@aestheticsgroup
combination with botulinum toxin, then I would recommended the toxin to be administered two weeks before manipulation with threads. I often carry out this treatment combination as I find that relaxed muscles give a better thread-lifting result; muscle movements may destroy barbs. Other techniques (for example, mesotherapy) should be applied two weeks after the procedure because, in my experience, this is the time when all side effects have worn off and neocollagenesis is activated. Mesotherapy can help to improve skin tone, structure and quality.12 Before the procedure, the practitioner should determine the indications and contraindications, examine the patient, introduce the technique and warn about possible complications, as well as asking the patient to sign an informed consent form. The practitioner should photograph the patient in five standard positions (one frontal view, two oblique views and two lateral views). Step by step procedure: 1. The local infiltrative anaesthesia is performed using ultracaine or lidocaine solutions, depending on whether the patient is allergic to either one or based on the practitioner’s preference. 2. The marking at injection site and the application area is carried out in an upright position, then the patient is laid horizontally. 3. The cannula with the rounded tip is introduced into the entry point. 4. Depending on the task, different methods of thread application are used, as shown in Figures 3,4, & 5. 5. After installation, the thread is trimmed at the skin so that the tip is hidden under the subcutaneous tissue. 6. At the end of the procedure the patient returns to the upright position, where the practitioner evaluates the asymmetry and soothes the tissues with light massage along the Langer’s lines and the puncture site. 7. The patient is photographed again in the aforementioned five positions. 8. The patient is provided with the post-treatment recommendations below and an ice pack is applied to the intervention zone for 20 minutes. I would propose the following post-treatment recommendations: • Apply ice packs immediately after the procedure • Antibiotics should be prescribed if there is deemed to be a high risk of infection • Analgesics should be taken in case of pain for two to three days • Patients should refrain from applying make-up for a minimum 24 hours Figure 3
Figure 4
Aesthetics Journal
Aesthetics aestheticsjournal.com
• Patients should sleep face up, in an elevated position on pillows for three to five nights • The face should be washed gently without rubbing or massaging for five to seven days • Excessive face and neck movements should be avoided for about two weeks and face and neck massages for one month • Over-exposure to direct sunlight should be avoided for two weeks • Sports and exercise should be avoided for two weeks • Saunas should not been used for three weeks • No dental surgery should take place for three weeks
I often carry out this treatment combination as I find that relaxed muscles give a better thread-lifting result; muscle movements may destroy barbs
Combination treatment for facial zones Even though thread lift procedures are a big part of my practice, injection techniques have not been replaced by them. Moreover, they are used in combination. Such combinations as botulinum toxin and threads or HA fillers and threads, in my opinion, give the most desirable results. Over the years of using various thread methods, I have developed unique algorithms for combining these methods, depending on facial zones, as described below. Upper third of the face In this area, the procedure should be done in two main steps:
Figure 5
Figure 3: Fan-method: five threads are inserted linearly through one entry point. Figure 4: W-method: used for repositioning of volume, as an alternative to fillers. One thread is inserted with the cannula and a ‘W’ shape is made under the skin (the thread is long enough for this). The cannula is moved back and forward without removing it totally from the entry point. Figure 5: N-method: used for the creation of the contour and volume reposition.
Step 1: Injections of botulinum toxin. It is better to do injections 10-14 days before thread application. Products and doses are chosen individually. Without blocking the muscles, active gesture may cause breakage of barbs or even of the thread, in particular during the two weeks after the procedure, and the fixation will be lost gradually.13 Step 2: Insert the threads in subcutaneous fatty tissue along blocked muscles. In my experience, the threads will get better fixation and retain results for longer. Middle third of the face Depending on the desire of the patient, we can reposition the volume or simply
Reproduced from Aesthetics | Volume 5/Issue 6 - May 2018