SAGGING - LOSS OF ELASTICITY – THREADS AND DEVICES
Fluctuating weight, smoking, sun exposure, illness, age and genetic factors collude to decrease the ability of the supporting fibres (collagen and elastin) to recover from stretch. The skin and underlying tissues are being moved and stretched all day, eventually they will not return to normal. Up to a point fillers can address this problem but sooner or later skin tightening will be needed to maintain a healthy-looking face or body.
We now have the option of threads for the face, neck and decollete as well as the time-honoured skin tightening devices.
THREADS – Silhouette Soft and PDO threads
Threads are the new excitement, and justly deserved. Threads literally lift and support the sagging tissues of the face whilst stimulating new collagen and tissue tone. They are recommended for skin quality, loss of elasticity and early volume loss.
Threading is not new; 20 years ago gold threads, cat gut, collagen and all sorts of bio-materials were used to lift the face. The results were good but the technique was eclipsed by the arrival of fillers that replenished lost volume and filled lines. Doctors have been content with fillers and toxin to achieve excellent results but have always been looking for a realistic, non-surgical intervention to lift the lower face.
Now we have them. There are two sorts of thread that we can use, depending on the area and requirements of the face and the desires of the client.
Silhouette Soft threadlift is made from polylactic acid (the same as collagen-generating Sculptra). It is a long thread with eight, twelve or sixteen unidirectional cones placed along the active segment of the thread. These are designed to anchor the tissues against the thread and provide a ratchet-like mechanism that lifts the tissues of the face. Both the cones and the thread will dissolve over 12 - 18 months.
We like to use two pairs of threads per face – one pair for the upper face and one for the jawline. Lifting the upper face first makes the jawline lift easier and more effective. The position of the threads is marked on the face and local anaesthetic injected to numb the area. The threads are then inserted and passed under the skin. Once they are all in place the skin is teased against them, lifting as it goes. The remaining thread is cut off tight against the skin to fall back under the tissues. There is a weird but satisfying sensation of the tissues passing over the cones and then being gripped to provide the new, uplifted face.
After the procedure the face will feel quite tight (almost too tight) but this will slacken off over the ensuing week. Sometimes the face feels as if it slackens off completely but this is not the case. The full lifting effect will be seen at 12 weeks. There may be some bruising and a sensation of tightness for a few days.
PDO threads originate from the Far East, mostly South Korea. They are specialists at micro-engineering and their threads are based on PDO (polydioxanone) used as surgical sutures for over thirty years. These, too, dissolve after eight months, generating new collagen throughout that period.
The Korean system has been used to make round oriental faces into longer, heart-shaped European ones and to make the large round heavy low face more angular, more pointed. We have adapted the technique for use on faces of all shapes and sizes and use the V Soft brand which has a CE mark.
V Soft will achieve a subtle lift of the low face, adding generalised volume and refreshing the complexion. The threads can be concentrated around any problem area so are very versatile. They can be used for the whole face or certain areas such as the neck, mid-face or forehead. They can revitalise a previous face lift and complete a Silhouette Soft lift.
Barbed threads are now available. These PDO threads include a unidirectional barb in their design that holds onto the tissues allowing both lift and volume. They fall between the simple PDO threads and Silhouette in their lifting capacity and are recommended for the forehead, cheeks and neck. They can be incorporated into a standard V soft treatment or a Silhouette treatment. The exciting aspect of threading is that they are all compatible and can be used in one treatment or over a period of time. The advantage is one of cost, simplicity in insertion and procedure time.
Skin tightening devices
For the face and body.
Skin tightening devices take time and do not give the immediate satisfying results that fillers or threads do. However they have a value in being non-invasive and a suitable alternative for threading. We have the Sublime and the Accent, both radio frequency devices with different modes of action. The Accent tends to reduce fat so is suitable for a heavy low face or abdomen, the Sublime tightens tissues without an effect on fatty tissue. We combine both machines where necessary; saggy face and heavy jawline. Radio frequency energy is picked up by the water in the tissues, heating the surrounding area up which makes the spiral collagen and other fibres contract and re-set the bonds between the collagen strands. More and more evidence exists to suggest that radiofrequency is the best tightening modality and that the tightening is seen deep down in the tissues, preserving the face for much longer than just the duration of the treatment.
Both Accent and Sublime heat up the tissues. The head is passed repeatedly over the skin of the face, gradually heating the tissues and maintaining that heat in order to bring about shortening of the collagen strands. It is never too hot or painful. Baby oil or gel helps the head to glide effortlessly over the face in a treatment that most people describe as relaxing. Afterwards the skin is a bit red but this settle within half an hour. We recommend that the first three or four treatments are every three weeks then follow ups at greater intervals.