Reducing thread-lift complaints

Dr Mahsa Saleki discusses the reported increase in thread lift complaints and what can be done to reduce complications going forward

After undergoing rigorous training in thread-lifting techniques in 2017, I was taught by a plastic surgery-led team. At that time, although thread lifts were established as a technology, they were not widely available and few patients were aware of them. Since the turn of this decade, there has been a shift towards more natural lifting and tightening results, which thread lifts offer very well. At SASAesthetics, I aimed to create a pioneering clinic and have performed over4,500 procedures and implanted upward of 50,000 threads.

I often hear that practitioners fear threads as there isn’t enough training and visibility around them in the industry. I also regularly discuss this with peers who tend to downplay their use, perhaps because it is a technique that many don’t have the time, inclination, or dexterity to learn.

Save Face, the national register for accredited aesthetic practitioners has just reported a 30% increase in thread lift complaints from the previous year. The findings compelled me to support education efforts around threads to increase consumer confidence and their overall safety profile and help with legislation to empower both practitioner and end patient.

As one of the first surgeons and cosmetics doctors to focus my practice on predominantly offering thread treatments in the UK, I feel passionate about putting my 10 years of knowledge and experience to good use. Anything that supports the education, health and safety of consumers is a worthy cause, so I am keen to dedicate my time to this.

STOMP OUT BAD PRACTICE

With the steadily increasing popularity of thread-based treatments, it is time to give threads the same care, attention, and airtime as other clinic- based procedures, such as injectables. In the right hands, threads can be highly effective for medium to long-term lifting, contouring and anti-ageing, but sadly, more and more, I am being consulted by both patients and practitioners to correct all manner of issues caused by a lack of understanding, experience and training. We need to stomp out bad practice fast.

The premise of thread lifts may appear simple, but the technicality behind them is complex, requiring practitioners to have a comprehensive knowledge of facial anatomy, contraindications, and possible complications. Inadequate training, inaccurate placement or incorrect thread selection can all lead to risks associated with poor practice, such as discomfort, pain, bruising, swelling, tenderness, blood vessel or salivary gland injury, hematoma, nerve damage, infection, facial asymmetry, protrusion, extrusion or migration of threads, dimpling or irregularities and thread migration.

When threads are done well by a highly-trained and regulated practitioner, thread lifts offer an effective solution, to rejuvenate, lift and tighten the skin and add structure to areas such as the neck, jawline, mid-face and cheeks, as well as around the eye area, in a procedure that bridges the gap between non-invasive ‘tweakments’ and cosmetic surgery.

EDUCATION AND TRAINING

By law in England, healthcare professionals such as doctors, nurses and dentists must be registered with the Care Quality Commission (CQC) to carry out thread lift treatments as they’re considered surgical interventions. However, this does not apply to non-medics, who can perform thread lifts unregulated. This has enabled the rise of inadequate training courses that often claim practitioners will be able to start practising immediately after just one day of training, orin some cases, merely an online tutorial. The lack of understanding of facial anatomy, in-depth treatment technique and the management of complications thus lead to a compromised quality of care for patients and substandard treatment outcomes.

In particular, there are growing concerns about complaints linked to inadequately trained practitioners, specifically, those attempting to imitate results, while also undercutting costs, overlooking stringent safety protocols and covertly captivating patients into a false sense of security that can lead to serious complications.

Since 2020, I have trained a group of peers carefully selected to ensure they can offer safe and effective treatments based on their medical and surgical background in specialist threads techniques, safety, and the proper protocols. However, I only opt to train healthcare professionals who have some surgical training, because their tissue handling is a lot more refined, and their complication rates will be lower.

NOT ALL THREADS ARE CREATED EQUAL

When I trained back in 2017, I was excited to explore threads as a real alternative to a surgical facelift but found them lacking in lifting capacity and the techniques were lacking in consistency. In 2020, I started to work with manufacturers to develop a unique cog which enables a much greater lift initially, which, once the patient has healed, will give much more substantial results compared to previous designs. The safety margins were much better compared to the double-loop threads that were previously thought to have the best lifting effect. This has resulted in a huge shift in the market thanks to the demonstrable lifts you will have seen on social media.

The elephant in the room is fox eyes. I love the procedure and I’ve had the treatment myself a couple of times. If nothing else, it is an outright statement of the capability of non-surgical procedures. Although it started as a trend, it has led to some legitimate alternatives for a lot of patients looking fora preventative approach for droopy eyelids and brow ageing to create a more youthful brow shape and eye shadow “show”.

PDO threads are one ofthree types of sutures commonly used in thread lift procedures. The othertwo types are made from polylactic acid (PLLA) and polycaprolactone (PCLA). PDO threads, which have been around the longest and have been used in surgeries since the 1980s, break down in yourbody afterabout six months. The presence ofthese threads in the skin triggers cells in the body called fibroblasts to produce more collagen.

PLLA and PCLA threads are newer than PDO. They last longer in your body and tend to stimulate more collagen production. PLLA threads take about 18 months to be absorbed and PCLA take about 24 months.

Each type of thread is best suited for a particular function. PDO threads are a better option for patients wanting to try a treatment whereas PLLA and PCLA threads are better for patients wanting longer lasting results.

The thing that sets threads apart is the cog style. Some threads have no cogs at all and are designed to create slight volume and stimulate collagen production. Some are ideal for scar treatment as they’re mounted on a needle which acts as a subcision of scar tissue. Lifting threads must have cogs to enable the skin to be engaged and lifted.

I don’t believe in bad trends in aesthetics. However, there are bad products that come on the market. The good thing is that most treatments are reversible. Loop threads were hands down the worst trend, with very high complication rates and undesirable results. When I speak about trends, I’m always cautious not to come across as judgemental of how my patient wants to look. In my practice, everyone has a body dysmorphia disorder (BDD) questionnaire in line with our unique protocol that they fill out and, if they have any cause for concern, I don’t treat them and encourage them to self refer to a tertiary service.

The digital landscape of social media is undeniably integrated into our every day, and as we find ourselves adapting and navigating our way through it, soaking up the trend-driven images, adverts and newest industry techniques, our time spent online is often considered a catalyst for the growing popularity of aesthetic treatments, not least when the transformative before and afters of revolutionary thread lift procedures flaunt scroll-stopping results.

In aesthetics, there is always a clear sequence of events when a newly perceived treatment comes to light. There’s a period of scrutiny which threads have certainly undergone. It’s now time to have a more evidence-driven discussion. Patients want an alternative to surgery, and that much is certain. The onus is on us as their medical caregivers to utilise our knowledge and skills to advance our abilities to meet their needs.

MOVING THE INDUSTRY FORWARD

I would like to work together with theJoint Council for Cosmetic Practitioners (JCCP) to help introduce and implement protocols for the Medicines and Healthcare Products RegulatoryAgency(MHRA) on the subject of thread distribution, whereby all those ordering threads provide theirCQC registration number. This would ensure that the supplier confirms the recipient clinics and practitioners are CQC-registered. All thread treatments need to be done using a sterile technique in an appropriate environment as they are regarded as a surgical procedure.

Disturbingly, there is no law in place for non-medics to be banned from using threads, much like filler, which has become such a commercialised treatment that the MHRA won’t enforce proactive measures to keep it in safe hands.Therefore, before threads become as commercialised as filler, we need to enforce licensing laws, to ensure consumer safety under medical supervision.

JCCP STATEMENT

“Threads are a surgical procedure requiring proportionate standards of competence, patient care and premises suitability,” says JCCP trusteeAndrew Rankin. “TheJCCP are concerned that current legislation permits an inconsistent approach to public safety, with certain groups of practitioners currently not required to register with the CQC to meet these, or any other standards. This is clearly a hazard to public safety.

“The JCCP firmly believes that all products used for cosmetic procedures, including medicines and medical devices such as threads, should only be procured from and supplied to appropriate organisations. The JCCP will continue to work towards achieving these goals as part of a framework of licensing.”

DR MAHSA SALEKI

Since graduating in 2012 and completing surgical training between 2014-2020, Dr Mahsa Saleki specialised in general surgery and was a cardiothoracic surgeon (CTS) registrar for six years. She trained in plastics and CTS at London’s St. Bartholomews’ and Newcastle’s Royal Victoria Infirmary. After undergoing rigorous training in thread-lifting techniques in 2017, she was taught by a plastic surgery-led team. sas-aesthetics.co.uk 7 Harley St, London, W1G 9QD