Softly does it

Threads are the new buzzword, and justly so. Threads have been used for at least the last 20 years. Silicon, catgut, silver and gold were threaded into millions of ladies seeking rejuvenation. Despite the techniques being safe and reliable the practice disappeared; eclipsed possibly by the dermal filler market and perhaps introduced too early onto a naive public not quite ready for such a procedure. Threading is very popular in the Far East and it is from here that V Soft Lift originates. Whilst the oriental face does not develop lines or sag like the Causasian face, the shape is not desirable to the young, pro-Western females and threads provide a nonsurgical option that changes a heavy jawed face into a more heart-shaped Western face. The technique sits well with their history of needlebased manually intensive therapies notably acupuncture. The technique used to create a heart-shaped face is certainly not the same as that used to maintain or revitalise a Caucasian face. The technique has been “translated” into European by our Swedish colleague, Dr Martin Richter of New Medic Era AB. The needles are currently made in Korea by the DongBang company, the world’s largest manufacturer of acupuncture needles and IV cannulae. They are CE marked as a class 3 medical device, patented and approved by the Korean FDA, stricter than the FDA. In the very near future they will be made in Sweden. 

The threads are made from PDO: polydiaxanone. This is absorbable suture material made by Ethicon. The inflammatory reaction is minimal but sufficient to create new collagen I around the thread once inserted. The number of threads criss-crossing the skin create the volume and lift rather than the action of one single thread. The thread has no barbs, is ready-threaded onto a 27 (5/0) or 29G (6/0) sterile needle in packets of five.T he basic concept of the V Soft Lift is to create a tiny amount of new collagen I around each thread, thereby achieving a small volume increase but more importantly increased tissue tone and elasticity. The threads are oriented at 90 degrees to the Lines of Langerhans to oppose the natural forces of skin weakness and line creation. The larger, longer threads (27G; 5/0) are used specifically in the lifting pattern, the smaller 29G 6/0 create bridges between the larger threads. The goal is to create a meshwork of PDO throughout the area to be treated. Any area of the face can be treated. The face can be treated as a whole or in parts in one treatment or several. The same basic tenets hold; restore the upper face before dealing with the lower since the lower part frequently responds to improvement of the upper. Aim to restore a harmonious balance rather than eliminate lines.

WHO BENEFITS FROM THIS TREATMENT?

V Soft Lift can be used as a preventative treatment rather like the original gold threads. It was rumoured at the time that Isabelle Adjani had a face full of gold threads; she was about 28. At the moment V Soft Lift may be something that the practitioner suggests to the client; awareness is not yet fully developed. However young women are requesting the treatment as a full-face option. Slightly older patients who have already received fillers often request more fillers to address the low face, or simply request something to address the marionette lines, weak jaw line, downturned mouth corners and saggy neck. Looking into a mobile phone emphasises the need for a V Soft Lift. Patients can ask for a lift of the forehead with or without the use of toxin, or are seeking a longer-term solution. V Soft Lift is a very good option for the forehead and can be performed in less than half an hour. Unless the patient has specifically requested the treatment and is fully aware of the procedure and recovery it is wise not to perform the treatment at the same time as consultation. The key facts to impart to the patient are as follows:

1. Multiple threads inserted all over the face or all over the desired treatment area.

2. Not painful but anaesthesia required (Pliaglis works very well)

3. Tight, bruised feeling for three to four days after preventing laughter and wide smiling.

4. Likely to bruise, lasting seven to 10 days

5. Results immediately but will improve over three months.

6. Can be topped-up at three months

7. Can complement other treatments but need to plan.

8. Results last one year +

9. Threads dissolve between 10-200 days.

10. Best results seen when low face not too heavy (fat).

There are a few contraindications similar to other cosmetic treatments. Keloid scarring, inflamed or infected skin, very thin atrophic skin, pregnancy and breast feeding, roaccutane usage.

THE PROCEDURE

Pliaglis is applied to the treatment area for an hour, then peeled off. The skin is cleansed with alcohol or chlorhexidine. With the patient sitting up, the areas are marked with a make-up pen. Vectors for the 27G threads are marked as well as the insertion sites for the small, cross-hatching 29G. Prepare the trolley with the needles that you will use; 20-30 27G and 30-50 29G, depending on the area. The patient may lie down for the procedure. Starting with the 27G, insert each needle subdermally, just under the skin right up to the hub. Continue to insert the 27G until one half of the face (or area) is loaded. Then removethe needles, leaving the thread buried subdermally. The tread remains in situ of its own accord. Then you may start with the 29G needles, working at approx 90 degrees to the first ones, aiming to cover the whole of the treatment area. Then remove these as well. Continue on the other side of the face until you have completed this side as well, using the same number of needles in the same place and direction as the first side. You may benefit from an assistant to pass you the needles and to remove them whilst you reposition yourself. A whole face will take about an hour. Aim to treat more than the target area in order to obtain the best lift. For the jawline, start at the line drawn between the nostril and the tragus and extend to below the jaw. For the neck, also look at the midface and ensure good coverage with the needles.

LEFT: This client was unhappy with circles under her eyes. She was treated with V Soft Lift PDO threads. RIGHT: This client did not want to be treated with Botox®. The forehead and tear were treated. The advantage is the PDO lift lasts longer than Botox®.

V SOFT LIFT AND OTHER TREATMENTS

V Soft lift should be seen as both a gentle volumising treatment and a skin tightening/toning treatment. The V Soft lift complements all other treatments such as fillers, toxin, peeling, etc. V Soft lift can also be considered as an alternative to fillers and toxin where the patient prefers not to receive fillers or toxin. In terms of forehead lift, V Soft lift will last much longer that toxin. V Soft lift is a real alternative to skin tightening devices. The advantage to both patient and doctor is that the treatment can be performed in one go and the results are seen immediately, reassuring the patient that the investment in time and resources was worthwhile. V Soft Lift complements existing threading techniques such as Silhouette Soft. V Soft Lift can be suggested where Silhouette has been rejected by the patient, or can be used in conjunction with Silhouette to refine the results, either at the same time or three months post Silhouette.

FUTURE OF THREADS

Threading has only just begun. Threads will develop to perform other functions. Lipolytic threads already exist but have yet to be fully tested. Threads with barbs, threads like screws and threads for the body are part of a host of new products emerging from Korea. Our experience of classical threads such as the V Soft Lift and Silhouette is long and we can rely on them to perform well and not to disappoint us. Different types and designs of thread need to be thoroughly tested in order to avoid unnecessary complications developing in what is an exciting development in aesthetic medicine.

PRACTICE OF THREADING

Threading is a technique that requires skill, manual dexterity, experience and an understanding of the anatomy of the skin and of the face. The main complication that can arise is linear scarring after incorrect (superficial) placement of the thread. The Swedish creators of V Soft Lift insist that only advanced practitioners (those with at least eight years experience) should be performing the technique. The perceived simplicity of the technique, the expected demand for the procedure and the possibility of an influx of cheap, non-approved threads onto the UK market may give rise to scares and complications, destroying the market overnight. Many of us old enough to remember the “Flab Jab” furore will see the obvious parallels. It is imperative that good quality training is provided with adequate supervision prior to a practitioner being allowed to perform the treatment in their own environment. 

Dr Elisabeth Dancey was one of the first medical practitioners to enter full time cosmetic medicine, 21 years ago. She has been involved in the introduction of many techniques, notably mesotherapy and electroridopuncture. She now runs her clinic in Belgravia, Bijoux Medi Spa and focuses on injection and needle-based treatments. She is the UK trainer for the V Soft Lift.