جهت تماس و مشاوره: 02188337515
فهرست
جهت تماس و مشاوره: 02188337515
Introduction: In the modern world, the need for cosmetic procedures and rejuvenating the skin has increased. Although great improvement in this area has been seen, we as aesthetics thrive to develop the techniques to perfection. That is why non-surgical and painless methods with minimum side effects have the most applicants among people. In this study, a new innovative method of rejuvenating and lifting the face, using absorbable P.D.O threads and mesotherapy products is being reviewed.
In this prospective review chart clinical study, a total of 110 patients were included in the study from October 2014 to July 2022. All patients underwent thread lifting using absorbable polydioxanone mono with needles 27G or 26G – 38mm or 60mm (Korea) and Mesoaroma cocktails (Italy) at the same time. Patients were followed up for the first week, one month and six months after the procedure.
Out of 110 patients in this study, the median age of 47 years old, 2.7% were men and 97.2% were women. The most common sites for the meso-thread-lifting in the face were the Nasolabial folds (part 1) and Jawline (part 2, picture1). All patients were satisfied with the results and the satisfaction rate increased from 92% (after a month) to 96% (after six months). There were no records of side effects in patients.
Conclusion: This combination therapy which consists of using mesotherapy cocktails whilst implanting absorbable P.D.O threads, showed significant improvement in face sagging, removing the wrinkles and rejuvenating the skin. Nonetheless, cosmetically, this combination therapy is a more accepted, safer and more effective procedure associated with minor complications.
This non-surgical method is a great alternative method especially for patients who are not comfortable with injecting dermal fillers of any kind.
Keywords: Meso-thread-lifting, Non-surgical procedure, Facial Rejuvenation
1) Medical doctor (Since 1990) -Skin and Aesthetic clinic, Tehran. Iran
Correspondence: Dr.Shohreh Shams M.D Medical Doctor of Dr.Shohreh Shams’ skin and aesthetic clinic. No.22, Golha Blv.Golha sq. Fatemi sq. Tehran. 1413873941. Iran
The human face is the part of the human body that is the most affected by sun exposure, air pollution, daily stress, diets, rapid weight loss and other external and internal changes in the body. These factors have a significant impact on the skin and are the most common causes of loose skin and the creation of fine or deep lines in the lower face area.
Aging of the face is a complex process involving two important factors: volume loss throughout the face, and repetitive muscle movements that cause wrinkles and folds.[i] This is the main reason new techniques for skin rejuvenation are introduced and updated every day.
To understand the Physical characteristics and histological changes after P.D.O insertion, some parts of The Art and Science of Thread Lifting, a book by Bongcheol Kim, Seungmin Oh and Wonsug Jung are mentioned below.
The thread of PDO ingredient has been used as a suture for a long period and it is proven to be safe. It lasts longer compared to Dexon and Vicryl and completely absorbs after 6 months and disappears from the body. Therefore, it has been used for closing the area which requires long tension. Accordingly, it has been accepted for its safety and sustainability as a suture. In general, a PDO is known to cause changes to the dermis. As discovered in several studies, it has the effect of improving pores or fine wrinkles. Especially, it is known to increase the thickness of the papillary dermis, which is done through the method of fostering collagen formation in the dermal matrix.Many PMN cells, including eosinophile, are gathered making granulation tissues around the thread which is inserted. In the granulation tissues, newly made collagenous connective tissues are abundantly observed. The newly made collagenous connective tissues converge into the pre-existing fibrous connective tissues nearby (merging effect). Through the merging effect, an inflammatory reaction is in progress to the surrounding area where the thread is inserted, and mechanotransduction (=cell signal delivery happens when granulation tissues are formed) starts and spreads as waves to surrounding tissues. Inside the granulation tissues which are newly made near the inserted thread, fibroblasts and myofibroblasts show. Myofibroblast is most clearly related to a wound contracture in the wound healing process, and it is a cell that serves a key role in causing elasticity in the area of the procedure and tight skin after the skin regeneration procedure. The cross-sectional area size of capillaries is larger in the experimental group where the PDO thread was inserted than in the control group. Also, many eosinophils were observed which shows effects for inducing fibrosis in the wound healing process. There was fat cell denaturation by granulation tissue only in the area where the thread was inserted, and there was no change in fat cells away from granulation tissues. Summary of histologic changes after inserting PDO: Newly developed fibrous connective tissue,Merging with existing fibrous connective tissue, Tissue contraction by myofibroblast, Increased capillary vessel size, Fat cell denaturation
Traditional rejuvenation techniques include chemical peels, rhytidectomy of the skin, laser resurfacing, injection of dermal fillers and neurotoxins, and invasive surgical procedures. Patients currently seek anti-aging procedures with no incisions and minimal downtime such as thread-lifting with barbed sutures. Thread lifting has been widely adopted for its minimally invasive nature. The esthetic effects depend on the proper placement of threads in the optimal anatomic locations. In a study on 151 patients who underwent thread lifting for the head and neck, the results showed that facial rejuvenation thread lifting is effective, safe, and cosmetically more accepted with minor complications than other face-lifting techniques. In another study performed to evaluate histologic and molecular changes induced by an absorbable, barbed face-lifting thread in an animal model, results suggested that implantation of barbed thread induces strong anchorage to skin tissue. On molecular analysis, Type 1 collagen and TGF-β1 levels were significantly increased, compared to normal skin. The quantitative analysis of collagen and its downstream signaling molecule TGF-β supports the long-term durability of the thread. Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting and a high degree of patient satisfaction with less incidence rate of complications. Augmented results are obtained when thread lifting is combined with other lifting and rejuvenation modalities.Such as Botox and Fillers injections and using Mesotherapy cocktails to obtain better results.
Mesotherapy is a medical procedure introduced by Pistor in 1958, which consists of intradermal injection of pharmacologic substances, such as nutrients, hormones, vitamins, enzymes, and other reagents that have been diluted and are administered directly into the region to be treated. The aim of mesotherapy in skin rejuvenation is the maintenance and restoration of the healthy and youthful texture of the skin. Several experimental studies have demonstrated that hyaluronic acid injected into the skin can stimulate fibroblasts to express collagen type 1 (Col-1), matrix metalloprotease-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP). This indicates that these new mesotherapy techniques can improve the clinical appearance of the skin in different age groups, via action on the maintenance and restoration of the healthy and youthful texture of the skin. Even though these improvements are not permanent. Another study on the effect of mesotherapy cocktails versus placebo suggested that mesotherapy with HA may effectively improve skin aging.
thread induces strong anchorage to skin tissue. On molecular analysis, Type 1 collagen and TGF-β1 levels were significantly increased, compared to normal skin. The quantitative analysis of collagen and its downstream signaling molecule TGF-β supports the long-term durability of the thread. Thread lifting for face rejuvenation has significant long-lasting effects that include skin lifting and a high degree of patient satisfaction with less incidence rate of complications. Augmented results are obtained when thread lifting is combined with other lifting and rejuvenation modalities.Such as Botox and Fillers injections and using Mesotherapy cocktails to obtain better results.
Mesotherapy is a medical procedure introduced by Pistor in 1958, which consists of intradermal injection of pharmacologic substances, such as nutrients, hormones, vitamins, enzymes, and other reagents that have been diluted and are administered directly into the region to be treated. The aim of mesotherapy in skin rejuvenation is the maintenance and restoration of the healthy and youthful texture of the skin. Several experimental studies have demonstrated that hyaluronic acid injected into the skin can stimulate fibroblasts to express collagen type 1 (Col-1), matrix metalloprotease-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP).This indicates that these new mesotherapy techniques can improve the clinical appearance of the skin in different age groups, via action on the maintenance and restoration of the healthy and youthful texture of the skin. Even though these improvements are not permanent. Another study on the effect of mesotherapy cocktails versus placebo suggested that mesotherapy with HA may effectively improve skin aging.
In this article, the combined method of simultaneous use of absorbable threads (Korea) along with mesotherapy cocktails of Mesoaroma (Italy) is used for rejuvenation, tightening of the skin and wrinkle removal. The meso-thread-lift method is painless, with no need for surgery and without causing any side effects. This method has been used for 110 patients, from 2014 to 2022, all of whom were selected by filing medical records at the aesthetic clinic of Dr. Shohreh Shams.
“After many years of professional practice, I noticed a need for a new and effective method to remove deep wrinkles and skin rejuvenation for many of my patients who were not interested in using fillers to reduce their aging lines. I found the best results by advancing a technique which combines utilizing P.D.O threads and mesotherapy cocktails.” — Dr. Shohreh Shams —
In this method, three basic principles have been followed: 1)Patient selection: The study is performed on a selection of male and female candidates (3%men, 97% women), aged between 20 to 67 years old with no history of acute/chronic systematic disease, acute inflammation, or infection. The purpose of their visit to Dr. Shams’ Clinic was to achieve rejuvenation and skin lift without using fillers or undergoing extensive skin lift surgeries. 2) Accurate planting of threads.3) Injection at the correct depth.
Using this combined method rejuvenates and improves facial skin along with tightening the skin and filling deep wrinkles or fine facial lines (without the need to fill with other fillers such as gel or fat) and brightening the skin color in the following areas(Figure1): Nasolabial folds (Laughter lines), 49.49%(98 cases) or other lines around or parallel to
it, in the mid-face or lower face, 8.58 %(17 cases), marionette triangle and areas around the chin, 22.22%(44 cases), on the jawline(Mandibular) 19.69%(39 cases) (Table 3).
This method can also be used for sharpening the jawline, tightening this area, and preventing sagging of this part of the skin. The effectiveness of this method reaches its peak overtime three weeks to three months after the procedure. In the process of collagen formation, the brain -being stimulated by biodegradable threads (P.D.O) insertion, sends nutrients along with GnTH and GRH to create a healing cascade in these areas where even more nutrients and vitamins are supplied by using mesotherapy cocktails. When removing the needle, the mentioned material surrounds the threads in each specific area, which leads to the continued effectiveness of this method. So in addition to skin lifting, the patients benefit from better filling in these areas for about a year. The result of this study is a method that shows no side effects, by using which patients experience no pain, and need no recovery time. This method can be used to improve and refine fine and deep facial wrinkles including jawlines, tear troughs, nasolabial folds and grief lines. The method could also be utilized to improve skin sagginess in arms, thighs, and wrinkles on the back of the hands.
In this prospective review chart clinical study, a total of 110 patients who were candidates for meso-thread-lift with an age range of 20-67 years were enrolled in the study from October 2014 to August 2022.
Every candidate was provided with two sets of forms. The first consisted of all patient information and a thorough questionnaire about past medical history and allergies. The second form was a consent letter filled out by every candidate indicating that they have confirmed their consent to do this procedure. All patients had equal welfare status and level of education. All procedures were performed at Dr.Shohreh Shams’ skin and aesthetic clinic located in Tehran, Iran. All candidates had average aging signs and needed a modest degree of lifting that did not resolve by other methods.
2.1.|Materials: The mesotherapy products used in this study are from MESOAROMA Company manufactured in Rome / Italy. Three types of cocktails were mainly used. From 2014 to 2018, the Mesolift cocktail was used on elderly patients (for rejuvenation and lifting of the skin) and showed significant lifting in the selected areas. The Mesohydrovit cocktail was used for younger patients (for anti-spot and brightening effects on the areas). And Antiage cocktail, which was first introduced and perfected in 2018 and had both lifting and brightening effects on the skin was used for all patients.
The P.D.O threads were mainly from Stellar Company. (Seoul, Republic of Korea). Different types of threads were used according to the selected area.
In this method, 4 regions were determined on the face.
Figure 1. The regions of face
1-The Nasolabial folds also known as laughter lines region. 2- Mandibular region. 3- Mid-face region .4- The Marionette triangle region.
For region1 (The Nasolabial folds) and region 2 (Mandibular) P.D.O mono (28G- 60mm) was used and for region 3 (Mid-face) and region 4 (Marionette triangle) P.D.O mono (29G-38mm) was used.
Treatment Protocol: To perform the Meso-Thread-Lift, at first a local anesthetic (i.e. Xyla-P cream=each 100gr contains: Lidocaine 2.5g/procaine 2.5g) is applied on the areas receiving the treatment and is left on the skin and covered with cellophane paper for 45 minutes to one hour for reaching maximum effect. Next, the skin is disinfected by applying 97% ethanol on cotton pads.
To prepare the cocktail, a lower lock syringe is selected and for every 0.3 ccs of mesotherapy cocktail, 0.1cc of lidocaine 2 % solution (injectable) is used to fill the syringe. After making the cocktail, the syringe is left aside for later use. The average usage of this syringe is 1-2 cc in every session of this procedure.
2.2. |Methods: Meanwhile, P.D.O threads are implanted deep into the skin in wrinkled areas. we enter the superficial hypodermis area at a 45° angle from the surface of the skin, and then proceed at an angle of 180° )parallel to the skin) in a wave pattern (going up and down) on the surface of the skin. Now P.D.O threads are planted in the hypodermis and deep dermis areas (at a depth of 1 to 2 mm).
2.2.A|After that, the aforementioned syringe that has been prepared in advance, which is filled with 1 to 2 cc of inj. lidocaine 2% and mesotherapy cocktail solution (according to the required parts), is screwed on the head of the P.D.O thread needle.
After aspiration and making sure that the thread is in the desired area of the skin, for every 3 mm of needle retraction (retrograde), deep intradermal and hypodermal injections of 0.1 to 0.2 cc are performed and the P.D.O needle and syringe are gradually removed. 0.5 cc of the cocktail is injected in random parts of the Nasolabial folds (region1) and the same goes for the mandibular area (region 2). As for the mid-face (region 3) for every 3 mm of needle extraction, 0.2-.0.3 cc of the cocktail is injected. The dose of cocktail for the Marionette triangle (region 4) is 0.2-0.3 cc in every part.
Figure 2. Entry and exit points
1) For the Nasolabial region Meso-Thread-Lift, (part1-Figure2), the blue dots represent the entry or exit sites. The entry site is 1cm away from the corner of the lip, aligned with the laughter line, 0and .5 cm below the starting point of the line. As the arrow illustrates, the thread needle goes upward, at 1-2 mm depth of the skin, entering the dermis and hypodermis region. After that, the syringe containing the cocktail is attached to the needle and while gradually retracting the needle, for every 2-3 mm of it, 0.1cc of the cocktail is inserted. At the same time, the bulging of the wrinkles becomes obvious. (Figure 3)
2) For region 2 or Jawline (Part2, Figure2), the blue dot represents the entry and exit site. Thread needle enters the dermis area just above Mandibular osseous. The direction of the thread needle is as the arrow indicates. The technique is the same as in part 1. (Figure 4a, 4b)-this patient had injection in part 1 and 3 too.
3) Concerning the mid-face region (Part3-Figure 2) the number of threads used depends on the degree of ptosis in the region, the number of wrinkles appearing with the patient’s smile and the length of them. One to three threads are usually required. Like before, the blue dots indicate the entry and exit sites. The direction of needles is, as the arrows show, upward. There should be a 0.5-1cm space between the threads implanted. It is important to note that Needles should Not enter the fatty pads of the cheeks. (Figure 5)
4) For Marionette triangle region (part4, Figure2), 1-2 thread needles (27G-38mm) are used with a 20-40 degree angle between them. The entry and exit sites are marked as blue dots in Figure 2, Part 4. The direction of entering the dermis is shown in the picture. The method of Meso-Therapy cocktail injection is the same in all parts. (Figure 6)
While the cocktail is inserted into the site, some patients might experience slight discomfort with a sting sensation that disappears after the injection is done; note that this is completely normal and is due to the mesotherapy cocktail insertion underneath the skin.
Before inserting the cocktail, Aspiration must be done. Avoid injection if the area has strong blood flow or in case of noticing visible bleeding in the transparent part of the needle tail (In this case, this PDO needle must be extracted completely).
Finally, as soon as the P.D.O needle is ejected, a sterilized gauze (10×10) is put on the area and an ice pack is placed on top of it. By applying mild pressure for 2-3 minutes on the area using the palm, any possible bruising can be prevented. Immediately after the procedure, significant improvement in the skin is detectable, as shown in before and after pictures of patients.
After every Meso-Thread- lift procedure, the results were assessed by Dr.Shohreh Shams and patients based on GAIS (Global Aesthetic Improvement Scale) scores. Patients were followed up the first week, the first month, and six months after the procedure. Outcomes were evaluated by asking patients to rate their overall satisfaction on the following scale: Exceptional improvement, very improved patient, improved patient, unaltered patient and worsened patient. (Table1)
|
Improved patient |
27.27%(30 cases) |
18.18% (20 cases) |
7.27%(8 cases) |
|
Unaltered patient |
0%(0 cases) |
0%(0 cases) |
0%(0 cases) |
|
Worsened patient |
0%(0 cases) |
0%(0 cases) |
0%(0 cases) |
No side effect was reported. A slight bruising in the area was detected in some cases which were recovered in a week and did not require any further treatments.
There were 3 types of MESOAROMA mesotherapy cocktails used for patients; MESOLIFT cocktail, MESOHYDROVIT cocktail, and ANTIAGE cocktail which was first introduced in 2019. The average dose of mesotherapy cocktails used in patients was 1.12±0.36 cc. The minimum dose used was 0.5cc and the maximum dose was 2 cc in one session. The Mesolift Cocktail was mostly used in the procedure due to its lifting and rejuvenating effects.
Due to advanced technology, all patients had access to their doctor via social media, in case they had any discomfort after the procedure. Nevertheless, no call or visit regarding the side effects of the procedure took place. The significant outcome of this study is that there were no side effects in patients and small amounts of pain or occasional bruising were not of much importance to report to their doctor. This outstanding outcome is the result of the practitioner’s proficiency, applying great-quality materials and proper use of the technique.
The principal measures taken for this study include the following:
One of the most important pre-procedure steps for Meso-Thread-Lifting is patient selection.
Thorough knowledge of patients’ past medical history and the reactions of their bodies in previous aesthetic procedures such as inflammation responses and the occurrence of severe ecchymosis is crucial.
The selected candidates should not have any history of infectious diseases acute or chronic and should not have any underlying or special diseases.
All patients’ allergies must be noted and the practitioner must ask about allergies to injection materials such as lidocaine, mesotherapy cocktails and etc.
The procedure is not safe for pregnant and breastfeeding women.
Drugs such as aspirin and vitamin E or supplements should be cut off three days before the procedure so that it does not cause any intervention in the course of their cardiovascular or pre-existing condition.
1) Areas that are swollen or visible bleeding from the end of the thread needle are obvious while entering the dermis area. 2) Areas that underwent subcision by the Thread-Needle or subcutaneous hemorrhage have accrued there. 3) Areas under the eyes are not suggested for the procedure.
All patients must be told not to wash their faces for 24 hours. Any hot or cold compress on the areas should be avoided. None of the patients needs any Antibiotics or analgesics after this procedure.
One of the most important pre-procedure steps for Meso-Thread-Lifting is patient selection.
Thorough knowledge of patients’ past medical history and the reactions of their bodies in previous aesthetic procedures such as inflammation responses and the occurrence of severe ecchymosis is crucial.
The selected candidates should not have any history of infectious diseases acute or chronic and should not have any underlying or special diseases.
All patients’ allergies must be noted and the practitioner must ask about allergies to injection materials such as lidocaine, mesotherapy cocktails and etc.
The procedure is not safe for pregnant and breastfeeding women.
Drugs such as aspirin and vitamin E or supplements should be cut off three days before the procedure so that it does not cause any intervention in the course of their cardiovascular or pre-existing condition.
1) Areas that are swollen or visible bleeding from the end of the thread needle are obvious while entering the dermis area. 2) Areas that underwent subcision by the Thread-Needle or subcutaneous hemorrhage have accrued there. 3) Areas under the eyes are not suggested for the procedure.
All patients must be told not to wash their faces for 24 hours. Any hot or cold compress on the areas should be avoided. None of the patients needs any Antibiotics or analgesics after this procedure.
5.| Outcomes:
This innovative technique which does not require surgery showed no pain or side effects which can be an easy and safe method for aesthetic practitioners and patients. As the results of the study showed the satisfaction rate of the procedure increased over the six-month follow-up, which suggests that this method is ideal for the rejuvenation of the skin.
This technique can be a great way of rejuvenation the skin along with filling and removing wrinkles of the facial skin, filling the laughter’s lines, removing the grief lines, the jawline sharpness and preventing sagging in the face.
All patients were informed that according to their condition the same method can be used again after 6 to 12 months.
For maintaining better and long-lasting effects, along with this method for rejuvenation, having a healthy skincare routine is always advised to patients by doctors.
Figure 3. Meso-Thread-Lift procedure in the Nasolabial folds.
Figure4.a. the procedure was performed on the Nasolabial folds and the Jawlines.
Figure 5. Meso-Thread-Lifting in the Mid-face region
Figure4.b. one year after the Meso-Thread-Lifting improvements in both areas are obvious
Figure 6. Meso-Thread-Lift procedure performed on the Nasolabial folds and the Marrionette triangle
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آدرس:
تهـــــران،میدان فاطمی، میدان گلها، بلوار گلها شماره 22
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همه روزه به جز تعطیلات رسمی
از ساعت 11 صبح الی 6 بعد از ظهر
گواهینامه ها و افتخارات
سوالات متداول
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گالری تصاویر
پاکسازی پوست صورت
آرایش دائم صورت
مشاور استفاده صحیح از محصولات بهداشتی و کرم ها
منشی امور پزشکی
الزامات سلامت و بهداشت و ایمنی در محیط کار
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