I had the pleasure of practicing facial plastic surgery in the US over the last 25 years and have seen many tech­niques and treatments come and go. I have seen the boom of chemical peels replaced by a variety of ablative and non-ablative lasers increasing the cost and fre­quently bringing little benefit to our patients. Some of those treatments had some useful nich­es, however most of them were associated with treatment discomfort and a prolonged post-procedure recovery. The results were noticeable, however they were frequently better with more “aggressive” procedures and were associated with greater risks and complications.

What was missing was a procedure that would fill the needs of modern working women (and men) to be safe, quick, effective, long-lasting with min­imal downtime. This procedure was missing until WiQo product PRX-T33 was introduced to the Unit­ed States at the end of last year.

The basic canon of aesthetic medicine was that procedure must be aggressive to be effective. This is something I learned in my residency and was reinforced in my fellowship. This is a belief I held until PRX-PROTOCOL was first integrated into my aesthetic practice. I was first introduced to this product at the International Aesthetic Con­ference by my fellow European colleagues in 2019. My wife had her first application and was amazed by the results. The effects were immediate. Her skin felt firmer, was more translucent with a sense of “glow”. The procedure was quick, no more than 20 minutes. There was no discomfort other than mild itching during the application. There was no downtime and she was able to use her makeup so we could meet our friends for dinner the same day.

Since its introduction, PRX-T33 has taken the US by storm. It is an ideal care protocol for a busy woman, as it does not require prolonged rehabili­tation and has immediate results. With over 2 mil­lion applications performed since the product was put to market in 2012, the safety and efficacy of this protocol - currently used in over 40 countries - is unmatched.

PRX-T33 contains 33% trichloroacetic acid (TCA) - which is reflected in its name - as well as hydrogen peroxide, the real key ingredient in an “effortless transformation” revolution. The symbi­otic relationship between those components leads to beautification: this is the stroke of genius which led to the international patent of PRX-T33, granted in 2006.

PRX-T33 Perfect Intense Liquid is easy to use in the practice setting, can be applied by skin thera­pists under physician supervision and has multiple immediate and long-lasting benefits to our clients. It is non-photosensitizing and can be used year-round, safe on all Fitzpatrick skin types and has essentially no need for downtime. As stated be­fore, results are visible and palpable after the ini­tial procedure and are stable for 6-8 months after a series of 4 to 5 weekly sessions.

For those who are scientifically curious, I can tell you that the mechanism of action is based on a controlled stimulation of the skin thanks to the bal­anced action of the ingredients on the skin. This allows to improve the quality and the skin texture without the side effects commonly associated with peels. There is a lot of science behind PRX-T33 pro­tocol and I invite you to reach out and take part in the extensive training provided.

Other than obvious patient benefit, there is also a significant benefit to an aesthetic practice. It is a “low risk, high benefit” office procedure that can be performed under physician’s supervision in a medical spa setting by a licensed aestheti­cian. WiQo.US will train and certify your staff in product use and a proper care protocol including step-by-step recommendations. A low initial cost and a high patient retention is ideal for a physician owned medical spa.

All products available through WiQo line have been thoroughly researched and are used exten­sively and nearly exclusively in our facility. PRX PROTOCOL is popular with both men and wom­en, has few limitations and is safe for all age and skin type patients. The company recommends the use of WiQo Moisturizing Face Cream for Dry Skin to restore the hydro-lipidic film immediate­ly after the procedure, and then at home to mini­mize post-care exfoliation. WiQo Facial Smoothing Fluid should also be used to lower the skin pH and create the ideal conditions to prolong the effects of the in-office application.

I have introduced PRX-PROTOCOL in Octo­ber 2019 and it has currently been used for care of face and chest, hands, acne scars and stretch marks and the results have been excellent! The product is well received by our patients and staff. Follow-up procedures are scheduled at the time of departure and the home care protocol is well followed by nearly everyone. Please be aware that advanced applications with PRX-T33 include Mi­croneedling and PDO threads. The company goes to great lengths to provide webinars for addition­al training and certification, and US based staff is available if requested for additional training and to answer whatever questions you may have. I found the manufacturing company GPQ srl to be both responsive and responsible in providing additional information and training.

I was so impressed with this product I be­came a US based Medical Director for GPQ srl. I am proud to be part of the WiQo team and to in­troduce “effortless transformation” care proto­col to my US colleagues.

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Partner Content

Since its introduction, WiQo PRX-T33 has taken the US by storm. An ideal care protocol for busy women, it does not require prolonged rehabilitation and has immediate results.

“Effortless transformation” PRX-T33 revolution in aesthetic industry in the US

The most successful doctors in aesthetics apply their knowl­edge and skill to comprehensive patient skin management. Of course, your patients show up for toxin and filler, but while you can temporarily erase their wrinkles with a syringe, it takes more to restore youthful glow and vitality to the skin. Advances in regenerative medicine have yielded a new tool to help achieve those results.

Mesenchymal bone marrow stem cells from a young adult donor are cul­tured in the laboratory to produce precisely the correct balance of cytokines and growth factors for skin healing with minimal inflammation. These biosig­nals, when topically applied, are able to restore the phenotype of young adult skin to a patient of any age.

Formulated into rational products for office-based aesthetics treat­ments and daily home use, this technology is available under the name AnteAGE MD®.

Research has unequivocally shown that chronic inflammation is the catalyst for visible signs of aging in the human body. The hallmark of AnteAGE MD® products are anti-inflammatory ingredients intentionally formulated to give you lasting results, at the cellular level. Conditioned media of the bone marrow stem cell has been shown in a controlled study to accelerate wound healing at twice the efficacy compared to fibroblast cell media.

Cellese together with sister company XOStem are pushing the envelope of regenerative medicine and the promising new field of Exosome therapies.

Exosomes are nanoparticulate extracellular vesicles that aggregate and export paracrine biosignals, nucleic acid modulators of phenotypic expression such as mRNA’s and miRNA’s.

Exosomes are able to diffuse through tissues, seek out target cells, alter local immune functions, and effect changes to skin through epigenetic modulation.

The scientists at XOStem are culturing, classifying, concentrating, and preserving exo­somes to address aesthetic treatment modalities for aging skin and hair loss.

Interested in being a trial site for exosome research in aesthetics? Email 

Patients want something that gives them results they can see quickly without getting convoluted in too many steps. AnteAGE MD® has solved for both. The body’s natural ability to heal and repair itself is the foundational premise of the 2-part Serum and Ac­celerator System. Precisely formulating cultured growth factors with 18 active ingredi­ents, we offer a solution that is easy, safe and effective.

Bone marrow stem cell media and recombinant growth factors combine with classical ingredients that re­pair and improve the signs of aging. In just two steps, flood the skin with regenerative growth factors, vita­min C, vitamin E, hyaluronic acid, bakuchiol (a non-irritating retinol alternative) peptides and antioxidants.

The results include an increase in collagen volume, reduced pore size, an even skin tone, reduction in fine lines and wrinkles and an overall luminous glow that your patients will notice within days.

AnteAGE MD® offers specialized treatment adjuvants to maximize results and minimize downtime. Combining modalities with anti-inflammatory growth factor tools promote healing unlike any other topically applied skin product in the post-procedural scenario.

AnteAGE® restores the skin’s ability to respond to damage and repeat­ed stresses at a level that would be typical of the same person at a much younger age.

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Advances in regenerative medicine yield a new tool to help achieve a youthful glow and vitality to the skin.

Healing Power from Bone Marrow Stem Cells

Dr. Bauman recommends that doctors try using 29 g smooth PDO in 28 mm and 35 mm lengths.

While serious complications from PDO thread procedures are rare, the threads can work their ways out of the scalp.

“The key to safe and effective treatment is the careful placement of the PDO threads, know your anatomy of the skin and the location of the hair follicles. They should be not too deep, but not too shallow either. You have to make sure when you place the threads that they’re fully embedded, or under the skin. If a piece of the thread or end of the thread is poking out, then obviously that’s an opening where bacteria and other microorganisms could gain entry and cause irritation, inflammation or even infection,” he says.

The worst complication Dr. Bauman has seen is patients’ threads becoming extruded, where the tips come to the surface. Patients might feel this and describe it as feeling like stubble or exposed fishing line. It’s simple to fix, he says. Patients come to the office and he removes the rogue thread.

“The procedure is relatively quick, like a PRP. We can put up to 100 threads in or more during a single treatment session,” he says. “I use Pro-Nox, which is a nitrous oxide delivery system for analgesia while we apply the local anesthetic ring block, which makes it super comfortable. The numbness lasts for three or four hours or more. Patients don’t really feel anything in that area. They can wash their hair immediately. Sometimes if they tap their scalp a day or two later, they can feel a little tenderness. Most patients don’t need anything at all for pain.”

Dr. Bauman recommends that patients combine the threads with PRP, unless they are not candidates for PRP. Some can’t have or don’t want their blood drawn. Another contraindication could be if they have a platelet disorder. But most patients are candidates for PRP.

“The scalp is already numb, why not use a high-quality PRP?” he says.

In addition to PRP, Dr. Bauman might add biological scaffolding in the form of porcine bladder matrix or, more recently, a human allograft like placental tissue.

“When applied with PRP and other topicals, we can use this approach to better stimulate hair regrowth in the scalp,” he says. “I’ve also used PDO threads in combination with hair transplant procedures to maintain or improve areas where we are not using the FUE [follicular unit extraction] grafts.”

Patients should be prepared to understand that whether they receive only the threads or a combination of treatments, hair growth takes time.

“Hair growth rates are essentially a third of a millimeter a day across all ages, which equates to about a centimeter a month or a quarter to a half inch a month,” Dr. Bauman says. “Even if you have a spectacular result developing, you might not see it for three to six months with the naked eye. You can measure it with a HairCheck trichometer during that time to see which areas are responding and how well the Hair Mass Index is improving and maintaining. Over the course of six months or more is when you’ll really perceive the visual results using standardized global photography and patients feel the difference.

Bharti J, Sonthalia S, Patil P, Dhurat R. Scalp threading with polydioxanone monofilament threads: a novel, effective and safe modality for hair restoration. 

Metwalli M, Khattab FM, Mandour S. Monofilament threads in treatment of female hair loss. 

Articles

Safe and effective treatment requires careful placement of PDO threads, knowledge of skin anatomy, location of hair follicles, and more.

Best Practices for Hair Regrowth with PDO Threads

Using polydioxanone (PDO) threads is a relatively painless lunchtime procedure that can stimulate hair regrowth for six or more months in men and women with androgenetic alopecia.

Alan J. Bauman, M.D., who pioneered and trademarked the PDO thread insertion procedure PDOgro for hair regrowth in the U.S., has been performing the procedure for more than two years. He presented results from research on PDOgro and did a live interactive hair restoration session at the South Beach Symposium for Clinical and Aesthetic Dermatology in Miami, Fla., in 2019.

PDO is a slowly absorbing synthetic surgical suture material that stimulates collagen production, elastin, hyaluronic acid and new blood vessel formation. It also activates fibroblasts while it dissolves. FDA-cleared PDO sutures have been used safely in surgery for decades, according to Dr. Bauman.

“When you put PDO into the body as a deep suture, it lasts for more than six months. In the aesthetic world, they’ve been using these really thin, fine filaments of PDO very superficially in the skin to trigger tissue regeneration and repair,” Dr. Bauman says.

An aesthetic colleague asked Dr. Bauman if he had considered using these threads in the scalp, explaining that studies had shown that an unexpected result when using the threads for facial rejuvenation was a boost in hair growth in treated areas of hair-bearing skin.

In fact, there are studies suggesting the threads result in noticeable hair growth. Indian researchers evaluated the efficacy and safety of PDO thread insertion into the scalp in a small study of men with androgenic alopecia. They found that at 12 weeks, all five patients had appreciably increased hair counts, according to a letter to the editor published in 2015 in the 

Journal of the European Academy of Dermatology and Venereology

“Although the exact mechanism of action of hair growth stimulation by PDO threads remains speculative, it is likely to be similar to that of microneedling, involving enhanced expression of hair‐related genes, release of growth factors like PDGF and direct activation of stem cells in the hair bulge area,” the authors write.

Monofilament thread treatment also significantly improved hair mass index and hair counts in a study of women with female androgenetic alopecia, researchers reported in March 2020 in the 

Dr. Bauman says he initially performed the procedure on a small cohort of male and female patients with thinning or receding hair in 2018.

“We did it without any other therapy. These monotherapy patients were exclusively ‘virgin’ and had used no other treatments previously. We tried it in different areas. For example, one woman had thinning in the crown and another woman had a receding, thinning hairline and temple area,” Dr. Bauman says.

Every one of the first six patients treated some visual improvement within 6 to 12 weeks of the PDO thread insertion.

Dr. Bauman then rolled it out to patients who were interested in using PDO threads for hair growth either with or without other treatments. He has treated nearly 100 patients so far.

Dr. Bauman says he uses cross-sectional hair bundle trichometry (HairCheck) in several areas and global photos for tracking. In this cohort, Dr. Bauman has used primarily a combination of PDO threads with dual-spin platelet-rich plasma (PRP) to optimize results.

“We’ve seen nearly 90% improve or maintain their Hair Mass Index within six months of treatment and patient satisfaction has been excellent for this quick and comfortable ‘lunchtime’ treatment,” he says. “Recently, it has been a little difficult to track some of these patients through the shutdown to tell how long these results are lasting. Threads typically last in the body for 6 to 12 months. We imagine that it will be similar for the hair — about 6 to 12 months before we need to redo it.”

Patients need to have hair follicles for PDO threads to work.

“Just like with PRP, if there’s no follicle in the skin in that area, you’re not going to get a new follicle to reappear,” Dr. Bauman says. “It’s a good idea to do some measurements. Use your microscope and really get down and dirty to see how much vellus hair, terminal hair and miniaturized/intermediate hair density you have in each zone. Intermediate or miniaturized hair is likely what could be rejuvenated. If the area looks like it has been severely depleted, meaning the follicle density is shot, then the treatment probably isn’t going to do much except maybe protect what the patient has.”

Dr. Bauman says he has seen the most robust improvement in cases where he treated women and men with high numbers of weak (intermediate) hairs.

“People in the earlier stages where hair is just beginning to thin are ideal,” he says.

NEXT: Best Practices for Hair Regrowth with PDO Threads

Hair restoration physician Dr. Alan Bauman says threads traditionally used in facial rejuvenation also are a safe, effective treatment option for some hair loss patients. 

Threads Stimulate Hair Regrowth

Part 1: Avoiding Legal Landmines During COVID-19

According to Jeff Segal, M.D., J.D., Founder, Medical Justice Service, you should assume that everyone is pre symptomatic.

“Assume they've been exposed. That way you will do the two things that you must remember, which is wear a mask, wash your hands; wear a mask, wash your hands; wear a mask, wash your hands. If you remember nothing else remember that,” he emphasizes.

Dr. Segal believes the best way to screen for COVID-19 is a prescreening call using the CDC checklist, which allows the physician to ask about symptoms and commit the answers to paper. If you’re in a state that requires testing, and a patient tests positive, he says, instruct them to follow up with their general physician.

“[After they’ve followed up with their general physician] if you want to be a nice person, you probably should call them afterwards and see how they did. It's helpful to… close the loop and get an understanding of what worked, what didn't work and so on,” suggests Dr. Segal.

As an additional measure of protection, Anthony Geroulis, M.D., J.D., a facial plastic surgeon in Chicago, suggests regular follow ups with patients who test positive for COVID-19.

“If anybody turns out to be COVID-positive… refer them to their family doctors, document it all and check on them every week or so. And document the fact that you're following up and checking on them, so that you cannot be accused of any kind of abandonment,” he says.

Amidst all the extra measures taken, it begs the question: Is testing more trouble than it’s worth? Dr. Segal suggests it may be.

“Unless you are forced to do it by law, I think you may be opening up a can of worms above and beyond just doing the clinical checklist on the telephone as well as assuming that everyone is pre symptomatic,” he says.

But, says Dr. McCollough, he has a good reason for testing in his Alabama practice.

“We do require testing for all of our patients… because that tells the patient or tells us whether or not the patient has an active infection,” he says.

In Dr. McCollough’s practice handshakes and hugs have been replaced by face masks and hand sanitizing.

“I want the patients to see that we're doing everything that we can,” says Dr. McCollough. “I walk in the room with my mask on, and… I squirt [sanitizer] in my hands. I have them seeing me do that.”

By doing so, he believes his patients will recognize that he and his staff are exercising an abundance of precaution.

"It's just a matter of being conscious of all of these things and trying to do the right thing. I don't know that we can ever totally protect ourselves against litigation. But I think it's making an effort.”

Ultimately, Dr. Waldman uses a fitting analogy to drive home the take-away message.

“This is like a marathon. We're in the first hour two or three maybe, but we want to be able to finish the race. We don't want to use up all of our energy on that front end. So if we're careful on the front end, I think we'll be rewarded at the end of the race with lots of cheers and patients who believe that we did it the right way… Ultimately our reputations are everything that we have.”

At the end of the day, “You’re in the business of treating healthy patients and you want to remain that way,” says Adatto. “If… there's just one takeaway [it’s] safety first. You do that [and] I think you'll be safe across the board, and you'll be able to sleep better at night knowing that you won't be stepping on those landmines.”

According to Jeff Segal, M.D., J.D., assuming everyone is pre symptomatic for COVID-19 will keep your safety senses sharp. 

Two Essential Safety Measures During COVID-19

On the broadest level, always think safety first, says Brad Adatto, J.D., Partner, ByrdAdatto,

“I always just go back to safety first: The safety of your team, your staff, the safety of your patients, the safety of your facility and of course the safety of yourself,” he says. “You have to be careful because you don't want to close yourself down because you expose your staff or your facility to COVID-19.”

Which begs the question, what should you be doing to minimize your legal risk?

According to E. Gaylon McCollough, M.D., F.A.C.S., Gulf Shores, Ala., his approach with every patient from the first point of contact has always been to prepare for a lawsuit.

“The first time that the patient calls your office for consultation, you should begin to prepare the file for a lawsuit,” he says.

“We put everything in the chart,” concurs Randolph Waldman, M.D., who is Editorial Advisor for 

 and Founder and Director of the annual multi-specialty Global Aesthetics Conference in Miami Beach, Fla.

“If it’s not in the chart, that means you didn’t ask it,” he says.

For surgical patients, in particular, “…you have to address the fact that you talked to them about potential infections after surgery …and that risks have probably gone up just a little bit [with COVID-19], but that you are doing everything you can to mitigate those risks. And I think that they'll appreciate that.”

Alex Thiersch, J.D., Partner, Salveo Capital and CEO, AmSpa, helps to paint a picture of the potential lawsuit opportunities by playing devil’s advocate.

“I'm putting on my sleazy lawyer hat right now thinking about how I would be able to go after somebody,” says Thiersch.

Failing to follow basic protocols and/or the specific protocols decided on for the practice.

Failing to provide staff with appropriate protective gear.

“That's what a plaintiff's attorney is going to do… they're going to take your protocols, they're going to take the governor's orders, they're going to go through every single step of it and see if you ticked off that box, and if you didn't they're going to say, ‘well that is clear and convincing evidence that you weren't doing what you were supposed to be doing,’” says Thiersch.

“The risk of exposure as an owner is coming from your employees first,” emphasizes Adatto.

The most important things you can do is to educate and protect your employees, he says. Even the best of protocols will expose you to risk if you don’t follow them to a T.

“A plaintiff's attorney will use that. The government will use that against you. Because as beautiful as the protocol can be written. If you're not following it, it’s actually worthless,” says Adatto.

Staff need to know not only the protocols but also how to implement them, including those for patient visits, patient or staff COVID-19 exposure and facility cleaning.

In terms of protection, every practice is required to provide necessary equipment to keep staff safe.

If you don’t, says Adatto, “Number one, it's going to slow you down. Number two, it is terrible press if you're a medical facility that is not providing the proper equipment. And number three, it's against the law when it comes to OSHA. OSHA will come in and find you and shut you down.”

NEXT: Two Essential Safety Measures During COVID-19

In May, we convened a panel of legal experts and respected physicians to discuss the legal landscape facing the private practice during COVID-19, including strategies for minimizing liability risk. Overwhelmingly, the panel agreed on several key points for avoiding legal landmines.

Avoiding Legal Landmines During COVID-19

According to panel member Joe Niamtu, III, D.M.D., who admits that he doesn’t use threads in his facial cosmetic surgery practice, “… it allows a lot more types of specialists to do some type of facial treatment.”

But this also begs the question of training, according to, Kay Durairaj, a Pasadena, Calif.-based plastic surgeon on the panel.

“I've done threads in the past and I feel that when they're placed deeply and anchored well, they work nicely. But my concern really is that people are not maybe effectively trained or… the depth of placement of threads is not as accurate, or people are not used to surgical plane anatomy. I think that teaching has to be addressed… we have to distinguish between the threads that are barbed, nonbarbed, absorbable, nonabsorbable and make sure we teach that accurately.”

Natalia Guzman, BSN, RN, CANS, a cosmetic nurse injector in Dr. Karimi’s practice and the only nonsurgeon on the panel, says that without an option to nip and tuck the mid face in her own toolbox, threads are a great option to round out her services.

“It really is a skill just like anything else,” she says. “The more I did, the more comfortable I felt… I love them because I don't have the option of being able to cut into skin and tighten the mid face.”

Importantly, knowing when to refer is a key consideration to performing effective treatments. Guzman notes that she sends patients with heavy, thick skin to a surgeon.

And for anyone who questions the nonsurgeon’s ability to safely and effectively use threads, Dr. Karimi points out, “I feel more comfortable with them doing threads than with fillers. Not that I'm not uncomfortable with fillers, but I have I'm less worried about devastating complications with threads with these modern threads than with fillers because there is no chance of necrosis. There's no chance of vascular compromise.”

Dr. Karimi suggests that, perhaps, it’s the nonsurgeons who may be in an ideal position to train for threadlifts.

“It’s a totally different ballgame with threads than it is with fillers or with surgery,” say Dr. Karimi. “Sometimes the surgeons are the hardest ones to get the point across to because we have an idea of what we do to the SMAS… I’ve found actually that sometimes working with expert nonsurgeons, like Natalia, or people that don’t already have this kind of prejudice of what should be happening, is a lot easier.”

Ultimately, threads are simply another nonsurgical option in the toolbox that can draw patients into the office.

Dr. Niamtu admits that he’s not much of a threadlift proponent, but he’ll also tell you that they can be an effective tool for getting new patients. “I was doing consults for threadlifts and it just bumped the hell out of my facelift practice. Probably the biggest blip ever because people were coming in and they weren't threadlift candidates.”

Dr. Karimi agrees. “…advertising threads and doing threads has increased my facelift practice. So I 100% agree with that because when people come in I'm not trying to sell them a thread lift. I'm basically trying to do the right procedure for the right patient.”

Thinking of threads as an injectable also means thinking about how and where they fit in the nonsurgeon injector’s armamentarium. 

Who Is the Best Thread Injector?

When facial plastic surgeon Kian Karimi, M.D., FACS, first heard about newer threadlifting technologies, he admits that he wasn’t a believer.

“I've heard about the threadlift. I heard it's terrible. I'm not going to go there. It's not an alternative to surgery,” was his initial response to threads, he explained during “Threadlifts: Let’s Argue,” one of the virtual panels offered via L. Mike Nayak, M.D.’s online Medspa Mastery course earlier this year.

But he did his research and gave threads a chance. Today, “I do [a] reasonable [number of] facelifts and neck lifts, but I also do a lot of threadlifts, and in fact, it's 30% of my injectables practice,” says Dr. Karimi.

And that’s an important distinction: threads as injectables. He calls it a paradigm shift.

“Current threads are simply a new injectable… an injectable that can reposition tissues very subtly… it doesn't cannibalize your fillers; it doesn't cannibalize your neuromodulators…. that's where it has been huge in my practice,” says Dr. Karimi.

Today’s threads are absorbable, Dr. Karimi emphasizes, not the nonabsorbable polypropylene suture used for the old contour threadlifts, which he describes as essentially tennis racket strings with hooks.

“People would put them in, and surgeons would have to take them out. There was no reversal,” which was largely responsible for casting a negative light on the procedure, he explains.

Currently, there are only two types of FDA-approved threads in the United States: PDO (NovaThreads, MINT, etc) and PLLA/PLGA (Silhouette InstaLift). Not to be confused with the aforementioned Contour Threads, which was approved in 2005 and revoked in 2007 for poor outcomes and safety issues.

“I do PDO thread lifts, primarily,” says Dr. Karimi. “I like combining them with fillers. I like combining them with platelet rich fibrin (PRF). And it's something that I use all the time.”

While patients were generally dissatisfied with Contour Threads, that’s not the case with today’s absorbable threads.

“I don’t do a lot of threads, but I’m always impressed with the patient satisfaction,” says Otto Placik, M.D., a plastic surgeon in Chicago.

And don’t let before and after pictures deceive you, he insists. Photos don’t do a great job showing results because those are best observed in facial animation.

“It’s very difficult for me to document the improvements. I think this is… where dynamic video or animation would be so much more useful in showing the before and after benefits of threads. I think it’s a dynamic benefit that people really see,” he says.

Not only are today’s threads more likely to satisfy patients in terms of safety and results, but Dr. Karimi also believes it’s time to think about using them differently: Not to create a face“lift,” per se, but for subtle tissue adjustment and biostimulation to generate natural results that last beyond the life of the threads themselves.

“I think the biggest paradigm shift that I understood, is that my surgical patients are not my threads patients and my threads patients are not my surgical patients,” says Dr. Karimi. “Current threads are simply a new injectable.”

It's a paradigm shift for the threadlift, which offers subtle tissue adjustment and biostimulation to generate natural results that last beyond the life of the threads themselves.

Threads as ‘Injectables’

Every aspect of our personal and professional lives has been affected in some way by the onset of COVID-19. 

As we work towards structuring new normalcies, we understand the importance of continuing to pursue the work we are passionate about. For us, that’s researching and sharing the latest innovations and insights within the aesthetic specialty. For our physicians, it’s practicing aesthetic medicine safely and doing so with confidence.

, we bring you cutting-edge treatment- and trend-related content, while also confronting some of the real issues affecting the specialty. We take a serious look at diversity in aesthetics as well as pandemic-related legal issues and lessons learned from the COVID-19 shutdown. This issue features several physicians who are finding ways to creatively navigate this largely uncharted territory in which we find ourselves. Dr. Suneel Chilukuri shares a new “functional” use for the body toning technologies. Others share new opportunities in skincare sales and addressing the rise in stress-induced hair loss. In one of the first virtual meetings that took place since the onset of the pandemic, Dr. Kian Karimi

suggests that threads are the new “injectable,” and Dr. Jacob Haiavyshares his protocols for managing or treating capsular contracture with LED light.

We hope you glean clinical and practice insights from this issue, and embrace hope during the current challenges, as elucidated by our Medical Editorial Advisor Dr. Randolph Waldman in his editorial, “‘Here Comes the Sun.’”

Click on the cover below to read the digital issue and let us know what you think on our social media. 

The Summer issue of Aesthetic Authority offers cutting-edge treatment- and trend-related content, while also confronting current challenges affecting the specialty.

Uncharted Territory: Aesthetic Authority Vol.1: No.2

The recent pandemic has affected everyone in one way or another. It has certainly been a time of reflection on life in general but also our practice life. Many of us have experienced what it is like to have our livelihoods put on hold, not to mention the incessant fear of contracting the coronavirus. No, these are not normal times and certainly not something most of us in the medical world even thought possible. But here we are. The reality has set in.

Most of us have reopened our practices but with some limitations and an abundance of caution — caution to protect ourselves but, just as important, our patients and staff. There have been countless webinars helping guide us through a landscape that is continuously changing. I have now collaborated with the 

 on four of these, all of which were developed with 100% editorial integrity and no outside sponsorship influences. We did it because we wanted to do our part: colleagues helping colleagues; professionals helping professionals. The Medico-Legal Panel was particularly sobering, as we live in the only country in the world with more attorneys than physicians.

Now we move forward and inch toward normalcy or, hopefully, something close. We will continue to network with one another, and this publication will continue to do its part in helping us navigate these treacherous waters. At this point, let’s hope we have seen the worst that mother nature can offer and that we all stay healthy and are in a position years from now to talk to our younger colleagues and grandchildren about the Pandemic of 2020.

But for now, remember to look at the process of rebuilding our practices as a marathon, with an eye on the months to come. Our focus should be on making certain that we do things the right way and should consider all of those who work so hard for us as well as those who love us. Wishing everyone health and happiness in the days ahead. And, hopefully, my favorite Beatles song, "Here Comes the Sun," paints a picture of where we go from here.

In his latest editorial, Dr. Randolph Waldman reflects on practicing aesthetic medicine during the pandemic and paints a picture of hope for where the specialty goes from here. 

‘Here Comes the Sun’

, we bring you cutting-edge treatment- and trend-related content, while also confronting some of the real issues affecting the specialty. We take a serious look at diversity in aesthetics as well as pandemic-related legal issues and lessons learned from the COVID-19 shutdown. This issue features several physicians who are finding ways to creatively navigate this largely uncharted territory in which we find ourselves. Dr. Suneel Chilukuri shares a new “functional” use for the body toning technologies. Others share new opportunities in skincare sales and addressing the rise in stress-induced hair loss. In one of the first virtual meetings that took place since the onset of the pandemic, Dr. Kian Karimi suggests that threads are the new “injectable,” and Dr. Jacob Haiavyshares his protocols for managing or treating capsular contracture with LED light.