Views: 11 Author: Site Editor Publish Time: 2022-04-15 Origin: Site
Barbed polydioxanone (PDO) thread that allow minimally invasive skin lift are widely and increasingly used in cosmetic dermatology.
In view of the increasing demand for minimally invasive and affordable cosmetic corrections with minimal downtime, incisionless skin lifts with barbed absorbable polydioxin (PDO) sutures have recently become more popular.
PDO is an absorbable synthetic polymer mainly used for sutures in the clinic. PDO is slowly hydrolyzed in the body and fully absorbed within 6 to 7 months.
Despite the appeal of this treatment modality, especially in its simplicity and minimally invasiveness, published clinical data are surprisingly scarce.
This study describes the use of multiple barbed PDO sutures for aesthetic facial correction in Caucasian patients, evaluates long-term safety and demonstrates efficacy in skin tightening, facial redefinition, and tissue elevation.
A retrospective chart review of patients whose face was routinely treated with barbed PDO sutures. Aesthetic improvement was assessed by attending physicians, patients, and an independent photographic reviewer at 6, 12, and 24 weeks after treatment. Assess patient satisfaction with treatment outcomes. Procedural effects were also objectively measured by marker-free tracking analysis.
PDO suture implantation is minimally invasive, takes approximately 20 to 60 minutes, depending on the number of sutures to be used and the area to be treated, and requires the following steps:
With the patient sitting, mark the wrinkle line of interest with a white pen;
Clean the treatment area with disinfectant. Optionally, inject a local anesthetic at the planned entry point location of the needle/cannula and/or along the planned path of the suture;
Insert the entire needle/cannula subcutaneously into the skin with the entry point approximately 1 cm above the intended suture location. For the cannula, first pierce the skin with an 18G needle to create an entry point for insertion. Sewing techniques are recommended (moving the needle/cannula up and down alternately between the dermis and subcutaneous tissue);
While removing the needle/cannula, apply light pressure to the treatment area to maintain the suture in place. The extruded end of the suture is then pulled until the desired elevation is achieved (the barbs are designed to hold the skin in its new position). Finally, use sterile scissors to cut the extruded end as close to the skin surface as possible, and when the tension is released, the suture end can be retracted into the skin;
The type and number of sutures implanted in a specific anatomical area depends on the thickness and laxity of the skin, as well as the level of correction required and the anatomical area considered;
A slight and subtle overcorrection is necessary to account for gravity and the reduction in suture strength over time; the associated downtime is approximately 2 weeks;
When finished, cleanse the surface of the skin and, if necessary, apply a cold compress to the treated area for about 20 minutes.
Sixty patients received a total of 388 barbed sutures in different anatomical regions and were followed up for 24 weeks.
At week 24 there was an 80% to 100% improvement in aesthetics (depending on the evaluator) compared to the skin associated with the pre-treatment photo.
Typical suture implantation patterns are shown in Figure 3 for various anatomical regions. Overall, 83% of patients were treated in one area and 17% were treated in two different anatomical areas. Bottom implants are preferentially used to lift the jawline. For patients with thicker or heavier skin, especially elderly or male or overweight patients, the barbed cannula model with thicker sutures (1-0 USP) is preferred over the barbed needle model as this provides more Strong lift. All procedures were performed during one session and placed bilaterally, except for 1 patient who only wished to have the left eyebrow treated to correct a slight asymmetry.
Movement showed significant variation in several different anatomical regions, and 97% of patients were satisfied with the overall treatment outcome. 15% of patients experienced transient, minor, and transient adverse events, mainly pain and hematoma.
For patients with mild to moderate symptoms of facial aging, skin lift using a non-incisional barbed PDO suture is a safe and effective treatment option. Other key factors are the selection of appropriate barbed suture size and introduction technique, and their careful anatomical positioning in the target treatment area, coupled with knowledge of skin properties and practical assessment of the degree of correction that can be achieved.
Side effects are usually mild and short-lived. Although there is a minimal risk of asymmetry, this risk can be further reduced through the use of appropriate implantation techniques.
In conclusion, barbed PDO sutures are safe and efficient for aesthetic correction compared to more invasive procedures, with results lasting at least 24 weeks.