Dr. Albina Kajaia takes us through a combined approach to facial ageing using Aptos threads, platelet rich plasma, dermal fillers and botulinum toxins.

Since ancient times, people always wanted to try and keep their youth and beauty for a long time. For example, the first plastic operations were performed in ancient Egypt and China, where noble persons used skincare tools. Nowadays aesthetic medicine is developing at a quick rate. There are more products, methods and devices to slow down the ageing process than ever before.

According to data from the American Society of Aesthetic Plastic Surgery, the number of aesthetic procedures has been exceeding the number of surgical interventions for last several years. Even more of our patients are asking for non-invasive procedures, and accordingly our task is to give good results using injection methods and combination treatments.

Ageing

In order to correctly apply different techniques, we must understand how the patient’s face ages. The basic ageing processes are loosing turgor and skin elasticity, atrophy of sub-cutaneous fat, mimical wrinkles and ptosis of soft tissues.

There are a lot of ways to fight against each form of ageing. For example, we can use mesotherapy, PRP or biorevitalisation to improve the turgor and skin elasticity. We can also use toxin injections to remove mimical wrinkles, or apply fillers to fill the lipodystrophy. We can also successfully apply chemical peels in our own practice. Unfortunately though, all of these methods are not enough to fight against facial tissue ptosis.

There is a need for mechanical transference of face tissues, which is not provided by any other procedures mentioned above. Previously, patients had to undergo a surgical operation for this but today there are methods to fight against ptosis without skin incisions. One of these methods is thread lifting, which has become especially popular among plastic surgeons and dermatologists.

Differences between threads

There are three different thread methods that I have divided into groups. The first group, A, are small, ring sized threads where the thread lift is ten centimetres, USB 4/0, 5/0, 6/0. Group B is biorevitalisation, which is lifting with free fixation, with a thread lift more than ten centimetres, USB 2/0, 3/0. Group L is skin soft tissue lifting, with points of fixation where the thread lift is ten centimetres and more, USB 0, 1/0, 2/0. The last group is F, which is hard fixation of soft tissue with small threads, all with barbs, USB 0, 1/0, 2/0, 3/0 and 4/0.

The composition of thread types are either non-absorbable material - mostly polypropylene or silicone, absorbable long material with a long-term duration (one to two years), based on polylactic acid and absorbable short material with a short-term duration (one to three months), which is PGO or polyglycolic acid.

As a cosmetologist, I apply the following types of threads in my practice:

•  Absorbable material with a long - term duration - one and a half to two years—based on polylactic acid.

•  Small sizes of threads for armoring.

•  Lifting with free fixation for biorevitalisation.

•  Skin soft tissue lifting with points of fixation.

Product lines

At the moment only one brand has all four size ranges - Aptos (antiptosis). According to patients’ age group Aptos offers different lines of absorbable threads. The first product line is intended for skin armoring, suitable for patients aged 25 years and above.

The Excellence line is intended for soft tissue lifting and armoring. They are suitable to treat patients aged 35 years and above, and a Light Lift line is also available for ‘true lifting’ allowing soft tissue and face skin to be transferred to an aesthetically advantageous position.

Another product line refers to type A armoring. It consists of polylactic acid which biodegrades after one to one and a half years. There are two basic products in the line - two smooth twisted threads and a spring threads. The application areas are horizontal forehead wrinkles, vertical wrinkles between eyebrows, nose tip lifting, filling the area of lipodystrophy, correction of wrinkles around the eye area, filling of tearthrough, skin turgor improvement, treating small wrinkles of neck and decollete, and removal of fine wrinkles on the face. 

The method is good for correcting nasolabial folds and marionette lines, performing the function of a filler. Even with such heavy tissues, you can see the results in two months. I perform this for patients who also want an injection of botulinum toxin. 

The Excellence product line includes two products, Excellence Visage for treating the face, and Excellence Body. This method offers both lifting and biorevitalization, with biodegradation occuring in one and a half to two years. The products have threads with multidirectional barbs, allowing them to be fixed in the soft tissue. 

This method is suitable for lifting of the brows, the middle and lower third of the face, treating ptosis, and neck and decollete area correction. For

the body it is good for the abdomen, buttocks and inner thighs.

The Light Lift product line is intended for heavier tissues and adult patients, and the threads are composed of polylactic acid in combination

with caprolactone. Application areas include the eyebrows, marionette lines, nasolabial folds, the mental area, submental area, correction of the

nose and ear. In my patients I have applied several products from Light Lift product line.

PRP

Threads offer a very good result, but we often use them in combination with other non-invasive aesthetic procedures.

Threads only work for the skin structure, but we can use biorevitalisation as well. According my experience I use the procedure of biorevitalisation and PRP in combination with the threads. This decreases period of rehabilitation and provides with better aesthetic effect.

Plasma lifting is the same PRP method of tis-sue regeneration stimulation by local insertion of injection of thrombocyte auto plasma. We have developed two basic schemes of injection in our clinic.

The first scheme is “soft therapy”, where we perform three procedures of PRP. The first procedure is performed two weeks before thread lifting, and the second procedure is performed on the thread lifting day. The third and last procedure is performed two weeks after placing the threads. The second scheme is “hard therapy”. The principle is the same and the only difference is that we double the number of PRP procedures.

Dermal fillers

We always correct platysma three to five days before a thread lifting procedure. After this, we find using threads with polylactic acid in combination with a hyaluronic acid, provide a complex solution for face, and offers good results.

When patients come to see us and we discuss what treatment they want, we look at what they want the results to be. We do combina­tions with fillers because no one product can change the effect of botulinum toxins. That is why it is necessary to combine all types of procedures - even if only noninvasive options.

In recent years and even now, the procedure of buccomalar area contouring and volumisation is still actual. Thread lifting does not always provide us with enough volume. In the middle third of the face some additional correction by hyaluronic acid fillers can be required. The correction should be performed three to four weeks before the thread lifting.

Toxins

I find combination of threads and botulinum toxin injections very effective. Blocking muscle movements with the toxins, you make threads to work

better. This is very important for correcting zones such as platysma, m. frontalis, m. orbicularis oculi and m. corrugator supercilii.

Botulinum toxin injections should be performed at least 7 days prior to thread lift. This is very important to make sure the muscle does not spoil

the fixed thread, especially in the eye area.

Conclusion

Combination of thread lift with other non-invasive aesthetic procedures results in shorter downtime and better result for the patient.

The key to cosmetic procedures and cosmetic outcomes is a very thorough assessment of the patient beforehand. Manipulating the face and seeing

what can be achieved is essential.

The most important evaluation of the procedure is the satisfied beautiful faces of our patients.