While facial aging might be a part of life, keeping and maintaining a youthful, natural appearance is becoming more accessible with the introduction of HDPDO Threads, a new non-invasive approach to turning back the clock. Dr. Martin Kassir, a board-certified Dermatologist who practices at Kassir Dermatology in Dallas, Texas, explains to Aesthetic Insider™ the importance of this new approach to facial aesthetics and why Threadlifts have become so popular among patients from many different age groups and ethnicities. To learn more about Dr. Kassir, visit www.kassirdermatology.com. To learn more about HDpdo Threads, visit www.HDpdo.com.
Dr. Kassir, please explain to our readers your approach to cosmetic dermatology.
I’m a board-certified dermatologist and have been in practice in Dallas and New York for the past 20 years. I have concentrated on non-invasive aesthetic procedures, with a specialized expertise in lasers, energy-based devices, injectables, needling techniques such as PDO threads and ethnic skin treatments. I also teach internationally and have been an instructor and lecturer in lasers and aesthetics in over 40 countries. This has given me the privilege of seeing how doctors (dermatologists and plastic surgeons) perform procedures in other countries and as I have a very diverse patient population it has helped me treat patients with all skin types and age groups which has been very helpful in both Texas and New York. My approach is unique in that I treat each patient individually and I can customize aesthetic treatments that address their specific needs, skin type and age.
How did you first become interested in offering HDPDO Threads to your patients?
It is very interesting because the Threadlift technique is very non-conventional, however, aesthetics procedures are evolving at a very fast pace and the non-invasive procedures doctors are able to offer are continuing to grow and expand rapidly. My initial foray into aesthetics was with lasers and, in my mind, threads relate to lasers because they are both scientific and they involve a lot of physics, i.e. lasers with light and how it interacts with skin tissue, and threads based on the technology on the threads itself. Threads come in a variety of smooth and barbed forms that work at various levels within the tissue, so the thickness of the threads, the thickness of the barbs, if they have barbs on them or not, the length of the barbs, the angle of the barbs, the distance between the barbs, all act differently within the tissue. Previous thread technology on the market had not impressed me and I was waiting for the ideal threads to become available and the HDpdo Threads are very close to what I envisioned as the ideal type of thread. So, once this came on the market, I was very enthusiastic about using it from a clinical standpoint and was able to rapidly move forward with offering this technique in my practice.
What are PDO Threads?
PDO stands for Polydioxanone. PDO Threads are basically made from suture material that has been used in medicine for 30 to 35 years especially in the cardiac and pediatric surgery fields. The suture material has since evolved into becoming usable in the aesthetic field. As mentioned earlier, some of the other threads that have been used previously weren’t ideal because they would break easily, couldn’t hold tissue effectively, and some of them dissolved too fast. The newer PDO Threads now do two things. The barbed threads can move tissues slightly and elevate it, and the smooth threads have shown to induce a collagen reaction that helps develop new collagen. Therefore, the PDO Threads can both improve the quality of the skin which is very important, and they reposition the skin giving the patient a smoother, tighter appearance.
What areas of the face benefit the most from the PDO Thread technique?
PDO Threads can be used on many parts of the body, but what I have concentrated on mostly is in facial contouring. We can do cheek enhancement, lift the jaw line and the brow area and in some patients improve the periorbital area of the face. The periorbital area can be a challenge with traditional fillers and injectables especially on a patient with deeper lines and wrinkles. With the PDO Threads in this area, we can lift the tissue and improve the skin quality by building up collagen. Overall, we can improve crow’s feet, forehead lines, sagging cheeks, upper lip volumization and skin laxity; also, these principles can be applied to other parts of the body.
With PDO Threads do you see a difference between ethnic skin and non-ethnic skin in terms of lifting?
When we use lasers or perform light-based procedures ethnic skin is more easily burned or can become damaged more easily because light gets absorbed in higher quantities in ethnic skin types. With threads, because there’s no light involved it is sort of color blind, thereby the effect is the same in ethnic and non-ethnic skin types. What I can tell you specifically about threads and ethnic skin is that ethnic skinned people tend to not develop as many wrinkles at as early an age as let’s say Europeans or lighter skinned people. So, typically, ethnic skinned people might present a little later and with less damage to be repaired so we can do more with less in ethnic skin.
Who is the ideal patient for a HDPDO Thread procedure?
Anyone can benefit from the HDPDO Threads. The ideal person is someone that does not have good skin quality and they’ve had a lot of collagen loss due to sun damage, genetics or aging. However, if they have mild to moderate laxity of the mid-face and jaw, and marionette lines, they would be a really, really good candidate. If a patient has excessive laxity and volume loss, they are probably candidates for surgery, but if the laxity is mild to moderate, they will benefit from HDPDO Threads. But, it’s just like anything else that we do, each patient needs to be individualized and treated according to their specific needs and what I find is that most patients (almost all patients) need a combination of treatments.
What other aesthetic procedures do you combine with HDPDO Threads, and how would a patient get started?
We first evaluate everyone with clinical and polarized photography so we can see under their skin and get an insight into not only what’s already happened but what’s going to happen as they continue to age. That’s a very important first step. Then we address level of wrinkles, skin laxity and overall skin quality, as well as eyes, lips, cheeks, chin, jawline, etc. to determine the best approach to meet their goals. If the patient has dynamic wrinkles or wrinkles because of movement, we will combine HDPDO Threads with a Botulinum toxin to stop the movement. Once the muscles stopped moving then you’re decreasing the rate of breakdown of the collagen and so forth. And then if they need volume, we can add volume loss by using a variety of facial fillers. In other areas such as the lower cheeks where we really cannot use Botulinum toxin and they don’t need volume, we may combine a laser or light therapy skin tightening treatment with HDPDO Threads. With so many great fillers and toxins available now, we are really able to address all aspects of facial aging using a wide variety of technologies including laser light and radiofrequency combined with HDPDO Threads to give a patient a natural and rejuvenated youthful appearance.
How long do HDPDO Threads last?
I’ll answer that in two parts. The first part depends on what they needed and how aggressive a treatment was performed in the first instance. If the patient wants a very aggressive, turn back the clock significantly procedure, the result will last longer. However, some patients don’t want a drastic change but rather a slow progression of treatments that while still offering a beautiful, rejuvenated appearance, might need for them to come in for smaller, maintenance treatments more often. HDPDO Threads are designed to absorb over time and as they absorb, they continue to build collagen in the tissue which gives a longer lasting result overall.
How is a HDPDO Thread procedure performed?
The threads are folded and loaded on to very, very small thin needles which are inserted under the skin and threaded gently into place. Once the needle is pulled out, the threads remain underneath the skin anchoring the tissue in place. It is what I call a “technique dependent procedure” and I recommend that patients go to experts in the field to obtain a great result.
Is there any discomfort with this procedure?
I’ll tell you an interesting point. Other than things such as tattoo removal, I usually have procedures done on myself before I ever do them on patients because I really want to know what they’re feeling. So, I had a considerable number of threads put into my face so I could experience this technique. Now, as a male, my pain threshold is not anything near that of a female and I’ll readily admit that with no shame, but the pain associated with HDPDO Threads to me is very tolerable. We only use topical anesthesia and for the conventional threading we don’t need to make any incisions other than just inserting the needle as I’ve related before. The interesting thing I’ve learned from having had them done and then performing the procedure on my patients is that if the needle is inserted in the right plane or the correct skin layer, you don’t really feel much and neither does the patient. So, my having the procedure performed on me first has given me very good insight on how to best perform this technique on a patient.
How long can a patient expect to spend recovering from a HDPDO Thread procedure?
When I had my treatment done, I was back to work the very next day. I wasn’t limited and did not have the need to take any time off after my procedure. For most patients, the actual procedure itself takes approximately one to two hours. When the patient arrives for treatment we go over the procedure with them and provide review materials so they understand what they are about to experience, they will do their patient consent and then we begin with sterile prep and getting them comfortably ready for their treatment. The actual HDPDO Thread procedure itself may only take 15 – 30 minutes to perform depending on how extensive a treatment is necessary. Most patients experience minimal bruising and discomfort but obviously the more threads we place, the higher chance of a small bruise. We do screen people to make sure they’re not on blood thinners, or if they are, they stop it at an appropriate period of time. So, age and other medical conditions come into play for both pre- and post-procedure and the majority of patients can continue as normal immediately after a treatment. We do ask that they refrain from swimming, heaving lifting or brisk exercise for two weeks after the procedure.
What pearls of wisdom can you share with our readers as it relates to keeping a youthful look?
Aging is a continuous process and patients can begin a small maintenance program early and by that, I mean preventative skin care, sun screen usage, botulinum toxins in the early to mid-twenties to prevent crow’s feet, good health, limited alcohol consumption and no smoking are all things a patient can do to retain their youthful look. Then, of course, we have fillers, laser treatments and HDPDO Threads that a patient can incorporate as they age. Starting preventative care at an early age is the best pearl I can offer but for those that did not, fortunately we now have many advancements in aesthetic treatments that really can help a patient obtain a renewed and revitalized appearance.
To listen to Martin Kassir’s interview at Aesthetic Insider™ Radio, CLICK HERE!