Introduction

Just as our favourite pair of jeans ultimately loses stretch, so do the tissues and support structures of the face. Continued use of the facial muscles relentlessly weakens the supporting ligaments, integral collagen and elastin fibres weaken and stretch. The domed architecture of the skin flattens out; skin surface area increases.

Unlike fabric, however, the skin and underlying structures are living tissues and can respond to interventions. We have several at our disposal to tighten the face and achieve a lift. Any lift that we achieve will not be a surgical lift, but suits those for whom surgery is not an option, or at least not yet. Medical lifting can prepare the skin for surgery or provide a realistic alternative.

Threads

Threading the face is not new; threads were used before HA fillers or toxin were invented. Gold, catgut, silicone, PDO, PGA and now PLLA have all been used with varying degrees of success over the last forty years.

PDO, Polydioxanone, is suture material; the absorbable thread that is used to bring together wound edges prior to healing. We know that it creates short-term collagen, collagen 3 which then is modified into the more stretchy, long-term collagen, collagen 1.

PDO Threads

PDO threads are used as either small free-floating threads that are inserted underneath the skin, or longer threads with some form of attachment mechanism such as barbs or hooks. These can grab the underlying tissues and allow some tightening. The main action of PDO threads is brought about by their collagen activating capacity and to a lesser extent the tightening capacity. The more threads that are used the better results that are achieved. PDO threads are inserted over a wide area of the face to achieve volume, freshness and a gentle lift. The results last around 8 months.

PGA and PLLA; Silhouette soft

PGA is polyglycolic acid and this also creates collagen 3 (then 1). PGA forms the attachment mechanism (cones) in the Silhouette Soft system. The thread is made from PLLA which has been used as a collagen generator as Sculptra. Silhouette Soft is a more substantial thread system owing to the unidirectional cones and method of insertion (literally sewing) under the skin. Silhouette Soft is threaded under the skin such that the thread has a broad anchor at a non-mobile site in the face (in front of the ear, the side of the neck) and wide pull across the face opposite to the age-related descent of the tissues. Several threads can be inserted; in general three or four across the vectors of the face. The unidirectional cones allow the skin to be lifted back against the direction of descent, but then to remain in place thus achieving a lift which should last about a year.

Silhouette soft will achieve a better, longer-lasting lift than PDO but is more invasive and requires some time resting to ensure that the cones are completely embedded by the tissues. This takes about 8 days.

Both systems can cause bruising (PDO more than Silhouette soft) and a sensation of tightness for a few days.

Like all of our treatments, threads are not a one-off treatment but should be incorporated into a holistic anti-ageing approach to include fillers, skin care and possibly toxin. At Bijoux we prefer to perfect facial volume first and then, if necessary, add some form of lifting.

Device based skin tightening; the Venus RF system

Radio frequency is an energy form that targets water molecules. They vibrate and heat up such that the tissues become hot in a controlled manner. Hot tissues shrink as the collagen returns to its normal shorter length. Circulation and lymphatic drainage improve as the warmth relaxes the vessels. The wider the area of heating and the more evenly distributed the heat the more effective the treatment, the better the circulation (therefore nutrition of the tissues) and the more uniform the lifting.

There are many RF devices on the market; Venus RF has the patented Multipolar head with the added benefit of pulsed electromagnetic field to improve lymphatic drainage, useful for puffy eyes.

RF treatments are pleasant and not designed to hurt. The wand is passed repeatedly over the face to create heat deep in the tissues. A screen informs the therapist of the energy delivered and the temperature profile. The energy delivered (dose) is determined by the system rather than the therapist and the time taken to deliver it approximately the same each treatment.

This is not a one-off treatment but one that delivers results gradually. A treatment every week for a few weeks followed by one every two to three weeks will lift the face, improve complexion and decrease puffy eyes in a completely natural and non-invasive way. It can be combined with any of our other treatments and also used to maintain the results achieved by threads.