Cog Thread Research Articles

Anatomical perspectives of brow-lifting using threads: Clinical cases with techniques.

Tailoring surgical interventions to target age-related transformations is paramount. Many candidates seeking blepharoplasty commonly exhibit eyebrow ptosis, underscoring the necessity for surgeons to possess a comprehensive understanding of techniques for brow and forehead rejuvenation. Various surgical techniques are available for eyebrow and forehead enhancement, contrasting the standardized approaches in upper and lower blepharoplasty. Thread lifting has gained popularity for forehead lifting, although a more precise term would be eyebrow lifting. The thread lifting methods using V and I techniques with floating-type threads (Secret Line, Hyundai Meditech., Inc., Wonju-si, Republic of Korea) are used. The natural aging process often causes the forehead and eyebrows to sag under the influence of gravity, leading to the appearance of heavy eyelids. Elevating the eyebrows can mitigate droopiness, enhance vision clarity, and rejuvenate the facial aesthetic. While non-surgical methods like Botulinum Toxin A can weaken muscles and potentially aid in brow elevation, their visible effects may be somewhat constrained. Surgical methods encompass endoscopic forehead lift, eyebrow lift techniques, and scalp excision-based forehead reduction surgery, each with specific advantages and drawbacks. Thread lifting bridges the gap between surgical and non-surgical modalities. Forehead areas often lack subcutaneous fat, requiring precise anatomical understanding for effective thread lifting. Cannula usage with partial tunneling ensures efficacy even in patients with strong adhesions. Presented cases showcase successful eyebrow lifting using cog threads, illustrating immediate and gradual post-procedure changes. Eyebrow thread lifting demands periodic procedures, offering subtler improvements than surgery. Anatomical knowledge is crucial, and the technique presents discomfort. Effects last about 6 months, requiring re-treatment as effects regress. Thread lifting, a middle ground between surgical and non-surgical methods, can rejuvenate brows with less downtime.

Volumizing Threads (Jamber) in the Midface and Managing Side Effects: Clinical Cases.

The clinical application of polydioxanone (PDO) threads, traditionally utilized for tissue lifting, is now being explored for its volumizing effects in midface rejuvenation. The novel approach involves employing PDO volumizing threads to achieve physical augmentation akin to a "solid filler." The study introduces a more convenient insertion method for these threads, prioritizing ease and efficacy. Clinical cases demonstrate the efficacy of volumizing threads in addressing midface concerns, such as nasolabial folds and midcheek grooves. Additionally, the integration of volumizing threads to provide support in sagging areas is examined for achieving natural-looking enhancements. While highlighting positive outcomes, potential side effects like thread protrusion are addressed, along with strategies for their mitigation. Volumizing threads are presented as a suitable procedure for patients wary of traditional fillers or seeking subtle enhancements, with the recommendation of combining them with cog threads for those desiring more pronounced changes in facial contour. In summary, volumizing thread offers a minimally invasive alternative with fewer side effects for midface rejuvenation.

Thread Lifting Materials: A Review of Its Difference in Terms of Technical and Mechanical Perspective.

Thread lifting involves the use of slender materials, reminiscent of threads, for aesthetic procedures. These materials are distinct from traditional sutures and vary in composition, purpose, and performance. The introduction delves into the literal and material significance of threads, establishing the broad concept of thread lifting materials. The article revisits the evolution of thread lifting materials, emphasizing the preexistence of cog threads for tissue manipulation before their widespread adoption in plastic surgery. Observations regarding the efficacy and longevity of absorbable versus non-absorbable threads are discussed, stressing the efficiency of high-quality absorbable cog threads. The conclusion underlines the proliferation of thread lifting materials beyond PDO, highlighting the importance of considering multiple factors beyond duration when selecting threads for lifting procedures.

Revolutionizing thread lifting: Evolution and techniques in facial rejuvenation.

This review explores the utilization of thread lifting materials, distinct from traditional sutures, in aesthetic procedures. It aims to elucidate the varied composition, purpose, and performance of these slender materials. The article contextualizes thread lifting materials by exploring their literal and material significance. The evolution of these materials is traced, emphasizing the preexistence of cog threads for tissue manipulation before their widespread adoption in plastic surgery. Observations regarding the efficacy and longevity of absorbable versus non-absorbable threads are discussed, with a particular emphasis on the efficiency of high-quality absorbable cog threads. The proliferation of thread lifting materials extends beyond PDO, necessitating consideration of multiple factors beyond duration when selecting threads for lifting procedures. This underscores the importance of comprehensive evaluation in choosing appropriate thread lifting materials.

Why Do Nasolabial Folds Appear? Exploring the Anatomical Perspectives and the Role of Thread-Based Interventions.

The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative 'Reverse Technique,' involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the 'Cross Technique using volumizing thread' is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety.

What Are the Factors That Enable Thread Lifting to Last Longer?

Thread-lifting traditionally addressed aging-related skin laxity by leveraging precise thread placement and traction. However, recent advancements, notably cog threads, expanded its application to younger patients seeking facial contour refinement. These newer threads effectively lift sagging areas and refine facial contours, broadening the procedure’s appeal. Challenges arise in selecting threads due to variable physician preferences and patient needs. Clear indications for thread efficacy are vital for credibility and tailored selection. Thread choice depends on tissue laxity, necessitating lighter threads for minimal laxity and stronger ones for significant sagging. However, no single thread universally suits all cases. Combining different threads is favored for optimal outcomes and minimizing side effects. Excessive traction post-procedure may lead to prolonged discomfort and skin irregularities. Post-procedural tension adjustments through massage remain debated, potentially conflicting with minimally invasive principles. Understanding thread characteristics guides tailored selection, considering patient conditions and procedural goals. This comprehensive understanding extends beyond specific products, aiming for optimal outcomes in thread-lifting procedures. Key factors influencing outcomes encompass thread materials, thickness, cog shapes, insertion depth, lifting vectors, and absorbable thread expiration dates.

Brow gliding: A new non-surgical concept for almond upturned eyes.

The eyes are one of the most prominent features of the face. To date, a vast majority of procedures have been described for periorbital rejuvenation. Among them, non-surgical threading is an alternative and minimally invasive technique. We developed a new non-surgical threading technique to achieve long-lasting almond-shaped upturned eyes with brow lifting that we call "brow gliding". We developed a new non-surgical threading technique to achieve long-lasting almond-shaped upturned eyes with brow lifting that we call "brow gliding". Here, we present details of our procedure and the clinical experience of our patients who have at least a 6-month follow-up period. We used polydioxanone cog threads in combination with knots to lift the lateral sides of the brows and eyes. By burying these knots in the subcutaneous tissue and extending the threads to the scalp fascia, we were able to spread the load of the threads over multiple stable structures in order to achieve an effective lifting impact. According to the subjective assessment scale, all patients described the improvements as very good or beyond expectations after the procedure. During the follow-up period, 4 of 34 (11.8%) patients stated it was very good and 19 of 34 (55.9%) patients stated that it was still beyond expectations. The Brow Gliding technique is a promising office-based cosmetic procedure for periorbital aesthetics with a prominent outcome and minimally invasive fashion.

Cog Threads for Transvaginal Prolapse Repair: Ex-Vivo Studies of a Novel Concept

The diagnosis and treatment of pelvic organ prolapse (POP) remain a relevant and scientifically challenging topic. The number of cases of genital prolapse increases each year, one in ten women need at least one surgical procedure and one in four women in midlife have asymptomatic prolapse. Using mesh implants to correct POP presents unsatisfactory clinical outcomes, requiring hospital readmission and further surgery. We hypothesize using an alternative surgical intervention technique, applying injectable biodegradable cog threads, currently used for face lifting procedures, to reinforce and correct vaginal wall defects. The threads used in this investigation are commercially available 360° 4D barb threads (PCL-19G-100), made of polycaprolactone (PCL), supplied in sterile packs (Yastrid, Shanghai, China). Eleven sows’ vaginal walls were used to analyze the immediate reinforcement effect of the threads. Uniaxial tensile testing and scanning electron microscopy (SEM) was performed for the initial characterization of the threads. Threads were inserted into the vaginal wall (control n = 5, cog n = 5) and were characterized by ball burst testing; a pull-out test was performed (n = 6). With SEM images, dimensions, such as thread diameter (≈630 µm), cut angle (≈135°), cut depth (≈200 µm) and cog distance (≈1600 µm) were measured. The mechanical behavior during uniaxial tensile testing was nonlinear. Threads could sustain 17–18 N at 18–22% of deformation. During the ball burst test, vaginal tissue reinforced with threads could support 68 N more load than normal tissue (p < 0.05), indicating its strengthening effect. Comfort and stress zones were significantly stiffer in the tissues reinforced with threads (p < 0.05; p < 0.05). Both groups showed identical deformation (elongation); no significant differences in the comfort zone length were observed, showing that threads do not affect tissue compliance. The pull-out test showed that the threads could sustain 3.827 ± 0.1891 N force when the first cog slip occurs, at 11.93 ± 0.8291 mm. This preliminary research on using PCL cog threads for POP treatment showed promising results in increased vaginal wall resistance to pressure load and, at the same time, not affecting its compliance. Nevertheless, to obtain long term host response in vivo, further investigation will be carried out.

Contemporary View On Thread Lifting: Histological And Anatomical Approaches

Currently, thread lifting in aesthetic facial rejuvenation is not the top priority, but nevertheless its popularity continues to gain momentum. In connection with increasing popularity, the number of issues related to thread lifting and its undesirable side effects also increases. In this publication, an analysis of Russian and international databases was carried out, including MedLine, PubMed, elibrary.ru, Wiley Online Library, Web of Science, over the period from 2010 to 2020 (10 years). In the search, the following keywords were used both in Russian and English: threads, thread lifting, rhytidoplasty, face rejuvenation, face lift, cog threads, Aptos, suture material. As a result, of all available publications, 51 articles were left for further analysis, on the basis of which the nuances of thread classification, histological changes in tissues in response to thread implantation, along with anatomical basics and features during the procedure of thread lifting were analyzed. The effectiveness and duration of the thread lifting effect is still subject to debate. Hence, sometimes, it is possible to identify the duration of the effect in the same study ranging from 1 month to 2 years. Despite the long history of thread lifting, there are still unresolved issues that need to be covered.

Histological and molecular biological analysis on the reaction of absorbable thread; Polydioxanone and polycaprolactone in rat model.

One of the most frequently performed anti-aging surgical procedures is thread facelift. Since the 2010s, thread lifts using absorbable polydioxanone (PDO) thread were developed and have become increasingly popular. This research aims to identify the changes in and the mechanisms of absorbable thread-lifting components, namely, PDO (polydioxanone) and PCL (polycaprolactone), with varied absorption periods in the body. Four different types of threads, namely, single-stranded thread, 4-stranded thread, 12-stranded thread, and barbed Cog thread, were used for each component. Histological changes in the thread and neighboring tissue of rat model were investigated for 2-week interval, and PCR was conducted for genes related to fibroblast proliferation including type 1α1 collagen, type 3α1 collagen, transforming growth factor beta 1 (TGF-β1). An increase in the collagen formation in all types of PDO and PCL groups was observed during the first 12weeks and decreased afterward. Collagen formation decreased later in the PCL thread group significantly than the POD group. PCL thread remained logner in the tissue for over a year regarding POD requiring around 24weeks of absorption-degradation. A larger surface area between the thread and the tissue induces a greater response in the tissue, resulting in an increase in inflammatory cells, myofibroblasts, and fibroblasts. Results showed a similar pattern of increase in type 1α1 collagen and TGF-β in the PDO thread group. This suggests that TGF-β signal transduction leads to fibroblast proliferation that stimulates collagen formation and tissue re-formation. In contrast, only type 3α1 collagen increased in the PCL thread group. More collagen formation and tissue responses are induced by PCL thread, remaining longer in the tissue than PDO, leading to more tissue tightening effects that is one of the most important points of face lifting. Morphological comparison of threads shows that not only an increase in surface area between thread and tissue but also multi-strand increase tissue response, which in turn increases tissue maintenance effects.

Mini-midface Lift Using Polydioxanone Cog Threads.

Background:Deepening of the nasolabial fold with reduced malar highlight caused by sagging of the midface is one of the most important characteristics of facial aging. This report describes the use of 18-G polydioxanone (PDO) cog threads to improve midface soft tissue sagging and achieve satisfactory results through a minimally invasive procedure.Methods:In total, 64 patients (all women; age, 33–60 years) underwent a midface thread lift from January 2017 to January 2018. After a stab incision was made through an 18-G needle over the lateral orbital rim, three 18-G precannulated PDO cog threads were inserted, targeting the deep medial fat pad and inner layer of the superficial muscular aponeurotic system. The threads were anchored to the periosteum of the lateral orbit, suspending the soft tissue to a more superior direction. Surgical results were evaluated subjectively (patient satisfaction ratings) and objectively (blinded physician ratings based on changes in the vertical position of the malar highlight).Results:No major complications (postoperative hematoma, infection, or temporary sensory/motor decreases) were observed. The mean procedural time was 15 minutes, and all patients underwent local anesthesia. Patient satisfaction was the highest at 1 month postoperatively (mean, 4.7/5.0), decreasing at 1 year postoperatively (2.8/5.0). The scores on the objective assessment followed the same trend (4.5/5.0 at 1 month; 3.1/5.0 at 1 year).Conclusion:Using PDO cog threads for midface lifting is simpler, quicker, and less invasive than using conventional surgical methods, and this method simultaneously achieves satisfactory results for at least 6 months.

Experiences of barbed polydioxanone (PDO) cog thread for facial rejuvenation and our technique to prevent thread migration

Background One of the most common nonsurgical options for facial rejuvenation is lifting using threads. Application of polydioxanone (PDO) threads is generally secure and effective procedure, but complications on the involved regions can occur. Objective In this study, we shared our experiences of efficacy and safety of PDO thread lifting for facial rejuvenation and presented our technique to prevent the migration of threads. Materials and methods Thirty-eight patients who underwent PDO cog treatment for facial rejuvenation were evaluated. Via 23 G/90 mm sharp needle, bidirectional barbed PDO cog thread was inserted into subcutaneous tissue. The outcomes of procedure were assessed by Global Aesthetic Improvement Scale (GAIS) and patient satisfaction. Results Thirty-eight patients were included in this study. Mean age of participants was 39.6 ± 7.5 years. The GAIS score showed satisfactory results (very much improved: 78.9%; much improved: 18.4%; improved: 2.6%). According to patient satisfaction, all patients were satisfied with the clinical outcomes of procedure (excellent: 76.3%; very good: 21.0%; good: 2.6%). No patient reported ‘fair’ or ‘poor’ result. Conclusions Our results revealed barbed PDO cog thread is highly effective in facial rejuvenation. Also, tying the PDO threads in same entry point to each other seems to be an effective technique to prevent thread migration.

Dual-Anchor Cog Threads in Fat Grafting Breast Augmentation: A Novel Scarless Method for Defining Breast Footprint and Enhancing Shape.

Modern fat grafting breast augmentation allows successful breast enhancement. However, there is no fine control of breast footprint, shape, and inframammary fold. The purpose of this article is to report a novel scarless technique and to evaluate its beneficial effect by retrospectively reviewing case-control consecutive data from 51 patients. Fifty-one consecutive patients undergoing cosmetic breast augmentation with fat only between September of 2012 and August of 2016 were retrospectively reviewed. In the first 29 cases (56 percent), the authors did not use threads (group A, control group), whereas in the remaining 22 cases (44 percent), the authors used dual-anchor cog threads (group B, case group). Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. The BREAST-Q was used to study patient satisfaction. The Mann-Whitney U and chi-square tests were used for categorical variables, and the independent-samples t test was used for continuous variables. No significant difference in mean graft take was found (group A, 71.2 percent; group B, 71.6 percent; p < 0.05). Group B showed a significantly higher rating than group A for lower pole profile, inframammary fold, and lateral footprint definition. No major postoperative complications were experienced in either group. In group B, no thread-related complications were experienced. The dual-anchor thread suture is a novel, effective, simple, reliable, safe, and scarless method of improving breast shape in fat grafting breast augmentation. Larger series are needed to further confirm the authors' findings. Therapeutic, III.

Immediate treatment of botulinum toxin type A-induced brow ptosis with polydioxanone cog thread insertion

Immediate treatment of botulinum toxin type A-induced brow ptosis with polydioxanone cog thread insertion

Outcomes of polydioxanone knotless thread lifting for facial rejuvenation.

Thread lifting is a minimally invasive technique for facial rejuvenation. Various devices for thread lifting using polydioxanone (PDO) are popular in aesthetic clinics in Korea, but there have been a few studies regarding its use. To describe PDO thread and techniques adopted to counteract the descent and laxity of the face. A retrospective chart review was conducted over a 24-month period. A total of 31 thread lifting procedures were performed. On each side, 5 bidirectional cog threads were used in the procedure for the flabby skin of the nasolabial folds. And, the procedure was performed on the marionette line using 2 twin threads. In most patients (87%), the results obtained were considered satisfactory. Consensus ratings by 2 physicians found that objective outcomes were divided among "excellent," "good," "fair," and "poor." Texture wise, the outcome ratings were 13 as excellent and 9 as good. Lifting wise, ratings were 11 as excellent and 6 as good. The incidence of complications was low and not serious. Facial rejuvenation using PDO thread is a safe and effective procedure associated with only minor complications when performed on patients with modest face sagging, fine wrinkles, and marked facial pores.

Tissue Reactions to Cog Structure and Pure Gold in Lifting Threads: A Histological Study in Rats

Thread lifting has become popular as a minimally-invasive suspension procedure, but there is little basic and clinical evidence in the literature on the long-term effects. The authors investigate the effects of two types of lifting threads in a rat model over the course of seven months. The dorsal skin of 18 Wistar rats was implanted with a 20-mm fragment of one of three types of thread: nonabsorbable monofilament cog, pure gold (24 karat) with no cog, and pure gold-coated cog. Six rats were in each group. Tissue samples were harvested and histologically evaluated at one, three, and seven months. Histological assessment indicated (1) acute tissue reactions to the regular cog thread involving myofibroblasts and (2) delayed tissue reactions to the pure gold thread involving giant cells. The gold-coated cog thread showed a combination of the histological reactions associated with the cog thread and the pure gold thread, including faint early reactions, strong delayed reactions, and long-lasting capsule formation. Notably, the gold coating gradually came loose from the thread surface, suggesting that the release of tiny gold particles may promote longer-lasting tissue reactions. The combination of cog structure and pure gold coating was evaluated for the first time in this study and results suggest that the gold-coated cog thread has clinical potential.

Dysesthesia and Fasciculation: Unusual Complications Following Face-lift with Cog Threads

LEE, CHOONG JAE MD, PHD*; PARK, JUN HO MD, MA*; YOU, SUN HYE MD*; HWANG, JIN HEE MD*; CHOI, SEONG HYE MD, PHD†; KIM, CHANG HWAN MD‡ Author Information

Effect of Cog Threads under Rat Skin

The aging face loses the tensile strength of structural integrity. Cog threads have been used recently to tighten lax skin and soft tissue. A comparative study of the effects of cog, monofilament, and multifilament threads under rat skin. Each cog, monofilament, and multifilament thread was inserted under the facial skin of a cadaver and the panniculus carnosus of rat dorsal skin. The maximum holding strength (MHS) of the thread and the tearing strength of the skin around the thread were measured with a tensiometer. The thickness of the capsule around the thread and the myofibroblasts was observed histologically. In the cadaver, the MHS of the cog thread was 190.7 +/- 65.6 g. It was greater than that of the monofilament (22.4 +/- 7.7 g) or multifilament (40.4 +/- 19.7 g) thread. In the rat, the MHS of the cog thread was 95.1 +/- 18.8 g. It was greater than that of the monofilament (4.3 +/- 1.3 g) or multifilament (10.9 +/- 2.1 g) thread in the second week. The thickness of the capsule around the cog thread was 93.0 +/- 3.2 microm. It was thicker than the monofilament thread's capsule, 39.2 +/- 12.1 microm, in the fourth week. The number of myofibroblasts presented significantly more in the cog (96.0 +/- 72.4) than in the monofilament thread (4.3 +/- 4.4). The rumpled in-between skin suspended by each of the three different threads returned to its original state in 2 weeks. The cog thread placed under the rat skin immediately pulled the skin and subcutaneous tissue. The myofibroblasts around the thread played a role in fibrous tissue contracture 4 weeks postinsertion of the thread. These findings could be the basis for clinical application.

Effect of Cog Threads under Rat Skin

Effect of Cog Threads under Rat Skin