A pioneering integrated approach that systematically combines facial rejuvenation techniques using PDO Threads, Microcannulas for filler injection and Platelet-Rich Fibrin injected with a needle, cannula or used with a microneedling pen, has been developed by Kian Karimi, MD, FACS. Dr. Karimi, who practices at Rejuva Medical Aesthetics in Los Angeles, CA, is a double board certified facial plastic/head and neck surgeon and head faculty of the American Institute of Aesthetic Medicine (AIAM) which is the only aesthetic organization currently training and teaching this integrated approach to facial aesthetics. In this interview with Aesthetic Insider™ Dr. Karimi, who has an impressive record of academic and scientific achievement, discusses how this new integrated and systemized aesthetic approach to facial rejuvenation is being rapidly adopted throughout the aesthetic medical community. To learn more about Dr. Karimi and Rejuva Medical Aesthetics, visit www.rejuvamedical.org. To learn more about the American Institute of Aesthetic Medicine, visit www.handsontrainings.com.
What inspired you to develop this integration of PDO Threads, Microcannulas and PRF?
I’m always looking for the cutting edge in aesthetics. Platelet-Rich Plasma or PRP has become a common and known entity in aesthetics and has been incorporated by lot of practices. I also utilized PRP for many years for my procedures. One of the limitations of PRP I found was that it didn’t last when I was injecting it into the soft tissues of the face or the body. Also upon looking at the scientific data on PRP I noticed that other than platelets, there weren’t a lot of other cells in the PRP, it was mostly just plasma. So when I heard about Platelet-Rich Fibrin (PRF), I decided to work on protocols to see how it could be utilized in aesthetics and I have been incredibly impressed.
Is the Fibrin in PRF similar to that found in Fibrin Glue?
Fibrin glues are synthetic, whereas PRF is naturally occurring in the patient’s blood. One of the biggest advantages of Platelet-Rich Fibrin is that you do get all the benefits of PRP, meaning that we can obtain a very high concentration of platelets, including fibrin. We are also able to derive white blood cells which are important as an anti-inflammatory effect and they also contain many growth factors. The most exciting thing about PRF, which we’re not sure of the clinical significance just yet, is that there are a small percentage of mesenchymal stem cells in PRF, that are not in PRP.
How do you administer the PRF?
PRF can be used in many different ways similar to PRP. Specifically when I utilize a PDO Threads and PRF procedure, I will usually perform the PDO thread lift first to lift the tissues, let’s say of the mid-face or in the lower third of the face then I’ll use PRF as an injectable. Usually I will inject it through a blunt microcannula to fill for example, tear troughs or to add volume to the cheeks, to fill lips, and to fill the marionette lines of the face. One of the other things we’ve been doing recently is to combine PRF with commercially available Hyaluronic Acid (HA) fillers for the ultimate smooth fill.
Where do you see the most benefit of this technique?
The area that I’ve been most excited about is treating under eye circles. Under eye circles are treated very effectively with HA fillers, but if one gets too close to the muscle or too close to the skin it can give a very characteristic puffy look and sometimes even appear bluish in color. When using the HA filler and diluting it with PRF we are able to inject a little bit more superficially without these consequences mentioned.
Does this combination of PRF and HA fillers create a more natural look for the patient?
Absolutely, and it is really a great booster when using HA fillers. Many doctors will dilute HA fillers with saline or lidocaine to minimize the chance of it looking blue or being visible through thin, fair skin. With this technique, we can dilute it with the patient’s own fibrin and platelets, and all these wonderful cells that are in the blood. The results really speak for themselves.
How often do you perform this type of combination therapy?
It is unique to combine these, and some practitioners prefer to perform them as standalone techniques. In my practice we have found that combination therapy yields the highest patient satisfaction and the most amazing and natural outcomes. In many instances, I will perform PDO Threads, microcannula injections with fillers or PRF and even micro needling at the same time. It is the ultimate combination office-based rejuvenation procedure that has little to no downtime for the patient and provides maximum results.
What type of anesthesia is used?
If we are only injecting PRF we don’t utilize any type of anesthesia except when injecting to the lips. The lips are very sensitive so we will use a topical numbing cream first. For PRF injection as a standalone through a blunt microcannula we don’t utilize any type of topical or injectable anesthetic (the same is true of most of our filler injections) as our patients find it quite comfortable and tolerable.
How long do the results last?
PRF as a standalone when not mixed with any fillers will remain effective for about six weeks but then it’s broken down by the body. What you do actually see with PRF, which I don’t think you see as much with PRP, is noticeable improvement of the skin tissue. There is more tightness of the skin, which actually has been proven in German studies. Usually when we perform PRF by itself, we will perform a series of treatments spaced 6 weeks apart to get that effect and create a longer lasting treatment overall. To make the immediate effect last longer, we will mix it with the fillers so that they are going to actually have the hyaluronic acid (HA) particles there to hold that fill. Therefore, we have a couple of different protocols where we can use the PRF depending on the patient’s needs and desires.
Are you teaching other doctors this combined PDO Thread, blunt Microcannula, PRF technique?
Yes. Partnering with the American Institute of Aesthetic Medicine (AIAM) www.handsontrainings.com, we recently conducted a live demonstration workshop in Las Vegas. We had an incredible turnout with over 150 doctors to watch and learn the integration of these techniques. We performed the techniques live and had a tremendous response. One of our model patients was actually an aesthetic physician herself. Just yesterday she sent me a glowing text and photograph on how impressed she is with the results of the combination therapies that we performed on her.
How long does it take AIAM to train a physician on this technique?
Technique is always key and more and more doctors are starting to use blunt microcannulas for fillers and the DermaSculpt Microcannula is the most widely used cannula in the United States. We estimate that approximately 25% of doctors are using these in their practices, whereas several years ago it was only about 5%. I consider this the most advanced and safe way to inject fillers, so any doctor or injector utilizing fillers can use PRF. The training takes about one day. The only nuance with PRF is that there is no additive. In other words, there is no anticoagulant in the tube, so there is a time limit to how soon it must be injected before it will form a gel. The gel can be used if the procedure requires a volumizing effect, but there is a little bit of a time limitation with PRF so learning proper technique and application is important. In terms of the NovaThreads PDO Threads there definitely is a learning curve to successfully utilize these products. After a physician or injector has successfully completed one of the AIAM courses or other thread course, it generally takes an additional 10 patient learning curve to become comfortable with the use of threads. So, once the injector is comfortable in each of these different procedures, they can then be safely integrated with each other to provide a combination therapy.
What is the American Institute of Aesthetic Medicine (AIAM)?
AIAM is a national training organization. They have trainings setup in many major cities. I train in Los Angeles, CA and Miami, FL, where I am also licensed. AIAM also has top trainers in other cities as well. AIAM was initially training on PDO Threads and the microcannula injections, but are now offering a more integrated and advanced course to teach combination techniques using all the things that we’ve talked about (PDO Threads, Microcannula filler injections and Platelet-Rich Fibrin (PRF).
What is your position with AIAM?
I’m the head faculty physician trainer and I initially trained all the other trainers. I also complete the review process for other potential trainers to assure that they have the standards and skills to ensure successful future trainings across the country.
Given your busy private practice, do you enjoy the trainings?
I actually do. It is a wonderful opportunity and most of us that are involved with education realize what a humbling field this is. I consider myself a lifelong student and at every single one of my trainings I always learn from one or more of the participants there. So being part of AIAM and other trainings actually enriches my own knowledge and gives me a spirit of collegiality and sharing of the latest techniques in the aesthetic industry, ultimate benefiting all of our patients.
How often are the AIAM training classes held?
The AIAM classes that I teach are held every month in Los Angeles and also every month in Miami. Other faculty trainers are teaching every 4 – 6 weeks in most major cities. The demand for trainings has steadily increased and so AIAM is implementing more training in more cities to meet the demand. I believe the trainings are in over 15 different cities now. Also, after a physician or an injector performs the training they will then have access to all of AIAM’s webinars. Plus we hold new webinars every one to two months where we go over the latest techniques, trends and uses of all these integrated techniques.
There are several PDO threads companies. Do you have a preference, if so why?
When I first started in this arena I was really impressed with CosmoFrance’s history. They are a 20-year old company and they’ve always been on the cutting edge of devices and so our visions really aligned and that’s how we began working together. I have also been very impressed with their adherence to strict quality control, to looking at data and evidence when reporting or when promoting any device and I have found that they continue to help me deliver state-of-the-art minimally invasive procedures to my patients. CosmoFrance were the first company to introduce the blunt microcannula (Dermasculpt) into the United States, and it’s impressive that they also partnered with NovaThreads to bring the first PDO threads to the United States. So my excitement and enthusiasm for them and their products really stems from all of that. I believe in them wholeheartedly.
To learn more about Dr. Kian Karimi, visit www.rejuvamedical.org.
To learn more about AIAM trainings, visit www.handsontrainings.com.
To listen to Dr. Kian Karimi’s interview of Aesthetic Insider Radio, CLICK HERE!