How to Maximize your ROI with Mono and Specialty PDO Threads
Hi, my name is Rio Calvert and I’m a nurse practitioner in Orange County, California. I’ve been an aesthetics for 15 years and I’ve been doing thread lifts for five years is a game changer for my patients. And today we’re going to be discussing threads. Okay, so there’s two types of threads. There’s barbed threads, which are the lifting threads. And then there’s monofilament threads, which are also called Smooth threads. Today, we’re only discussing smooth threads. Now the smooth threads are much easier to insert, and they are don’t require as much skill. The barbed threads are a little bit more complicated, does require a little bit more technique. But today we’re going to be discussing smooth threads and the purpose of smooth threads and where we can use them. And sorting mono threads are very easy. They’re basically these little hair like sutures on a needle and you’re just going to place it underneath the skin doesn’t take virtually any time at all. There’s very little downtime, and there’s very little risk it basically is a suture sutures had been around for a very long time and your body absorbs them overtime breaks it down to simple sugar. Within the mono thread family, you have smooth mono threads and then you also have twisted mono threads. Both of these have a fantastic ROI. Basically how you want to figure out your profit margin is look and see how many threads are you going to use and then maybe double or triple when you will charge the patient for it. Minor threads are easy to integrate with other modalities in your practice, they will work synergistically with your IPL with your micro needling RF they’ll actually work together to help stimulate collagen and get a longer lasting better outcome. Okay, so this is a basic setup of your tray we want to have a clean environment doesn’t have to be sterile, but we want it as clean as possible. We want to have some kind of an antiseptic, whatever it is that you use in your practice. This is hibba cleanse and some alcohol some nonwoven gauze, I have a tongue depressor here to apply the topical numbing. This is a one ml syringe with a 32 gauge needle on it. This has straight Lido with EPI and that’s going to be used to make my entry point with my introducer. I have an 18 gauge needle here which will make my port white eyeliner or you can use markers to create the lines and the vectors that you’re going to use to insert the threads and then I have the threads I’m going to use for the procedure. A tip here is to go ahead and pre release this cap so that they’re easier to grab and insert into a tissue once you’re ready to begin. So I go ahead and I release all these prior to the treatment. Okay, so we’ve applied topical numbing to our patient here. We’re gonna go ahead and leave the numbing on her decolletage because we’re going to save that for last and we are going to be treating her face I’m going to clean everywhere because we’re going to be using our needles and our marionettes or nasal labial folds back here in the pre regular area. So it’s really important that we clean everything very thoroughly. You can use Pearson you can use HIPAA cleanse, you can use alcohol, whatever you typically use in your practice, it’s just important to really get that skin as clean as you can all the way to the hairline. And it’s very rare that you’re going to get infection that we really haven’t had any infections with this particular procedure but it’s also very good to practice good cleaning technique. Now we’re going to do a facial assessment. What bothers this patient is the under eye hollows, her nasal labial fold her marionettes prejowl sulcus and the pre auricular area, we’re going to be using a multispecialty thread and the nasal labial folds, marionettes and the prejowl sulcus and the periauricular region. And then under the eyes, we’re going to be using a blunt tip thread for the under eye hollows. What this means is we’re going to make maybe one or two entry points per area and be able to put multiple threads through each hole as opposed to having multiple holes put in the patient’s skin. Prior to numbing the area, we need to measure where we want to begin inserting the thread. So what I’ve done is I’ve determined where I want my thread to end. And I need to make my injection with lidocaine right at the base where I want to insert so that it will end up in her nasally you’ll fold. Same with the periauricular region, I want my entry point to be back here so that I can have the bulk of the thread be where she has the most volume loss.
So now I’m just naming my areas where I’m going to be placing my port. So straight 1% lighter with epi, you want to allow for time for the numbing to take effect. And what we see here we see a little bit of blanching and we’re getting some vasoconstriction that will help with reducing the amount of bleeding that you get in the area. But it also you know, once it’s blanch that there aren’t going to really feel anything. I’m going to use an 18 gauge needle to make my entry point. Go ahead and turn away from me. I’m going to tap tap tap. Do you feel that? No. Okay. And then it’s just a little frightened of the drips. And we just want to pause and let everything kind of just settle down for a second. Did you feel that very little And then we just go ahead and remove our needle and I applied pressure in the event that there’s going to be a little bit of brain bleeding. That way I can reduce any bruising. Okay, good. Here’s a little bit of my HIPAA thoughts here.
Now, once you’ve done that, if you don’t get any bleeding, it’s almost impossible to find the hole. So you can, if you want, leave the needle in there before you insert your thread, but we can see a little bit of lead there. Now I’m gonna go ahead and I’m going to make sure I know where I want to end up. I’m going to insert my cannula underneath the skin, it’s going to feel very, very easy to insert. If you’re in the wrong plane, it’s going to be difficult, but you can see where I am and just want to be a little bit more superficial and we’re just going right up into the nasal ala, all the way up. Once you’re all the way in, go ahead and give it a little twist, pull and release. And now we have a multi specialty thread in the nasal labial fold. It’s going to help stimulate collagen and pop that area up. We can put multiple threads in that area. So we can start to see that we’ve already raised a little bit of that nasal labial fold, I’m gonna go ahead and put another multi specialty thread with this thread is basically 18 threads in one. So I’m able to get right now, two of these in there and it’s almost as if I’ve put 18 times to 36. Okay, these threads are basically 18 threads. So I’ve already put 18 threads in there with just one entry point and I’m going to put another multi specialty thread 18 threads again, and the nasal labial fold and help pop it up. We just want to be right underneath the skin and holding that skin tight a little bit to allow for this thread to insert smoothly into the nasal labial fold. Are you feeling that a little bit okay, and then I twist the wrist six 360 degrees. And there we go. And we can already see that that nasal area fold is starting to pop up. Now we’re gonna go ahead and insert a multi specialty thread into the pre gel sulcus. I’m gonna make my entry point with an 18 gauge needle. I’ve already named the area we can see that it’s blanched. And here we go. Do you feel that? No. Okay, just a little pop 123. We want the bulk of those threads 18 threads are there to be right here. We’re prejowel sulcus.
Let me go ahead and just right underneath the skin just under the dermis kind of push it all the way through making sure it’s engaged 360 degrees and Out we go.
Now we’re gonna go ahead and fill in the prejowel sulcus with this thread the multispecialty thread which is 18 threads. And right here is where she has some deficiency. So I want the bulk of the thread in that area. So I’m going to come through my port here. I’m going to pull that skin taut and a little bit more superficial just underneath the dermis. A little bit of resistance is fine, you just knock knock knock on the door, it’ll let you through released and I’m right where I want to be push all the way through forward so that your cottonelle is touching skin. Go ahead and press down, rotate 360 degrees and pull it out. And now you’ve got a multispecialty thread right in the prejowel sulcus. With that same entry point, what we’re going to do is go ahead and take another multispecialty thread and we’re going to build up the gonial notch back here we’re just going to apply some insert some threads right into the angle of her job to help enhance that and stimulate more collagen, we can even go up into the pre auricular area as well and start to fill in that area okay, multi specialty threat to go and fill in the gonial notch, twist and 360 degree Okay, so I’m just feeling for the facial artery and runs right along here this little notch. So I want to avoid hitting that facial artery. I do want to measure where I’m going to put my multi specialty thread that basically is 18 threads. So with one entry point I can insert 18 threads into this area and fill that up. So I’m just measuring to see where I want the bulk of the thread to be. And I’m just going to make a little mark here. And then I’m going to use my 1% lito with Epi and I’m gonna avoid tattooing her and be just right in front of my little marking here. Give that just a minute to Blanche and help with that vasoconstriction. So we’re not increasing the risk of having a bruise. And then once it’s blanched, we know that she should be pretty comfortable. I take my 18 gauge needle here and I’m just going to tap tap tap. Do you feel that? No. Okay, so I’m gonna go ahead and insert my entry point. This is just my pilot hole, where I’m going to be inserting the thread through and I go ahead and I put pressure, just in case there’s a little bit of bleeding This is my multi specialty thread. You can see that it’s 18 threads. And what I’m going to do is I’m going to insert make sure that the bulk of those threads are where she has a deficit and the pre gel sulcus, I want to stay fairly superficial, we just want to be just sub dermal. And when you’re in the right plane, it’s fairly easy to advance. Okay, and a little bit of blood is okay. If you don’t make your pilot hole big enough, you can always go back in and make it a little bit bigger now just going to be subdermal. I’m just going to go straight to the prejowel sulcus. Want to push that all it should be fairly easy to push through and it’s it should be comfortable.
Yeah, I want to make sure I advance all the way. There take a 360 turn pressure and then I’m going to remove the cannula.
Okay, now we’ve just filled in that prejowel sulcus so you can put multiple multi specialty threads in that area to help build that up.
Alright, this is our multi specialty thread, it’s 18 threads. We’re gonna go ahead and go through our little entry point here. And we’re just going to glide that right up into the nasal labial folds. Pull that skin tight, you just want to be subdermal sure should be fairly comfortable for the patient all the way up to the nasal ala. I’m gonna go ahead and press and 360 degree turn and then I’m going to remove the cannula. There we go. That’s one thread. Here’s another multi specialty thread with 18 threads on one cannula. I’m going through one entry point for that skin taunt. We’re going to slide it into the nasal labial fold. Pull that skin tight. You feel okay. Oh yeah, just feel a little pressure. Yep, perfect. There we go right up to the nasal ala. Make sure we have it all the way up, press down 360 degree turn and Out we go. So we’re able to fill in this area with one entry point. And on one cannula we had 18 threads so you could put multiple multi specialty threads in the nasal labial folds and the prejowel sulcus and in the pre auricular area. What I’ve done here is I’ve already measured to see where I want my smooth thread on a blunt cannula to enter. I’ve went ahead and I numb with a little lighter on epi and you can use Bicarb to take some of that sting away. I have a 21 gauge needle now that I’m going to use to make my port. What I’m using underneath the eyes are 29 gauge 38 millimeter thread. It’s a smooth thread. It’s 29 gauge 38 millimeter. So I don’t know if you can see that but it’s very, very thin and it’s short. So we’re gonna go ahead and insert that into her tear trough. You can also use threads that are on a candle that are twisted, which gives a little bit more volume. Here we go. We’re just going to be right underneath that skin. Super easy to insert. I like to put at least five to 10 and the tear trough. These will absorb over time her body will break it down. And while it’s doing that it’s creating fibrosis and new collagen and elastin helping to firm up that skin. So this is great anywhere where you’re going to have crepey skin. We have a little bit of volume loss. We’re not really replacing volume. What We’re doing is really helping to thicken and tighten up that skin should be right underneath the skin. Just so subdermal just right underneath the dermis. You can also be a little bit in the dermis just not intradermal Okay, that’s two threads already
so the point of having this on a blunt tip cannula, you have one entry point, so you’re not having to poke multiple needles into her skin and increase the risk of bruising. So with one entry point with the blunted cannula for the under eye threads, I’m able to put many threads in and help build up that area and tighten up that collagen. These will absorb in about three months or so but the lasting effects can last even longer. All these threads, the lasting effect depending on their body. Depending on the types of threads you’re using. You could have the results lasts for up to two years. But your body does start to break them down and we start to see the peak collagen production at about six weeks to three months. And this is something it’s not one and done you want to continue to do these treatments to help build up that collagen. So I have created my port with my 21 gauge needle. I’ve named it with 1% lido and epi. I’m gonna go ahead and take my 29 gauge 38 millimeter smooth thread on a blunt tip cannula. So I’m able to go ahead and insert as many threads as I want through one little port. And we’re just going to be dermal just right below the dermis. Just to help with that neocollagenesis, we’re creating more collagen, we’re creating more elastin, we’re helping to thicken up and tighten up that skin.
Okay, just pull the skin tight, very, very easy to insert your patients comfortable and pressing down and turn in 360 degrees just to help get the thread off of the cannula. So you can see how quick this procedure is and basically painless for the most part. Right just right underneath the skin right there. Right into the tear trough. Go ahead and make sure the cottonelle is already pushed forward, press down turn to help engage and get off the cannula and there you go. Body’s gonna absorb this over time, it’s going to get better and better it’s not one and done. It’s something that you want to continue to do based on how the patient’s needs you can also use smooth threads that are twisted that provide a little bit more volume in the under eye area. We can also make an entry point out here on the lateral canthus and go ahead and make a port and we can stream these threads in this direction as well. With one or two entry points we can fill in this entire area where she has some volume loss in the tear trough area. It’ll stimulate collagen over time and this is something that she can continue to do to help build up that area. We also have the twisted threads that will also create more volume in this area.
Just right underneath the skin here just subdermal right into the inner cathus right underneath the skin. You can see the tip of it. It’s very comfortable for your patient we’re gonna avoid a lot of bruising by using a blunt cannula.
One of the areas that we have a problem with is that we start to get what’s called these waterfalls and the décolleté area. So how we can treat that is with these smooth threads placed these smooth threads right underneath her skin. These again are 29 gauge 38 millimeters, and we want to have this cross hatching effect. Now there’s there’s many different ways to insert smooth threads. You could have the starburst, the spiderweb but really what we want to do is help create some support and volumize this area with the smooth thread so I’m gonna go ahead and go ahead and go in at a little bit of an angle, just get underneath the skin should be fairly comfortable for the patient. When you’re in the right plane, it should be very easy to insert. Now these are on needle. So you are going to have multiple pokes, topical numbing and typically works very well. And every once in a while, they might feel a little bit of a spicy poke. But if you stay in that superficial plane,they should not really feel too much. But again, they will get some bruising going at a little angle, you’re in the right plane, you’re going to stay superficial. And you’re just going to slide it in, we want to keep these close together because we want that neocollagenesis. If you’re only putting in a couple and you’re spacing them out far apart, then you’re not going to get the desired effect, you really want to create a support system and a mesh underneath just collagen and that scaffolding effect to help with supporting that area. And these will be absorbed by her body over a three month period, as it’s doing that we’re getting more vascularity we’re increasing the volume, the blood flow, and increasing that collagen production. Elastin helping to volumize and thicken up this area. Now if you’re going to incorporate any lasers, you want to space them out. Because we don’t we don’t necessarily want to do deep lasers and a micro needling RF at the same time because you’re going to disrupt those threads. So I like to do all my energy based treatments ahead of time, allow those energy based devices to help prepare the skin and then I’ll come in with my threads. But you want to space them out a couple weeks to a month apart. And if you’re in the right plane should go in very easy. Sometimes the other threads will get in your way and you can you can remove them.
Go ahead and push them forward, press down, give them all a little turn, and they’re just gonna go ahead and remove them all it was same here, we’re just going to press down, give them a little turn, and then remove them and shouldn’t have any bleeding. Okay, this is a multi specialty thread and what we’re doing is we’re building a bet jawline. I made my entry point with an 18 gauge needle and I numbed it with some lido with epi. Just pull that skin talk. Alright, so we built up the angle right there. I’m going to press down I’m going to give it a little twist and pull out so we could put multiple multi specialty threads in this jawline area to help build that up. We can also place many of them in the pre auricular area and then we can also fill in the temples with those multi specialty threads. With one entry point we’re able to insert 18 threads in one shot. Okay so I’ve numbed the area with the 1% lido and epi. I’ve got my 18 gauge here I’ve got my 21 gauge here and I’m going to insert the 26 gauge 50 millimeter blunt lip threat. So this we can help invert the lip give it a little bit of a lip flip. also fill in some of that volume loss a little bit of collagen production help tighten up this whole upper lip area
This is a 26 gauge 50 millimeter thread. I’m gonna go ahead and place it in my entry point. Pull that skin tight. We’re just gonna go into the vermilion border. We want to be subdermal just very very superficial. Okay, Turn away. So now I’m going to use a 26 gauge 50 millimeter thread to insert into the vermilion border to the belly of her lip and above her lip as well and that’s just going to help create a little bit more collagen production helped to elevate that lip a little bit and give it a little bit more hydration. I’ve made a I’ve numb the area with 1% light on epi using my 21 gauge needle here to go ahead and make my port and do you feel that? No? Okay, then I’m just gonna go ahead go right into the skin leave that there for a second okay, so this is your 26 gauge 50 millimeter lip thread and it is on a blunt tip so I can put multiple threads through one entry point. Okay, well you want to stay just subdermal or almost dermal very superficial try to find our little entry point here well that skin top we’re going to be superficial Okay, I’m gonna press give it a little turn and remove We’re just helping to restore some of the collagen loss and tighten up the upper lip and the vermilion border and the belly of the lip. And we go a little bit definition here we go right through here. Alright, here we go a 26 gauge 50 millimeter thread, we’re going to help to restore volume loss and tighten up the skin and the flip of the lip
26 gauge 50 millimeter thread it’s on a blunt tip I just made an entry point with my port and we’re gonna stay superficial and go right into the vermilion border keep that skin pulled taut. We just want to be sub dermal and it should go in fairly easy if you’re in the right plane and it should be very comfortable for the patient. Okay, I’m gonna give it a little press and a twist and remove it and there you go. And we’re helping to Evert that upper lip produce collagen help define that vermilion border and we can also put some threads into the belly of her lip
We can basically place these smooth threads in a hashtag or in a sundial pattern and really help to produce more collagen to strengthen that skin. So this is also a good technique to use prior to using the BB lifting threads. If I can prepare the skin and help it thicken up and get more collagen elastin. When I do my BB threads, she’ll get a much better outcome. You combine that with your technology based procedures, she’ll have much longer lasting effects so you can do that hashtag to support the marionettes hashtag to support the nasal labial folds. You can do a sundial pattern along the jaw line to help tighten up the whole jawline. You can help to enhance the cheek as well by just placing that sundial pattern or even a hat hash tag pattern to help support all the tissue in her upper cheek as well to build up that volume. If you want to support the segmentum again, you can do the hashtag pattern down here as well. So basically anywhere that you can put smooth threads, you can put them in any pattern to help produce that collagen and support that tissue, thicken it, firm it up produce that elastin, and it’ll last them for anywhere from a year to a year and a half, two years depending on how quickly they’re aging. So we’re offering support to her lower face, she’s starting to get a little bit crepey skin, and we’re just creating some support with some 29 gauge 38 millimeter threads. And I’m just gonna go ahead and use the hashtag pattern to help provide that additional support for her and she’ll start to notice the improvement over six weeks to three months. The lasting effects can last up to a year, it is something that you want to do frequently it’s not just a one and done because we are continuing to age and we want to stay ahead of the aging curve and continue to build collagen as we’re losing it. So this is a great way to support this area we’re gonna stay superficial we want to stay subdermal. And if you’re in the right place, it should go in fairly easy and should be fairly comfortable for the patient. So what I’m going to go ahead and do now make sure that all these are inserted. I’m going to press give a little twist and remove them. Going to press give it a little twist and remove. There you go. We can expect a little bit of bruising, our face is very vascular. But over time this whole area is going to start to get thicker and thicker. And then she’ll come and reassess again in a couple of months.