This technique helps drastically reduce the number of threads that cause subcutaneous bleeding, a big fear in Japanese patients. It also helps lower the amount of the dermal filler injection to create a more natural outcome. The non-cogged thread lifts the deep cheek fat pad and corrects the migration of superficial fat. As shown in <Figure 1>, several strands are placed laterally to pierce through the deep fat pads while lifting the sagging subcutaneous fat.

  

Recently, the cogged thread is widely used for lifting, however, I personally prefer creating an upward lift in the mid-face (Figures 2, 3).

 

Figure 2. How to lift up cheek.

 

Figure 3. Traction against change with aging.

 

Sometimes, threads are placed along the facial outline. The focus here is to place the strands to anchor the skin to the platysma under the chin, to provide a slimmer jawline, rather than to create a lift. Dermal filler is injected from the center of the cheek to supplement the volume above the fascia to address the age-related atrophy and sagging of the mid face. To create a tight, youthful jawline, the filler should be injected above the fascia to create a round protrusion from the lower middle point of the chin (I mainly use Radiesse for this procedure).

 

This is my personal technique and is not commonly used in Japan. However, a growing number of doctors in Japan are trying combination therapies. Unlike Korea, not many doctors try combining various new treatments such as energy based device, injectables, or thread lift, etc. Each time I visit the practices of my fellow doctors in Korea, I see Korean doctors are very confident and venture into various new treatments based on their own creative ideas. On the other hand, only a few Japanese doctors are confident about their own techniques and most just follow the common practices.

 

 

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This does not mean there are no problems about safety. Most Japanese doctors are very cautious but accidents do happen. One inexperienced doctor charged over JPY 1 million for a thread lift using cogged threads, which caused a bit of a social outrage. On top of being completely ineffective, the treatment caused various complications such as convulsion, anxiety, pain, etc. This incident became national news as his patients brought a class action suit against him.

 

In summary, both patients and doctors are very cautious to accept the non-invasive treatments in Japan. The preferred modality is the energy-based treatments, sometimes combined with dermal filler injections or even thread lift depending on the doctor. Patients prefer painless treatment that does not have downtime and are often satisfied with even very minimal improvement. 

 

-To be continued