Could you take a moment to introduce yourselves and share a bit about your backgrounds?

Dr. Paisal Rummaneethorn: I'm Dr. Paisal Rummaneethorn, a cosmetic surgeon paragraph in Bangkok. I graduated from Chulalongkorn University Faculty of Medicine in 1984 and later trained in laser medicine at Tokyo Women’s Medical University. My research focused on post-dialysis treatment for port-wine stains, a red birthmark, which I presented at the American Society of Laser Surgery and Medicine in 1992.

After returning to Thailand, I ran my private practice and later joined my university as Dean of the School of Anti-Aging and Regenerative Medicine, where I served for eight years, teaching master's and PhD students in dermatology and anti-aging medicine. Over the years, I’ve expanded my practice to six clinics across Bangkok.

Thread lifting has been a major focus of my career since 2003 when I first trained under Dr. Sulamanidze from Georgia, the pioneer of thread lifting. Over the past 20 years, I’ve worked with various types of threads and trained many younger doctors, emphasizing dexterity, precision, and safety.

Dr. Amit Luthra: Hi, I'm Dr. Amit Luthra from Delhi, India. I completed my undergraduate studies in 1994 and finished my postgraduation in 2003. My initial interest in aesthetics gradually led me to specialize in lasers, injectables, and later, thread lifting.

Injectables have been my primary focus from the beginning, and I have developed a deep understanding of facial aesthetics, considering cultural beauty differences rather than following a standardized approach. Over the years, I’ve seen a shift from permanent fillers and threads to temporary, safer alternatives. My philosophy in practice is that while efficacy is important, safety should never be compromised.

What are some of the latest advancements in thread lift materials and techniques? Would you say dissolvable threads are the preferred option?

Dr. AL: Yes, dissolvable threads are now widely used, but permanent threads still exist. The focus has shifted to longevity—earlier, PDO threads were common but had short-lasting effects. Patients often complained about the results fading quickly. Now, we have longer-lasting PCL threads, which dissolve but maintain results for an extended period.

Dr. PR: We’ve also worked with silicon-based permanent threads from Paris, which offer long durations. However, permanent threads have a controversial history. About a decade ago, gold-coated threads were used, but a case of severe burns during an MRI scan made headlines, scaring patients away. Since then, we’ve moved toward absorbable threads like PDO, which are safer. Though their effects are shorter-lived, they can be repeated more often. We also combine them with other treatments like toxins and fillers for a more comprehensive approach.

What factors influence your choice of thread type for each patient? Do you follow a specific process for screening and selecting the right product?

Dr. AL: The first decision is always between fillers and threads. If a patient has volume loss, I lean toward fillers. If they have sufficient volume but require lifting, I prefer threads. Among threads, I primarily use cog threads on cannulas for lifting and mono threads for rejuvenation. I often combine threads and fillers, sometimes in the same session, although it's controversial. I ensure an aseptic technique to minimize risks.

Dr. PR: I agree. Additionally, we assess skin thickness and fat distribution. If a patient has very thick skin or excess fat, we may first use energy-based devices like RF or ultrasound before placing threads. Thread selection also varies between ethnic groups; for example, Asian patients often have prominent malar bones, requiring different thread placement than Western patients.

Newer floating threads on blunt-tip cannulas are now preferred over double-needle threads since they minimize vascular injury, bruising, and hematoma while achieving comparable results.

Are there any combination therapies that doctors should be cautious about to prevent complications?

Dr. PR: We typically follow a structured treatment approach:

1. Start with energy-based devices like RF and ultrasound.
2. Proceed with injectables (toxins, fillers, or biostimulators).
3. Then move to threads.
4. Finally, consider more invasive surgical options if needed.

Dr. AL: Yes, but we also consider patient budgets. While combination treatments yield the best results, not all patients can afford them. We try to strike a balance between patient expectations and financial feasibility.

Has social media influenced aesthetic treatments, both positively and negatively?

Dr. PR: Social media has made aesthetic procedures more accessible, allowing direct communication with patients. However, it also amplifies negative experiences. A single complication can go viral, causing panic. Additionally, exaggerated marketing claims, often from non-medical influencers, create unrealistic expectations.

One of my colleagues became a social media sensation on TikTok, working until 2 AM due to overwhelming patient demand. Eventually, another colleague advised, "If you want more sleep, stop TikTok!" (laughs)

Dr. AL: I take a more conservative approach. While social media brings in patients, it also leads to unrealistic expectations. I rely more on word-of-mouth referrals, ensuring patients understand realistic outcomes before treatment.

What are the most common challenges and complications in thread lifting, and how do you address them?

Dr. AL: Dimpling, thread visibility, extrusion, and swelling at entry/exit points are common but manageable. The key is proper training. Many complications arise from incorrect placement, such as inserting threads too superficially. Fortunately, most issues resolve naturally as absorbable threads break down over time.

Dr. PR: Yes, most complications are minor and reversible. However, I’ve encountered severe cases, like large hematomas affecting the facial nerve, temporarily causing facial paralysis. In such cases, we administer corticosteroids to reduce swelling, and function typically returns. While rare, these cases remind us of the importance of precision and anatomical knowledge.