31/10/2019 Trends and Evolution of Thread Lifting: PDO vs PLLA vs PCL

Trends and Evolution of Thread

Lifting: PDO vs PLLA vs PCL
October 7,
2019

Gone were the days where patients would shun cosmetic and aesthetic
procedures. Thread lift procedures today are known for their ability to deliver
results comparable to surgical procedures, albeit semi-permanent.
 
A very common and highly sought after procedure in the fields of medical
aesthetics - both by practitioners and patients alike, threads continue to gain
traction in the medical field for its ability to lift, refresh and rejuvenate the
skin. 
 
This has also led to an increase in the number of studies being conducted in
recent years, with most, if not all, drawing the same conclusion - thread
lifting is safe and patients now are not only favouring the procedure, but also
actively seeking effective and innovative non-surgical approaches in aesthetic
and cosmetic procedures. 
 
Evolution of Thread Lifting
 
Introduced in the late 1990s, PDO threads were initially designed mainly to lift
ptotic facial tissues; but over the years, variations of the original design such
as mono, screw/tornado, and cog were developed and used. These
variations involved the placement of threads along a planned trajectory and
these threads are then pulled to lift the skin, secured and trimmed at the entry
point. 
 
At its initial stage, thread lifting was viewed with a degree of suspicion
amongst some medical aesthetic practitioners due to the high incidence of
post-operative complications. However, as technology and techniques
continue to advance, new suture and variations have become increasingly
available, and if one were to review the available literatures regarding
threads, it should be noted that although early data showed inconsistent
results and early relapses, recent findings have provided clear evidences of
the effectiveness and safety of thread lift.
 
Today, new devices, thread variations, materials, designs and techniques are
continuously being developed and the indications for each technique are
further refined, thereby resulting in significantly lower incidences of
complications in the initial stages. In fact, the evolution of thread lifting has
progressed so much that aside from the popularly known PDO threads, the
market has now availed new threads such as PLLA and PCL. 
 
In the last 3-5 years, a growing trend shows that patients today are actively
seeking non-surgical procedures, including thread lifts. This proves that when
performed correctly with the right threads and techniques, previous thread
lifting associated complications can be greatly reduced, minimised and
prevented.
 
Types of Threads - Mono vs. Screw/Tornado vs. Cog
 

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31/10/2019 Trends and Evolution of Thread Lifting: PDO vs PLLA vs PCL

While threads have made significant progress since its introduction, there are
fundamentally 3 types of threads - they are, Mono, Screw/Tornado and Cog.
 

 
Mono: Mono threads are smooth threads without barbs. These thread type
are usually placed into the face in a mesh-like fashion for skin tightening
effects by improving and stimulating collagen formation around the thread.
 
Mono threads are often used on neck lines, neck sagginess, forehead and
under eyes. These threads are designed to be attached to an “anchoring
point” under the skin. Although effective in the stimulation of collagen
production and synthesis, mono threads are generally effective only for
tightening of the skin but not lift.
 
Screw/Tornado: Screw threads are sometimes known as Tornado threads.
They are often in the form of single or double threads intertwined together
around the inserting needle. These threads have a great effect on volumizing
sunken areas of the skin. Naturally, the intertwining threads have a stronger
effect over the singular threads and are usually used for general face-lifting.
 
Cog: Cog threads are essentially mono threads, but with barbs deigned to
hook to the underside of the skin. These barbs are usually either cut or
molded as part of the thread and purposed as a support structure to lift
sagging tissues. Unlike smooth mono threads, cog threads do not require
anchoring points. In the case of cog threads, collagen formation will occur
around both the threads and their barbs; making it most effective for jawline
lifting and slimming.
 
PDO vs PLLA vs PCL
 
Generally, thread lifts are performed primarily to tighten skin, with its
secondary effect to shape and contour the face. In recent years, the use of
threads have progressive moved beyond the face, on to other body areas
such as arms, thighs, abdomen and even buttocks.
 
The basic of thread is that they can, and are, usually made of one of the  3
different types of materials: Polydioxanone (PDO), Poly-L-Lactic Acid
(PLLA) and Polycaprolactone (PCL).

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31/10/2019 Trends and Evolution of Thread Lifting: PDO vs PLLA vs PCL

Polydioxanone (PDO): Most commonly used for stitching suture in

surgeries, the effects of polydioxanone (PDO) threads can last between 6 to
12 months. With the threads complete dissolved and absorbed by the by skin
after 6 months, it helps to stimulate the production and synthesis of collagen
in the skin for up to 12 months.
 
The functions of PDO has been known to cause changes in the dermis and
many studies have shown that it is effective in improving pores and fine
wrinkles. Furthermore, it is able to foster collagen formation in the dermal
matrix to increase thickness of the papillary dermis. 
 
PDO threads can also induce tissue changes by placing them into the
subcutaneous layer, as PMN cells, including eosinophile, are gathered
making granulation tissues around the thread after insertion. It has been
observed in some studies that there is an abundant of newly made
collagenous connective tissue in the formed granulation tissues. 
 
Some studies have also shown that these newly made collagenous
connective tissues converge into the pre-existing fibrous connective tissue
creating a “merging effect”. Through this effect, it causes an inflammatory
reaction to the surrounding area where the thread is inserted, and by effect of
mechanotransduction, it will spread as waves to the surrounding tissues.
 
In the granulation tissues newly made near the threads, fibroblast and
myofibroblasts have also been reportedly observed. This shows that PDO
threads can effectively improve the elasticity of the skin in the area of the
procedure and by the effect of myofibroblasts, tighten the skin. 
 
Lastly, fat cells have also been observed to have denatured by the
granulation tissues in the area of treatment, proving that PDO threads, if used
correctly, can be very effective in face shaping, contouring and rejuvenation
procedures.
 
Poly-L-Lactic Acid (PLLA): Another material often chosen for surgical
sutures is the Poly-L-Lactic Acid (PLLA). The PLLA has been observed to be
even more effective at simulating collagen production than PDO.
This material has a lifetime of two years or more, and once dissolved, the
PLLA breaks down into harmless ordinary substances like lactate, glucose,
carbon dioxide and water. 
 
Some times used an alternative to fillers and botulinum toxin, PLLA can
function as a volumizer and is able to stimualte the production of Type 1 and
Type 3 collagen. One benefit of using PLLA over PDO threads is that it

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causes almost no or very small amount of inflammatory reaction to the

surrounding tissues, yet delivering similar, if not better results.
 

 
Polycaprolactone (PCL): Although not as commonly used or as popular as
the PDO and PLLA,  polucaprolactone (PCL) threads is one that can last up
to more than 2 years. This is because, the chemical bonds and structure in
PCL are stronger and more complex, hence it takes a much longer time to be
dissolved completely. The slower rate of degradation of the PCL threads also
makes it ideal to be inserted to the surrounding tissues over an extended
time; achieving a longer lasting result. PCL is also known to be very potent at
stimulating collagen production as compared to PDO or PLLA. Once
dissolved, the material breaks down into nontoxic ordinary substances and
even after the thread has dissolved, collagen production can last for up to
one year.
 
Future of Thread Lift
 
The pace of which thread lift procedures is evolving suggests that it
is expected to continuously progress and advance in the near future, and
similarly, the demand for shorter, quicker, more effective and innovative
procedures should expect to move in linear. Hence, it has become inevitable
for a practitioner to be equipped with the latest and most advance tools, skills
and techniques to deliver better and longer lasting results in patients.
 
Hope you have enjoyed the article! Stay tuned for our future posts about
more techniques and information related to our advanced aesthetic and
cosmetic training courses! 
 
 
 
 
References:
https://aestheticsjournal.com/feature/understanding-thread-lifting

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