Preface

The history of thread lifting starting from 1996. The first devices and methods invented by Dr Marlen Sulamanidze were intended to simplify surgical interventions. Later in 2000, surgeons started to use the first and second generations of threads for lifting soft tissues of the face. The next generation of treads - absorbable threads caused wide interest and attracted not only surgeons but also dermatologists.  

2012 became the turning point for Aptos and thread lifting. With the launch of Excellence Visage, Aptos went beyond the boundaries of plastic surgery and approached dermatology more closely.

Excellence Method had simplified work of the specialist in aesthetic medicine for lifting soft tissues and skin, as well as giving the possibility of skin rejuvenation in further follow-up. In fact, Excellence Visage has become the best and unique product for thread lifting.

3rd Generation threads

The 3rd generation Aptos threads with Hyaluronic acid composition has been presented by Dr George Sulamanidze, the co-inventor and author of Aptos methods on 16th Aesthetic and Anti-aging medicine World Congress.

“How we did it?

We took the best thread in the world Excellence. This thread has the unique direction of barbs and allows to achieve strong and stable soft tissue lifting.

- It is preloaded in classical round tip cannula and inserted through only one entry point. It ensures minimum injury and simple application.

- It could be applied to different areas of the face, for lifting effect and for the creation of tissue volume by soft tissues reposition. 

- PLACL threads absorb up to 50% for 1.5 years. Although, lifting effect is kept for two years”, - Sayed Dr George Sulamanidze During his presentation. 

Why HA?

-  Anti-inflammatory effect

-  Collagen and elastic stimulation

-  Hydration of tissue

“All abovementioned advantages allowed us to make one step forward from Excellence to Perfection”, _ Dr George. 

What should we expect from this thread?

The product is being used in plastic surgery for 2,5 years, in more than 100 patients. In accordance with clinical case results, patients developed not only instant effect of tissues lifting but also significantly improved skin texture soon after the procedure.

Pre-clinical trials

Aptos has performed the comparative clinical study to evaluate the effectiveness of implantation of PLACL and PLACLHA threads in the subcutaneous tissue of pigs. 

Histologic analysis was conducted on 14, 30, 60, 90 days after the procedure.

Connective tissue capsule

In case of PLACL:

The implanted thread was surrounded by the interlayer of connective tissue (74,00 mcm) after 14 days. The thickness of capsule achieved maximum value of 275,82 mcm by 30 days with consequent thickness decrease to 129,93 mcm by 60 days, to 112,97 mcm by 90 days. Thickness increase by 30 days could be explained by the active creation of own connective tissue, reaction to the foreign body, big number of fibroblasts and fibrocytes. Thickness decrease by 60 days is explained by connective tissue maturing, organization and decreased the number of fibroblasts.

In case of PLACL with HA:

The implanted thread was surrounded by an interlayer of connective tissue (91,31 mcm) after 14 days. The thickness of capsule achieved maximum value of 94,82 mcm by 30 days with consequent thickness decrease to 89,00 by 60 days and was decreased to 86,07 mcm by 90 days. The thickness of connective tissue capsule was less, also had wavy dynamics, but the level was approximately the same.

The grey line on the chart shows thread encapsulation without any inflammation and collagenoses. That means, in case of thread with hyaluronic acid the fibrous capsule is much thinner.

Advantages:

-   Shortening of rehabilitation time

-   Less inflammatory reaction

-   Decreased fibrous tissue formation

Elastin

In a small percentage of patients, histologically yellow fibers in derma and subcutaneous fat around PLACL thread were found. The initial number of yellow fibers started to increase first 60 days. The yellow fibers in connective tissue capsule showed stronger activity after 60 days.  

In case of PLACLHA

The number of yellow fibers began to increase in 14 days. Whereas the yellow fibers in connective tissue capsule showed stronger activation after 30 days. 

As can be seen in the histological shots above, the significant supremacy of elastin fibers is noticeable in case of P(LACL)HA material.

Conclusion:

P(LACL)HA threads improved elasticity and texture of skin soon after thread implantation.

Elastin is fibrillar protein, one of the most important components of derma intercellular matrix. Elastin contains atypical amino acids – desmosine and isodesmosine. Elastin structure ensures skin turgor and elasticity. Due to tissue reaction (increased elastin content in the dermis), the face looks younger and fresh.

Collagen

PLAHA thread also supports collagen synthesis. Collagen synthesis is activated after 14 days of PLAHA threads, what is caused by hyaluronic acid. By 90th days after thread implantation was observed reduced collagen content, which was explained by hyaluronic acid degradation. Right after this, starts the second wave of increased collagen synthesis which is caused by polylactic acid activity. All above-mentioned processes explain the prompt bio-revitalization effect on skin structure.

The type I collagen is illuminated by a red spectrum of light, and type III collagen is illuminated by a green spectrum of light.

Production of collagen I type increased by more than 55% within 14-60 days period, and collagen III - by more than 20%.   

Conclusions:

Unmentioned results give us possibility to conclude that PLAHA has stronger bio-revitalization effect on the skin during the testing period (14-90 days after implantation).

1.      PLAHA thread implantation causes 20% increase in III collagen production during the first 14-60-day period. As long as, this type of collagen positively influences elastic properties peculiar to youthful skin and subcutaneous fat.

2.     PLAHA material increases the amount of fibrillar collagen I by 55% in 14-60 day period. This type of collagen is the  building block for derma and impacts its strength.

Outcome Summary

              The P(LA/CL)HA threads have a more favorable effect on the skin within 14-90 days period after implantation:

1.     The thickness of the capsule is more stable, that fits into the normal course of encapsulation of the material, with less inflammatory reaction. That’s why the rehabilitation period is shorter.

2.     Elastin begins to be intensively produced at the earlier stage that allows observing visible improvements in the short period after implantation  

3.     The earlier activation of collagen synthesis supports early recovery and bio-revitalization of the ageing dermis

Patients have more comfortable rehabilitation period and get desired results much faster!