Resulting from an unending quest by consumers to turn back the hands of time and revive their youthful glow, the field of aesthetic medicine has witnessed remarkable innovations. One such example – the combination of a full-face thread lift and injection of neurotoxin into the lower face – has proven to be a gamechanger in rejuvenation, helping individuals regain their lost confidence.
This treatment, powered by absorbable polydioxanone (PDO) threads, has evolved to be one of the most flexible, durable and resilient techniques. In this edition of Talent & Techniques, I will take a deep dive into the specifics of this transformative combination approach, from precare to post-treatment, and explore how it has revolutionized outcomes for individuals like my patient Rachel, discussed in this editorial.
The Genesis of Rediscovering Youth
My journey to exploring nonsurgical, minimally invasive solutions to the signs of aging began with the core utilization of PDO threads. PDO exhibits heightened resilience, offering a durable solution with results lasting from 12 to 18 months. The hydrophobic nature of PDO threads ensures a gradual 
breakdown through hydrolysis over time, contributing to a sustained and natural rejuvenation. Equally significant is the biocompatibility of PDO threads, characterized by their remarkable ability to integrate seamlessly with the body’s natural processes, devoid of antigenic or pyrogenic reactions.
Application of neurotoxins to the lower face represents a sophisticated approach to noninvasive facial rejuvenation. By strategically injecting neurotoxins into key muscles, such as the depressor anguli oris, mentalis, nerfertiti, platysma bands, accessory salivary glands and cutaneous neck, the lower face experiences a transformative lift. This precise intervention allows for the elevation of pull-down muscles, which fosters a balanced interplay with opposing muscles. Consequently, the zygomaticus major, zygomaticus minor and levator labii superioris are enabled to elevate, thus enhancing midfacial fullness. Furthermore, the release of these pull-down muscles contributes to the refinement of jawline contour, achieving a harmonious and natural outcome. Beyond its aesthetic impact, this technique, as exemplified in studies, is proven safe and effective, providing patients with a comprehensive solution for achieving a refreshed and revitalized lower face without resorting to surgical interventions.
Rachel’s Transformation: A Journey Towards Rejuvenation
Rachel came to my practice feeling self-conscious about the skin laxity on her face. She was not ready for a facelift just yet and inquired about nonsurgical options.
Pre-Care: The pre-care phase initiates the strategic groundwork for transformation, emphasizing meticulous consideration of each patient’s unique requirements.
1. Comprehensive Consultation: During the consultation, Rachel expressed her concerns regarding her facial skin laxity and its impact on self-esteem. A thorough facial assessment provided insights into skin quality, extent of laxity, and texture, guiding a tailored approach.
2. Personalized Treatment Plan: The heart of the pre-care phase is the development of a personalized treatment plan. It is not a onesize- fits-all approach, but rather a highly customized roadmap for rejuvenation. For Rachel, I recommended a powerful combination of the full-face thread lift and lower face neurotoxin.
Full Face Thread Lift: This component of the treatment was chosen to provide a cheek pop, snatched jawline and restore youthful contours. I recommended the use of PDO threads as they are renowned for their flexibility and durability.
Neurotoxins: Known for their ability to smooth and reduce the appearance of wrinkles and fine lines, injecting neurotoxins into the patient’s pull-down muscles – depressor anguli oris, mentalis, nerfertiti, platysma bands, accessory salivary glands and cutaneous neck – enables the lower face to be elevated. Once the pull-down muscles are released, it allows the zygomaticus major, zygomaticus minor, and levator labii superioris to be elevated as they are no longer working against the pull-down muscles. In addition, using the neurotoxin cutaneously can help the skin look tighter and refreshed. The lower face neurotoxin treatment aimed to provide a comprehensive solution to Rachel’s facial concerns and enhance the overall results of her transformation.
3. Informed Consent and Education: Preceding any procedure is the critical step of informed consent. My patients, like Rachel, receive comprehensive technical information about proposed treatments, fostering transparency and confidence as active participants in the journey.
Intra-Care: The treatment involved the strategic placement of PDO threads under the skin, creating a scaffold effect that lifts and tightens the sagging areas. Simultaneously, lower face neurotoxin was administered to elevate her lower face, creating a snatched jawline.
Post-Treatment: The post-treatment phase underscores the need for practitioners to continue to establish clear, realistic expectations with the patient. This stage provides the opportunity for patients to understand achievable outcomes, with practitioners playing a pivotal role in expectation management. In Rachel’s case, meticulous pre-care preparation ensured she approached the chosen procedures with welldefined expectations. Following the procedure, Rachel experienced ongoing improvements as collagen production was stimulated, contributing to a gradual and enduring enhancement in skin texture and elasticity.
Clinical Data Support
The effectiveness of the PDO thread lift technique is further validated by clinical data. An article from Dermatologic Surgery provided valuable insights into the impact of PDO threads on the skin. Changes in expression of collagen were demonstrated after a thread lift, showing mean levels compared to nontreated sections. The increased collagen production was maintained until the end of the study at seven months.1
Synergizing with Neurotoxins
In the realm of ‘r
ediscovering youth’, one study from Toxins on the mentalis muscle proves instrumental. Classifying it into dome-shaped (Type A, 86.4%) and flat (Type B, 13.6%), the research informs tailored approaches based on morphology. This study also offers precision in injecting botulinum toxin into the mentalis muscle, identifying optimal locations: 5 mm to 10 mm from the midsagittal line and 20 mm to 30 mm from a line connecting mouth corners.2 This anatomical insight, crucial in aesthetic procedures, enhances our ability to pinpoint effective injection points and depths for targeted facial rejuvenation. As we navigate patient journeys, incorporating this research seamlessly aligns with our commitment to scientific precision in the pursuit of ‘rediscovering youth’.
Facial soft tissue repositioning with neurotoxins is a concept illuminated by Claudia Hernandez, MD, and her team, who found that neurotoxin injection is a safe and effective option for enhancing midfacial fullness and jawline contour without the need for fillers or surgical intervention.3
Conclusions: A Journey of Transformation
The combination of a full-face PDO thread lift with lower face neurotoxin proves to be a dynamic duo for extended aesthetic benefits. Neurotoxin used in the lower face plays a pivotal role by strategically limiting muscle movement and creating an environment where the effects of the thread lift are prolonged. The reduced muscle activity ensures less stress on the threads, contributing to their longevity.
Results from this technique have been consistently promising. Facial soft tissues are repositioned, midfacial volume increases, lower facial volume decreases and jawline contouring is enhanced, all without any reported adverse events. This approach has not only restored confidence to individuals like my patient Rachel but also exemplified the possibilities of non-invasive aesthetic medicine.
References:
- Kim J, Zheng Z, Kim H, Nam KA, Chung KY. Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread. Dermatol Surg. 2017 Jan;43(1):74-80. doi: 10.1097/ DSS.0000000000000925. PMID: 27748691.
- Choi DY, Bae H, Bae JH, Kim HJ, Hu KS. Effective Locations for Injecting Botulinum Toxin into the Mentalis Muscle; Cadaveric and Ultrasonographic Study. Toxins. 2021 Jan 27;13(2):96. doi: 10.3390/toxins13020096. PMID: 33514053; PMCID: PMC7911364.
- Hernandez CA, Davidovic K, Avelar LET, Alfertshofer M, Freytag DL, Frank K, Moellhoff N, Bihun R, Green JB, Cotofana S. Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics. Aesthet Surg J. 2022 Sep 14;42(10):1163-1171. doi: 10.1093/asj/sjac090. PMID: 35416929.
