EXPERIENCES IN FACIAL THREAD-LIFTING USING SILHOUETTE SOFT NON-SURGICAL

APPROACH

Dr. Qikun Bao

Cosmetic Physician

Disclosures and legal stuff

■ Training Disclosures

– SilhouetteSoft for Austramedex and Sinclair Pharma for Silhouette Soft

– On Galderma’s Dysport and Fillers at Taylor Clinic/Collective Care

– On Allergan’s Botox and Juvederm at Taylor Clinic/Collective Care

– On Laser Physics and Theory at Taylor Clinic/Collective Care

■ No one paid me for this talk, I volunteered to be the young gun the spotlight

■ Views and opinions here are my own opinions and do not represent anyone else/any

companies mentioned

■ I like fried chicken, pork, and whiskey #OxfordComma

I heard threads are bad/don’t work and so I avoid them…

Nuanced Thinking Starts with the Grey in the Middle Ground…

■ I’ve actually never seen this movie, but the title was low

hanging fruit as a segue(pronunciation: seg-way)

■ Nuance helps stratify patients into surgical vs non-surgical

“facelift”

■ Going one shade of grey darker, some require multiple non-

surgical modalities

What is SilhouetteSoft?■ Polypropylene dissolvable threads attached to 23 gauge needles on both ends with

medially placed knots intercalating between 18 gauge polylactic acid cones oriented

in a bi-directional fashion

■ In English that means:

But doctor how can make do pretty blonde in face??!?

Other variations exist, it’s all about vectors… who knew high-school physics and algebra would apply to aesthetics #asianskillsftw

Why can’t we just use filler to “lift”

Breaking down the treatment effect in my words

■ Instant gratification: 0-6 months

– Cones compress and hold tissue and create instant lift

■ Long term gratification: 1-18 months

– PLA thread and cones creates a foreign body like reaction in conjunction with

insertion trauma to create linear strands of collagen

– Long term collagen “scar-scaffold” contraction in linear fashion

– Polylactic in a thread, think linear, pre-molded Sculptra

Instant Gratification – Standard Procedures

Instant Gratification – Evolved Techniques

Evidence for Long Term Collagen “Scar-Scaffold” Benefit

More Academic Evidence Things

No one talks about their failures, I WILL

My Failures … the Greatest Hits

Lessons Learnt

■ If the pinch feels “loose”

1. Mid Face Fillers, HA

2. Ellansé/Sculptra/Radiesse in the sub-malar buccal fat pat and mandibular

region to give the cones more of an ECM milieu to grab on to

3. Consider ablative laser such as Er:YAG 2940nm or CO2 10600nm to reduce

skin layer laxity to control “puckering”

■ Fitzpatrick skin types 4+ may require 3% Hydroquinone/2% hydrocortisone/0.01%

retinoic acid prior to treatment

■ Alternatively, three rounds of PicoSure Focus treatments within 3 months

Conclusion■ It’s a big market, let not be divisive, lets collaborate and stratify patients appropriately

■ Identify which patients need volume or laser/biostimulant skin laxity

■ Play around with your placements once you get comfortable with the basic methods

– This requires patience and persistence with some more difficult techniques you

master the basics, but all learning is like that. Don’t be that physician boss you had

in internship who would consult for everything just to play defensive medicine