PDO--the thread that bolsters!

You may have heard about PDO (polydioxanone)threads; but if you’re here reading, clearly you want to know more!

PDO is a biodegradable material that is commonly used for suturing—but for the purpose of this blog, we’re going to discuss it as a tool in our fight against aging. While threads have been around for decades as a non-surgical option to “lift” the face, those in play today are different from those utilized even 15 years ago.

Threads are made from many materials (PDO, Polylactic acid (PLA), and polycaprolactone (PCA)) but the most commonly seen in the United States is good ol’ polydioxanone. These threads come for insertion in a variety of ways: mounted on a needle, or a cannula. And their presentation also vary: some are smooth, some twisted similar to a screw, and others have molded hooks designed to attach themselves to the tissue they contact to and give a little lift in whichever direction they are placed. And while these are biodegradable (how long it takes them to dissolve depends on the thickness of the thread to begin with, and your body’s own response to them) it isn’t just about the thread being present that makes them useful.

If you’ve read any of my other blog posts you’ll know I’m a big fan of collagen induction. Collagen in our skin gives it it’s bounce and fluffiness. The natural aging process and exposure to UV and free radicals over the years causes a breakdown of collagen and a thinning appearance to our skin—none of us have the same fluff at age 60 that we did at 16! Treatments like medical microneedling, radiofrequency microneedling, poly-l-lactic acid injection (sculptra) and calcium hydroxylapatite injections (radiesse) can all trigger the body to think there is an “injury” and prompt the response for repair—aka collagen production! Generally speaking, the more collagen we have the less translucent we appear. Of course, collagen isn’t the only thing we lose over the years—loss of elastin also occurs giving us more slack and less snap. But we need to tend to what we can.

So, despite that these PDO threads degrade over time, their simple presence in the tissue provokes controlled inflammation which is the trickery we are looking for to promote collagen strand growth right around that space! This collagen then lasts much longer than the thread did initially. Yahoo!

In my professional opinion, PDO threads are a compliment to other facial treatments; but rarely are stand alone when it comes to lifting. In someone with lax, not-too-thin skin it can provide a very nice scaffolding and the start of “lift”. Filler can then still serve to provide contour to specific areas and be more efficient once the tissue is closer to where it belongs. Other non lifting uses for PDO? Well, in one who has heavy “angry 11” creases, placing threads within those valleys along with their usual neurotoxin dose can help change the Grand Canyon into a rolling meadow (much less harsh!). And if there is laxity or crepey-ness around the mouth, fine threads (smooth, not lifting) can help reduce the “swag” of that tissue without increasing the fullness so you don’t move toward a Homer Simpson look. And how about that turkey gobble just under your chin skin? Yes, threads can be place there to help create less drape in that region too. But remember, this is a process, not a one-stop-shop.

Threads are sometimes referred to as “solid” filler, but I’m not super keen on that description. Still, in areas that I feel are too risky for actual filler, threads can contribute to that end, over time. They are prickly going in, and some are aware of their presence for a week or so. If skin is super thin to begin with, they may be visible at first—but the thread starts as blue/purple, and quickly changes to transparent when it interacts with your body fluid. Bruising, inflammation, and discomfort is manageable. If you’re inclined to consider a face lift, go get your consult. But if you’re scalpel averse, we can certainly discuss threads as an alternative. Book a consultation or bring it up at your next regularly scheduled visit with Teri (not everyone is a great candidate for threads so consultation and managing expectations is key). Package pricing—check out the website service menu for current costs!

A stitch against time….PDO just might play a role for you!

Melasma is annoying!

Melasma is annoying, and a challenge to treat. Once a melanocyte knows how to produce pigment, that becomes its sole mission. Any heat or sun exposure can kick up the activity which is why I do support using topicals prior to and during the process of recovery. The only true FDA approved topical agent scientifically reported to lighten pigment is hydroquinone. It is sold in varying strengths, and has a little bit of bad press. I feel it is reasonable to use this for no longer than 3 months, then stop for a spell. I do like it prior to any treatment that might invoke a perceived trauma that could possibly trigger melanin production (like a peel or a laser). So, one option for you would be to start using Hydroquinone 4% once daily for 2-4 weeks before the peel. I carry one made by vitality institute at my office that is priced at $116.

Another more complete option is to use a pigment correcting kit which includes morning and night products for use to complement the peel. Morning includes a specific moisturizer that includes prep/brightening agents and a vitamin C product; and evening includes use of a tretinoin serum as well as 4% hydroquinone. (kit is $300 and would supply you for a couple of weeks both pre and post treatment).

With regards to the peel, you could do a Vi peel specific to pigment correction (that would be my recommendation). The peel is applied by me and is self-neutralizing. You rinse after 4 hours. It comes with a small kit of post peel towelettes that actually extend the peel’s penetration. The flakiest days for the peel typically are days 3, 4, 5. Sunscreen will be super important after—but you’re already in the habit so that should be easy! Give your current sunscreen a try and if you want more recommendations let me know!

There is one more thing you might want to look into particularly if you like being outdoors a bit during the nicer months. Heliocare Advanced antioxidant is a fern leaf extract that has been made into a nutritional supplement and actually protects you from UV rays when taken internally (sort of an internal sunscreen). You can buy it at the drug store—and you might even be able to purchase it online. Scientifically proven—I anticipate more products like this coming in the next several years.

Help is on the way!

*all pricing subject to change

The new lip journey

Toying with the idea of a little lip augmentation, but not wanting to look “ducky”? Relax, lips can be very tastefully done!

There are many things to consider—first up is finding an injector who is passionate about what they do and with whom you can clearly communicate with. You may know what you’re hoping for, but you have to rely on their expertise to assess your anatomy, have a working knowledge of what products they carry and how each of them will respond in the area being treated. Then those ideas have to be married in a way to optimize your ultimate outcome. Getting your lips to their perfect state is a team sport!

When I assess first time lip goers the first question is “what are you hoping for?” Are you looking for volume or light hydration? From there I can start turning my little brain cells over to decide what filler I want to use. Some hyaluronic acid fillers provide more structure for crisp borders, some are soft and fluffy for a luscious pout. Some are super soft and stretchy and others are more firm, but may have more durability.

What are your native lips like? Does the upper lip have a swoop, like a ski jump? Are there points to your cupid's bow or is it more tubular? Does your upper lip seem to vanish when you give a toothy smile? Is your lip more like a raisin, or a little more inflated like a prune? We can enhance your born-with lip, but do have some limitations. You can’t put larger tires on a Prius and make it look like a Tesla…it just doesn’t work that way. These factors contribute to my final filler decision.

After conversation, cleansing and topical anesthesia—we get to work on creating a wow lip. And whether or not you are looking for va-voom or just a little less ho-hum once I get to the sweet spot and hand you the mirror to see them for the first time, there is a classic gasp in first time filler patients.

In your brain you silently say, “OMG, they’re big. Maybe this was a bad decision”. Then I work on talking you off the fence. Some of what you see is filler, and some inflammation from the needle pokes. I know that one syringe of filler is 1/5 of a teaspoon, and I know how much I have put in; but to the filler newbie they are quite different than what you came in with, so seem larger than life.

Then I warn you: “later tonight or tomorrow morning you will likely be swollen and what is currently huge will seem ginormous. But rest assured the swelling will go down. And in all likelihood by the end of tomorrow when you are less puffy, you will probably wish they were a little more swollen.”

During the first 2 - 4 weeks the filler will attract more body fluid (that’s what hyaluronic acid does, it attracts 1000 times its molecular weight in water). During the time of fluid movement, you may detect irregularity, even lumpiness—particularly detected by your probing tongue. Please leave it alone it will soften on its own. If you squish it, massage it or manipulate it not only can you potentially make the swelling worse but you may move filler around in the plane of tissue it was carefully placed in. Fourteen days out, if there is a visible lump that makes you crazy because your entire focus is on it—let us know and we can help guide you!

Be kind to your lips during the early healing phase. Do not use old lipstick or gloss until your needle injuries have closed. Do not use your new lips excessively for extracurricular activities (straw sucking, referee whistling, oral gratification, drug paraphernalia such as bong use or the like)—give yourself 4 or 5 days of relaxation—but admire them in the mirror all you’d like!

Once you adjust to having fullness you likely won’t want to be without. Each person makes a varying amount of the enzyme that breaks filler down, so it’s really hard to say exactly how long it will last, but for those who love having moist lips plan on a refresh every 6 months or so. First time lips tend to not last quite that long, but consider that you’re building a foundation on top of which the house will stay strong!