Although advances in injectable fillers, neuromodulators, radiofrequency, microneedling, ultrasound, and heat technologies have been effective for treating different aesthetic indications, many physicians will agree that there continues to be an unmet need in minimally invasive aesthetics for an actual “lift” of the skin and soft tissues in different areas, particularly the face. In this exclusive interview with double-board certified Facial Plastic Surgeon Kian Karimi, MD, FACS, of Rejuva Medical Aesthetics in Los Angeles, CA, he explains how he feels that NovaThreads® are the answer to this unmet need and represent an exciting new tool that with training an aesthetic practitioner can immediately incorporate into their practice.
NovaThreads® are an exciting new addition to aesthetics. Why do you think they meet an unmet need among aesthetic physicians?
NovaThreads® are a very exciting and new addition to the aesthetic tool box. They meet an unmet need in aesthetics in that they actually lift the soft tissues of the face and neck with a basic, in-office procedure with little to no downtime and with excellent results. NovaThreads® themselves are dissolvable threads that are placed under the skin in different areas to achieve lifting of the cheeks, the jowls and the neck bands. The procedure is performed effortlessly in the office and is quite comfortable for patients. It achieves instant result that last anywhere from 9 to 12 months, sometimes even 15 months, depending on how many threads are placed at the session and the level of skin laxity or excess that the patient has.
The thread technique is a non-surgical procedure. As a double-board certified surgeon how do threads actually fit in with your surgical practice?
This procedure does not replace a facelift, that’s why the initial patient consultation is so important to asses who is a good candidate for this procedure, and who is not. In terms of the technique itself, this is an injectable just like fillers or neuro-modulators, so the skill level required to perform these procedures is on the same level. In fact these threads are placed at a more superficial level in the skin than injectable fillers are, and so that actually gives them a very nice safety margin for both the doctor and the patient. Offering this technique does not take away from the surgical side of my practice in any way. In fact, I use the threads as an addition to many other surgical and non-surgical techniques and on a demographic of patient that I previously may not have been able to offer such a solution.
What exactly are NovaThreads® and how do they work?
It is a subcutaneous and knotless technique that uses a polydioxanone (PDO) material for office-based skin tightening and neocollagenesis (NU-MESH technique) and for lifting of the soft tissues of the skin and body (NU-LIFT technique). They have been popular in many Asian and European countries for some time and can now be utilized in the United States. NovaThreads form a V-shape and are deployed in a hypodermic needle ranging from 18 gauge to 31 gauge and can be smooth, have a twist, or have uni- or bi-directional “barbs,” reminiscent of other barbed sutures. The threads are inserted in the superficial subcutaneous plane and when the needle is withdrawn, the thread remains under the skin. For the smooth and twist fibers, there is no “catching” of the dermis but simply placement of a dissolvable suture material that then undergoes breakdown over a period of 4-6 months, depending on the thickness of the thread and the relative metabolism of the patient’s skin. The smooth fibers are typically placed in a crosshatching pattern to create a “mesh” of threads which will result in improvement of the skin quality and texture over time. This procedure is generally repeated after 4-6 weeks for improved results and to sustain results achieved from previous treatments. The twist fibers are generally placed in areas that would benefit from a slight amount of volume such as medial to the nasolabial folds, the marionette lines, or in the vermilion borders of the upper and lower lips.
What are the best uses for NovaThreads®?
The most effective results I have seen are in the mid-and lower-face. Lifting the cheeks up with placement of the threads and in the lower third of the face is a really exciting area for the placement of NovaThreads® as traditionally this has been a difficult area to address with just injectable fillers. For example the small folds in the corner of the mouth and the jowl are areas where the NovaThreads do an excellent lifting and re-draping of the tissues resulting in a smoother jaw line and addressing those real tricky corners in the fold of the mouth. The other areas where NovaThreads® are effective, which I have not found anything else to be effective for these areas, are for little extra skin bands under the neck. We have tried everything outside of surgery to help patients with obvious neck bands from Radio Frequency and other heat treatments to injectables but the bands were just too stubborn and would not lift. NovaThreads® now address that problem.
Is there any one area of the face that you feel NovaTreads® excel? And who is your typical patient?
The jawline has always been a difficult area to treat without surgery. Recently there have been advancements in reducing fat under the chin that can make the jawline look better and more attractive, but as a stand-alone treatment even that is not effective in some patients with sagging skin that needs to be lifted. Until NovaThreads® there has not been any treatment I know of beyond surgery that can actually address the excess skin and bands in the neck.
Our typical patient is generally going to be in their 40s or 50s. That being said here in Los Angeles and many other areas some of the patients have had surgery in the past and so their facial profile and configuration can be of someone 10 years younger than their real age. So I do have patients even in their 60s and beyond that are still appropriate candidates for this procedure.
What is the patient downtime and how long do the NovaThreads® last?
Well, of course, it all depends on the patient and their particular problem. Generally there is little to no downtime with this procedure. As mentioned earlier, the NovaThread® technique is an injectable superficial skin lifting treatment. There is little discomfort and the patient can continue their daily routine after undergoing a treatment. Some patients require a second treatment, depending upon the extent of excessive tissue and status of neck bands. Some patients can get a longer lasting result of up to 12 months with the average longevity of this procedure being between 8 and 10 months.
There were “threads” on the market over a decade ago which were touted as the “thread lift”. These threads were problematic in that they were permanent threads and were being misused as in many cases the patient actually needed a surgical lift. The old threads were being used on patients that were not the ideal candidates for a thread procedure as the extent of skin sagging was too great. For an office based type of procedure the old threads were being used to push the envelope per say in someone who wasn’t necessarily an appropriate candidate. Also, due to the permanency of the older threads there were issues with irregularity, extrusion and infection. These threads actually fell out of favour among aesthetic surgeons in mid-2000. NovaThreads® are completely dissolvable so they are dissolved from the skin and body entirely at 6 months. The way that they provide a result that lasts longer than 6 months is that the body actually forms bands of collagen which allow for the results to stay.
NovaThreads® are new to the US. How long have they been around in other countries?
This technique has been used in Europe and in Asia for many years now with great success, and we finally have access to it here in this country.
Is there specialized training for surgeons here in the USA. If so, how can a surgeon get trained?
We have formed a training academy, the American Institute of Aesthetic Medicine, to meet the training demands for the United States. It is very important for physicians and patients to understand that a medical doctor actually cannot even purchase these threads without being appropriately trained first. This is another big difference from the previous threads that were mentioned earlier that were available over 10 years ago. Back then those threads were available for anyone that wanted to purchase them regardless of any type of training or technical experience. NovaThreads® are combining a new dissolvable thread that is safe and easy to perform in the office, with correct training by the injector thereby developing a really exciting national experience that is favourable and with effective and long-lasting results for the patient.
What’s next for NovaThreads®?
NovaThreads® has actually started a training academy that was created to assure that physicians and nurse injectors are appropriately trained on these procedures. It involves a one hour didactic lecture followed by a one hour hands on session with a live model. This way we are certain that proper techniques and procedures are being performed to maximize the results with the threads, and to minimize the complications which are quite manageable. This training academy is also aware and in compliance with state laws that can vary state by state. For example in California a nurse can perform injectable fillers only under the supervision of an MD. In terms of who are appropriate injectors for this it is preferable that there has been a good experience with other regular injectables such as fillers and neuro-modulators, etc. This really allows for the injector to minimise the learning curve and be able to produce maximum results. I have been training for over 4 years now on advanced injectable techniques and it’s really fun to see previous attendees at the NovaThreads® courses coming and really learning together. We all learn from each other in this industry and that’s why it’s so important for all of us to attend meetings, attend conferences and collaborate with each other so that we can maximise the experience for our patients everywhere.
For more information on NovaThreads® visit www.novathreads.com. To get trained on PDO threads (Nu-Mesh & Nu-Lift) go to www.pdotrainings.com. To learn more about Dr. Kian Karimi visit www.rejuvamedical.org.
To listen to Dr. Kian Karimi’s radio interview on BlogTalkRadio and iTunes discussing NovaThreads® CLICK HERE!
To watch Dr. Kian Karimi demonstrate NovaThreads on a patient on CBS The Doctors TV Show CLICK HERE!