threads that are coming out all the time and new techniques. There are PLLA threads coming out and on and on…

So there's a lot of exciting stuff with threads. But back to, back to threads.

There's also a subcategory that's called smooth threads. And smooth threads are different than lifting threads. These are lesser in cost as well, and these are primarily to build collagen. So, some of my favorite areas that I do the smooth threads are, are the chest wrinkles, the lines between the brows, (glabellar lines), those 11 lines, that's wonderful for smooth threads as well. I don't like to use filler there because it's such a high-risk area for vascular occlusion. So that's a, a key area that I put smooth threads in and we'll go into indications of where I place them as we go along.

Okay the main difference that I heard you say is that smooth threads really are just to build collagen versus the PDL lifting threads are designed to both lift tissue as well as stimulate collagen and elastin.

Correct. And they're more involved as well. But you know, the other thing that you have to consider too is who's the correct patient, like, who can benefit from this?

My classic patients are probably my 40- to 60-year-old patients with thick skin and not too thin of a face (they must have some subcutaneous tissue). So thin skin patients are not a great candidate for this.  For these thinner patients I would begin with a series of Sculptra or fillers.

You got to have enough subcutaneous tissue enough.  kind of fat in the face that you're trying to bring that up. So when patients are really thin or very volume deprived, again, I will utilize sculptor, I'll utilize fillers, and then maybe later on they might be a thread patient. But that I would start with, with bringing their volume back.

The little lines on the sides of the face where you already are filled. It's almost like a focused laser.  that I'm doing with smooth threads, creating that collagen there. But there is one big negative of the smooth threads, and that is they're delivered with a needle, not a cannula. So, you will bruise, 90% of patients will bruise with smooth threads, so you really have to plan it accordingly.

But it's a, it's a simple, straightforward procedure. Doesn't take a lot of time, no downtime other than the fact that you can just expect a Bruce.

You can bruise there might be a little bit of swelling that's present too slightly, so with the smooth threads, but the bruising is the big downtime with the smooth threads. 

Well, I think I've even seen you utilize smooth threads on the abdomen on your Instagram.

If we combine that with radiofrequency-microneedling we often do that and just smooth threads in general on the face and whatnot.

But lifting thread. Now they're delivered with a cannula. And I have posted some of those and , my hairdresser, Laura, which Laura, you know what I am talking about Laure😊  , she was like, don't do that. It really wigs people out to see that. So I will say that, that it's, it's sensitive material to look at. They look worse than they actually are. We numb that area first, and then we place the lifting threads in. And again, this is delivered with the cannula. So, you bruise less with lifting threads, but there is certainly some technique that's involved with that.

And you will be tender for at least a good two weeks post lifting threads. Because remember, Kane, they've, they're the ones that have these tiny little teeth or these little cogs that you'll feel when you press down for the first couple weeks.

I think that's probably the key word that you use is subtle. This is going to give a subtle lift. And then typically, how long will that lift 

About 10 to 12 months. And sometimes I will bring patients, when we initially started doing them, we were actually doing too few, because remember, these are 17, 18, 19 gauge threads.

You have to have enough.  in, in your face, and I really think the face needs about 10 to 12 at least to give that nice lifting effect. And so you want to put enough in them. But I bring patients back at about four to six weeks just to see where they are, to see if they need any boosters at all. And then you can expect about, about a year later, nine, nine months to a year later we'll place more in. 

So you place them in, they slowly disintegrate and as they disintegrate, you're also building your own elastin and collagen. And that will generally last for about a year or so,

In summary:

PDO threads lift and fillers fill in the gap of loss.  With threads, we may need less filler than without the lift of the thread.  

It is important to note that threads are NOT a facelift, but rather give a subtle lift to the tissue which can last about 1 year. 

PDO threads are made of suture material and as they begin to disintegrate, your body produces your own natural collagen around the area to help bolster the tissue.  

Immediately post procedure, there will be some swelling from the lidocaine and there will be a "windswept" look.  There may be some puckering at the insertion site which dissipates around 2-3 days (rarely up to 2 weeks). 

PDO threads will be tender for about 1-2 weeks post procedure when you push down on the area of the threads.  Please plan accordingly.  We also recommend sleeping on your back for the 1st 2 weeks post threads. 

Lifting threads are $225/thread, but when patients allow us to use photos on social media to educate other patients, we do them for $180/thread.

Please note that a face takes roughly 10-12 threads for support (we have done as many as 20 on certain faces).  

It is also important to note that the lift, while greater than filler alone, is still subtle.

We have placed photos on our instagram page at "SalujalaserMD".