By Donna Potter
Today, more and more people are shying away from surgical procedures and turning to noninvasive or minimally-invasive face and body procedures to help them age gracefully. Although advances in cosmetic treatments such as Botox and fillers, laser resurfacing, microneedling, chemical peels, and ultrasound technologies work well in general, there seems to be an unmet need for lifting of the skin and soft tissues, particularly in the face and neck areas.
Threads were originally introduced in the aesthetic field in the 1990s and were popular in Europe and Asia as a contour thread lifting procedure. They were made of polypropolene and were permanent sutures. Although they gave a good lifting result, they received a lot of bad press due to complications with extrusion and infection. They were pulled off the market in 2007 and reintroduced in the United States in 2015 as NovaThreads. They are now made from an absorbable material, Polydioxanane, or PDO, and offer a solution for lifting the soft tissues of the skin, face, and body.
These Nova threads are FDA approved sutures used for biomedical applications. They are fully absorbed by hydrolysis within 4 to 6 months and do not create scar tissue. These foreign bodies stimulate collagen synthesis and the skin structure that is created will hold for approximately 12 to 15 months. Longevity depends on many factors, including the age and weight of the patient, overall health, and individual metabolism.
There are no cuts or incisions involved. The procedure consists purely of injections. The needles are pre-loaded with the PDO thread. The whole suture is simply inserted through the needle into the interstitial tissue below the skin, parallel to the skin surface, and the needle is pulled out. The PDO thread remains deployed under the skin. There are no antigenic or pyrogenic reactions and collagen production is stimulated. The new collagenases in the skin and mild fibrosis strengthen the connective tissue of the skin.
There are three types of threads.
1) Smooth threads are generally placed the most superficially, in a crosshatching pattern, and are used for skin tightening and smoothing the texture of the skin. For improved and sustainable results, they are typically placed every 4-6 weeks. They are commonly used in the cheeks, crow’s feet and crêpe skin of the neck.
2) Twisted threads are used to slightly volumize skin tissue and are most commonly used at the nasal labial folds, marionette lines, and lip borders.
3) Barbed threads are used to lift sagging tissue and are commonly used in the cheeks, jowls, and neck. The lifting result will be immediate. The barbed threads can also be used to lift other areas of the body, such as breasts and buttocks.
Good candidates are generally middle aged, 30 to 65 years old, with mild to moderate flat cheeks, jowling, or neck bands, and preferably have had no history of plastic surgery. The skin should have good elasticity and thickness and not too much excess skin. It is fine if a candidate is currently using Botox and fillers, but these should be done at least two weeks prior to the procedure day. Blood thinning medications will need to be stopped five days prior to treatment.
On the day of treatment, there should be no active infections such as colds, sinus infections, cold sores, upper respiratory infections, or rashes. After treatment, patients will need to avoid excessive animation, massage, or manipulation of facial tissue for two weeks. Strenuous exercise will need to be avoided for 72 hours. Complications are minimal. The most common side effects are bruising and irregularity. These are self-limiting and resolve on their own within a few days to a few weeks. There is no risk of intravascular injection with risk of blindness, stroke or tissue necrosis that fillers can cause. Although fillers can be used to volumize areas in the face should a patient desire more volume after thread placement.
NovaThreads are very popular in Europe and Asia and are becoming popular in the US. They may soon revolutionize the field of medical aesthetics with this new minimally-invasive skin technique. The procedure does not take the place of a face lift but can delay aggressive surgical procedures or be a good option for those with realistic expectations who prefer to not undergo surgery but would like to continue aging gracefully.
Donna Potter, NP, works with Southeastern Vein Specialists of Hyannis and Mashpee. She can be reached at (508) 775-1984 or firstname.lastname@example.org.