Thread method of rejuvenation has become extremely popular all over the world nowadays. And its popu­larity continues to grow every day.

How to attain lifting, correct the facial oval and improve the quality of the skin at the same time without plastic surgery?

I tried to analyze meaning of the GOLD STAN­DARD for me.

First - this means SAFE products for me. Revers­ible effect, ability of correction, predictability of short- and long-term results guarantee the product quality and possibility of combination with other techniques.

The second - is certainly EFFICIENCY. Unfortu­nately, many products that caused a lot of ex­citement in the first two years of their appear­ance on the aesthetic market, did not confirm their effectiveness with the time...

And the third - my personal criterion, is the flexibility of the technique in the hands of a professional. What do I mean? In medicine, I prefer techniques where in the presence of a clearly outlined treatment algorithm, there is always possibility for the doctor to create new method of application to achieve the unique result for the patient.

One of my favorite methods, which meets all the criteria I have stated above, is the Aptos thread lift.

Ten years ago, all of us looked at this tech­nique with caution, considering it rather sur­gical than cosmetic. But now the doctors with extensive experience who does not apply this method became rare (Pic.1).

In this article, I would like to describe my TOP-3 techniques, as I call, “play list” of Aptos thread lift methods for facial rejuvenation. In my practice, I try to choose the softest meth­ods with the significant effect. Such qualities are possessed by Aptos threads, methods - Ex­cellance Visage, Thread 2G.

Excellance Visage - Universal threads with barbs for armoring and lifting of soft facial tis­sues. The thread consists of poly L-lactic acid and caprolactone. Due to its composition, we get an additional rejuvenating effect due to stimulation of skin regeneration. There are 10 threads of 15 cm long in one pack. The threads are preinstalled in an atraumatic cannula with a hole aside and round tip.

Indications:

• Complex skin armoring;
• Lifting of the eyebrow;
• Lifting of the lower and middle thirds of the face;
• Formation of the volume of the cheek and malar area;
• Correction of the submental area and neck.

Aptos Thread 2G - is presented in the form of absorbable (Light Lift Thread 2G) and non-ab­sorbable polypropylene (Aptos Thread 2G) material - this is a thread with barbs, attached to two needles. The thickness of the thread - 2\0.

Indications:

• Lifting and hard fixation of tissues in the upper third of the face (eyebrow lifting);
• Increasing the volume in the middle third of the face
• Suspension of sagging soft tissues in the mental (the so-called “jowls”) and the submentalareas

Aptos Thread 2G - is presented in the form of absorbable (Light Lift Thread 2G) and non-ab­sorbable polypropylene (Aptos Thread 2G) material - this is a thread with barbs, attached to two needles. The thickness of the thread - 2\0.

Indications:

• Lifting and hard fixation of tissues in the upper third of the face (eyebrow lifting);
• Increasing the volume in the middle third of the face
• Suspension of sagging soft tissues in the mental (the so-called “jowls”) and the submental areas

Eyebrow lifting (Pic. 2)

A procedure that can be recommended to any woman who wants to get a feminine bend of the eyebrow (so-called “gull wing”), to open the eye, to compensate for the age-related changes in the periorbital region. It can be rec­ommended to patients with botulinum toxin Injections in m.frontalis, as patients with a high and prominent forehead, sometimes have a feeling of “drooping eyelid” associated with the weakening of the forehead muscle. Of course, colleagues may object that there are tech­niques that hold back this effect, for example, botulinum toxin injection at the edge of hair growth, distributing the dosage depending on the type of nerve bundle (depressor-suppres­sor) of the muscle, etc. However, sometimes these preventive methods do not work, and sometimes we consciously choose in favor of a “low” injection scheme.

We use Light Lift (LL) Thread 2G threads. We make an injection at the edge of hair growth of the lateral part of the frontal hillock. We move vertically downwards. The thread exits medially above the eyebrow, laterally imme­diately under the eyebrow. Then we compress the tissues.

Advantage of the method:

• Does not require incisions and anesthesia;
• Absence of special preparation of the patient before the procedure;
• A stable result for up to 3- 4 years with a non-absorbable method (Aptos Thread 2G- -the thread is composed of polypropylene) and 1,5-2 years with a resorbable method (Light Lift Thread 2G, the thread consists of polylactic acid + caprolactone).
• Minimal downtime, for about 5-10 days.

Next Top procedure: Lifting Bucco-zygomatic area, which is often combined with the lifting of the oval (the so-called “jowls”). In general, it is very popular procedure in the Slavic coun­tries, as to adjust the characteristic of the Slavic face gravitational ptosis (in the broadest sense of the word: a combined result of all hyper­plastic and atrophic processes of deep and su­perficial fat compartments, loss of relaxation, tension and elasticity of connective tissue lig­aments, changing the mimic muscles, forma­tion age related hypertonicity and atony of the muscles) with other methods is very difficult and ineffective.

I want to limit the range of patients: unfortu­nately, “heavy” faces of fat women with hy­pertrophic type of aging will not give a good result. Before thread lifting, excessive subcuta­neous fat and the volume of deep fatty pads should be reduced. The use of drugs, including indirect lipolytic - is absolutely indicated for the preparation of such patients.

Another complex group of patients are wom­en with “loose”, flabby, atonic tissues. If in the first case the threads cannot with­stand the weights of the tissues, in the second case one can expect a lack or the worst result. Loose tis­sues move through the thread frame and “sag” again quickly enough. For the preparation of such patients, I use various techniques to strengthen the con­nective tissue: from mesotherapy to RF-lifting.

In the picture 3, I performed a correction of the bucco-zygomatic and mental areas of the face in one session. For the midface I used the universal Excellence Visage method, for the mental area LL Thread 2G.

However, in sufficiently “dry” patients with a mixed type of aging (when we observe atro­phy of the central cheek compartment, supra­orbital fat, formation of the jowls is more due to the gravitational displacement of the lateral fat and the ligamentous attenuation), thread correction of the cheeks may not be required (on the contrary we will increase volum by HA fillers), in this case we only correct the “jowls” with LL Thread 2G (Pic. 4)

Patients often need a complex correction: the eyebrow - as described above, the cheek and the neck. In general, the aging neck in com­bination with well-groomed face in women is quite a common phenomenon. And even if we get used to work with vertical hypertonic platysma bands using botulinum toxin, and to solve the problem of “Venus rings” with the help of skin boosters (although with insuffi­cient, in my opinion, effect), the problem of excessive skin, gravitational ptosis and sag­ging atonic thin tissue of platysma, is effective­ly corrected only by the thread insertion. With such a complex procedure, I divide a pack of Excellence Visage that consists of 10 cannu­las with preinstalled barbed threads: I use 2 threads for lifting the cheek according to the afore described method, 3 on the neck (Pic.6). I use two threads of LL Thread 2G for the correc­tion of jowls. The technique of neck correction is quite simple, if you remember the main goal: to perform lifting of platysma. Enter point is determined individually: passing from the cor­ner of the lower jaw to the scalp in the zone pr. Mastoideus depositing 1-2 cm, almost to the zone behind the earlobe, from the anatomical point of view this zone can be described as the attachment line of the m. sternocleidomas­toidus. The threads pass strictly through the platysma, in a form of a fan, as shown in the Pic. 5. Exit points are determined individually depending on the severity and type of age re­lated changes of the neck.

More than 7 years of active practice convinced me that all the legends about the long downtime are rather the category of “horror stories” for patients. Preparing the patient before the procedure, using the products facilitating the rehabilitation makes it sufficiently shorter and painless.

In my practice of post-operative care, I constantly prescribe heparin-containing ointments (Lyo­ton, etc.) and oral drugs and bruises go away in 3-4 days .

In the Pic. 6 I represent the results the last patient of mine. The photos are not retouched, they are taken on the 5th day after the procedure! As you can see, there are no large hematomas, bruises, small bruises are in the process of “fading”. There is some post-traumatic swelling, but on the 7th day it almost disappeared. Ideally, it is recommended to take medicines week before and after the procedure, this reduces almost all risks of invasive procedures.

Another fear of the beginner specialists is the rippling of the skin at the time of compression. As we know, quite often in patients with excess tissue it is necessary to perform some “hypercorrec­tion”, to get long-term and satisfactory result. An insignificant fold with such a small hyper correc­tion typically resolve itself within a week (clinical experience is confirmed by histological studies demonstrating powerful neo-callogenesis in the area of the thread insertion. Scientifically proven increase in skin elasticity, its turgor, are the basis for this effect).

For beginners who cannot adequately assess and predict the extent of the “tightening”, I can only advise to perform the procedure without hyper correction, but to warn the patients of the possible need to repeat the procedure in 9-10 months, when the tissues loosen.

This is how my working “play-list” looks like with Aptos threads. The combination of safety and high efficiency of these procedures has brought them to the TOP in my patients. They spread information among their friends and it brings me the new patients with a classic request to lift eyebrows, jowls, etc. ... Of course, this is not a complete list of methods, which I would like to recommend. The company develops swiftly, pleases with constant novelties of thread products. In combination with fillers, botulinum toxins, hardware techniques, they give excellent, long-term result. The aim of my methods is to achieve the maximum result with minimal costs and minimal traumatization, since not all patients today want to be operated.