BEWARE - MESOTHREADS! Invitation to discussion

Interest increased in a new minimally invasive technique for rejuvenating the face, neck and decollete by implanting smooth resorbable threads based on polydiaxone (PDO) – threadlifting with “mesothreads”. estet-portal.com decided to cover this topic in more detail. The material was written on the recommendations Evgeny Shagov, chief physician of the Anti Age Clinic.

It is announced that the “mesonite” allows you to achieve two results – lifting (tightening the skin of the face, correction of facial features) and improving the structure of the skin due to the revitalizing and reinforcing effects:

• there is a significant difference between the term threadlifting in its classical sense (threads with micro-notches or cones are used for this purpose - Aptos, Silhouette Lift) and “mesothreads”, which have a smooth surface; it is generally recognized that smooth threads cannot give a lifting effect as such, and in this matter they are inferior to threads with notches or cones;
• threadlifting with Aptos threads I learned from the author of – George Sulamanidze in his own clinic (Total Charm, Tbilisi), later on – we practiced this technique together for a year; the impression of this technique is the following – a pronounced and rather long period of rehabilitation (as for a cosmetic procedure), a relatively short duration of the lifting effect; and this is for threads that have a significantly greater potential for lifting than smooth “mesothreads”;
• in own practice since 2012 threadlifting technique with Aptos threads occupies a small share, which is primarily due to the emergence of a decent, high-quality alternative – new technology of non-invasive tissue tightening - ultrasonic SMAS-lifting, which allows to achieve high-quality clinical results without a rehabilitation period with a stable clinical result;
• as for the second aspect of “mesothreads” – improving the structure of the skin, it raises the question of the expediency of achieving the effect of reinforcing the face for 3-4 months (the period of resorption of threads) with such trauma and potential risks; With regard to the revitalizing effect due to the introduction of a synthetic inert material into the thickness of the skin, I, as a dermatologist, have a question – due to what? And what in this matter “didn't please” traditional, time-tested preparations of hyaluronic acid, mesotherapy, palsmolifting…?

Today, there is a stable information field:

• on the one hand: there are wary or negative reviews about the mesothreads of Russian and European colleagues; I personally have a flow of patients with complications after mesothreads at the reception;
• on the other hand: there is active promotion from mesothread manufacturing companies and trainers engaged by them, and at the same time, there is a lack of adequate explanations about complications from the same trainers;

The subject for discussion (exchange of opinions) is the effectiveness and safety of mesothreads for patients. Their cost-effectiveness for doctors does not raise questions.

Efficacy and safety of mesothreads for patients

Terminology issues:

2013 was marked by a literally explosion of interest in a new minimally invasive technique for rejuvenating the face, neck and décolleté using the implantation of smooth resorbable threads based on polydiaxone (PDO) – threadlifting with mesothreads. This technique was developed and started to be used in South Korea two years ago, and quickly spread to the countries of Southeast Asia (China, Malaysia, Singapore, Vietnam, Japan, Philippines). She is currently gaining her popularity in Russia and Ukraine.

There is still no established name for the threads themselves, nor for the method based on their application. Most often, such threads are called “mesothreads” (although such a name seems to be incorrect in essence), but there are other terms: "microthreads", "3D threads". The technique itself is often called “threadlifting”. (A.A. Sharova, Ph.D., Associate Professor of the Department of Plastic and Reconstructive Surgery, Cosmetology and Cell Technologies, Russian National Research Medical University named after N.I. Pirogov, Moscow).

On the one hand, everything is correct – literal translation from English of the phrase “thread lifting” means “thread lifting”. However, the term “threadlifting” not new (10.5 million links in the Google search engine) and according to prevailing ideas means a minimally invasive facelift operation using special threads with micro-notches / cones / teeth. In Ukraine, these methods are represented by the world's leading brands – Aptos Silhouette Lift. This technique is well known and recognized worldwide (1-3). It was approved by the US FDA in 2005 (4).

It is worth emphasizing once again that “thread lifting” using certified and globally recognized brands such as Aptos, the Silhouette Lift is fundamentally different from the "mesothreads/3D threads" that this publication is actually talking about (6).

Briefly about the technique of mesothreads

The system for setting the thread is a hollow flexible steel needle, in the lumen of which a piece of smooth thread based on PDO is freely placed. Part of the thread is outside the needle and is fixed with a foam ball or piece of foam rubber. Needles can have different caliber, their length – 25-120mm. An important condition for an adequate procedure is the correct level of implantation of the thread. If the needle is not inserted at an adequate level, there is no way to remove it along with the thread.

The thread inserted into the needle is a monofilament structure, made of polydiaxone – The material, which has long been used in surgery for stitching tissues, biodegrades in tissues within 4-6 months. After application anesthesia, the needle is subcutaneously passed to its full length along the intended trajectory. Then the needle is removed and the thread remains in the tissues.

When comparing the properties of five types of materials used for skin stitching, it was PDO that was characterized by the least manifestations of irritating action. A group of researchers analyzed the results of wound healing after the application of more than 1500 intradermal sutures using PDO threads (5).

Clinically, after the initial lifting is achieved, there is a slow increase in the effect and improvement in the quality of the skin over the next approximately 4 months.

Depending on the area of ​​injection and the number of threads inserted, the rehabilitation period takes about a week. The most common adverse events observed after the introduction of PDO threads are hemorrhages, soreness and swelling of the implantation zone. After the procedure, the patient may experience some discomfort during active movements in the places where PDO threads are installed (6).

Complications after thread insertion procedure

Comments by leading experts in aesthetic medicine in Russia

The method of threadlifting with smooth PDO threads has appeared quite recently, we are just starting to accumulate our own clinical experience, develop scientifically and clinically substantiated approaches to placing threads. The technique still requires a detailed study, clinical and experimental studies, as well as an analysis of possible long-term effects, both positive and negative. Only a calm, reasonable attitude to the method, without prejudice, but without unnecessary euphoria, will determine its place in the arsenal of therapeutic cosmetology. (A.A. Sharova, Candidate of Medical Sciences, Associate Professor of the Department of Plastic and Reconstructive Surgery, Cosmetology and Cellular Technologies, Russian National Research Medical University named after N.I. Pirogov, Moscow, 2013).

I have little experience with niitei yet. Limited to 3 months. I did not observe any adverse events in my patients, with the exception of swelling and soreness during the first week after the procedure. However, patients came for a consultation both with complications of an infectious and inflammatory nature, and those associated with the migration of the thread to the skin surface. The euphoria associated with the use of “mesothreads”, of course, will soon pass, and it will be replaced by balanced recommendations and proven methods of setting threads. (E.I. Karpova, Ph.D., plastic surgeon, “Danischuk Clinic”, Moscow, 2013).

My experience with threads does not exceed a year, and observations of patients indicate that the cosmetic effect lasts for 2.5-11 months. To achieve a long-term effect, we perform an additional procedure 1-3 months after the first one.

The most important moment in the prevention of infectious complications – thorough make-up removal of the face; double treatment of the skin, including the hairline, with an antiseptic solution; isolation of hair and neck with fixed sterile wipes; after the implantation of the threads, the skin is carefully treated with an antiseptic; before the procedure, quartzization is carried out in the office.

Typical adverse events after – local hemorrhages and edema. At the stage of mastering the technique, one of my patients developed an extensive hematoma in the temporal region, which “slipped” on the cheekbone The patient complained of pain during articulation and chewing. Another patient developed severe edema that persisted for more than a week.

As for other undesirable phenomena, only two cases have been noted in my practice: displacement and thread eruption 3 days after the procedure. “Erupted” we deleted the thread, displaced by – could not be removed, we are monitoring the patient. A patient of one of my colleagues had an infectious complication – abscess of the soft tissues of the cheek. The abscess was surgically treated against the background of antibiotic therapy, anti-inflammatory and desensitizing therapy. Also, once I consulted a patient with the visualization of the threads under the skin when they were implanted too superficially (shone through with blue stripes). The threads have been removed.
In my experience, the most common – this is the absence of the result of mesothreads!

Summarizing, I would like to say that the method and materials are promising, but need further study. Of course, we want the promises that companies give us and that we broadcast to patients to come true. (M.A. Shirshakova, Ph.D., dermatovenereologist, assistant of the Department of General Medicine of the Russian Medical Academy of Postgraduate Education, scientific consultant of the REC “Expert”, Moscow, 2013).

Indeed, when implanting threads such as Aptos or Silhouette Lift, they are fixed to the skin or fascia. And due to the tension due to the presence of micro-notches or micro-cones, a pronounced lifting effect develops – moving the array of soft tissues upward, against the vector of gravitational ptosis. When using smooth threads, direct tissue displacement is not possible.

Today, the implantation of PDS threads is a “fashionable sentence”. In the future, I expect a significant increase in the number of these procedures. This is due to the availability of the technique for cosmetologists. The clinical experience accumulated over time will allow us to improve the methodology and clearly formulate indications and contraindications for mesothreads. It is possible to discuss the real possibilities of the procedure, its advantages and disadvantages only in the future. (M.I. Barannik, Ph.D., plastic surgeon, associate professor of the Department of Plastic Surgery of the FPCVR RUDN University, head of the clinic “Diamand”, Moscow, 2013).

Advantages and disadvantages of using mesothreads

Important read!

As a practicing doctor, I want to draw attention to a number of facts and share my own opinion about the “revolutionary technique” - mesothreads:

• the technique was developed and started its application in South Korea two years ago (6);
• leading experts in the field of aesthetic medicine in Russia have less than a year of experience in applying this technique (see paragraph 3 “Comments by leading experts in aesthetic medicine in Russia”);
• in Ukraine, the widespread use of the methodology began even later than in Russia …; therefore, there is no question of having significant practical experience and, as a result, understanding the effectiveness (feasibility) of the methodology, the risks of developing immediate and long-term consequences (imho);
• at the time of this writing “mesothreads” are not widely used both in Western Europe and in the USA; for ALL cosmetic products, equipment and methods, medical products;
• every doctor in his practice is constantly faced with certain weights “result // safety”, making a decision on the appropriateness of a particular treatment method, a particular procedure; what do we have in “mesothreads”:

- security:

• in the vast majority of patients, the rehabilitation period takes about a week; the most common adverse events observed after the introduction of PDO threads are hemorrhage, soreness and swelling of the implantation zone;
• only for the last 6 months of 2013. we observed more than 20 patients who underwent the procedure for setting “mesothreads” in certain institutions of Donetsk and the region with more serious complications: purulent inflammation along the threads (violation of the rules of asepsis and antisepsis during the procedure), aseptic inflammation that developed several weeks after the threads were placed (probably, we are talking about an allergic reaction of the body to the injected suture material) – the most complex complication, which is extremely difficult to correct even by surgery, is contouring // protrusion of the ends of the threads under the skin (violation of the method of setting the threads, or the nuances of the technique itself); and these are only those slacks when a doctor,

- efficiency: the manufacturing companies announce two effects achieved when setting “mesothreads” – lifting (lifting the skin of the face and improving facial features) and improving the quality characteristics of the skin (6).

in modern aesthetic medicine, there are at least two directions aimed at achieving a lifting effect (threads with protrusions or cones are more effective in this respect - Aptos or Silhouette Lift // hardware technologies operating at different levels – CO2 lasers, radio wave lifting, ultrasonic SMAS-lifting), which have a more pronounced effect and, importantly, – understandable, high safety profile, confirmed by both European certificates and the US FDA;
improvement of the qualitative characteristics of the skin: for the purpose of “reinforcing” for a long time, such technologies as intra and subcutaneous injections of stabilized hyaluronic acid, calcium hydroxyapatite preparations have been successfully used for a long time to moisturize and improve the processes in the dermis – injections of unstabilized hyaluronic acid (biorevitalization) and mesotherapy // to improve microcirculation, the functioning of fibroblasts and the quality of skin metabolic processes – injections of PRP (Platelet Rich Plasma – Plasmalifting)… and this is not counting the whole arsenal of various methods of hardware cosmetology. Isn't that enough?! The main thing is that each of them has an achievable result understandable to the doctor, a confirmed safety profile.

what makes the doctor opt for “meso-threads” with this “losing balance: efficiency/safety”?

on one side – this is a desire for a new, more perfect, effective one (but it’s worth being objective and differentiating the promises of manufacturers from the results of clinical trials, documented evidence of effectiveness and safety by quality committees in Europe and the USA);
with another – I will only express my assumption - the cost of one thread is 20-60 UAH. (depending on the manufacturer), 30-40 threads are usually used for face treatment, the average price of a procedure in Donbass is 7.500 UAH. I think the economy is interesting.

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