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Understanding Facial Ageing

Facial ageing is a combination of bone, skin and connective tissue changes.

The connective tissue becomes thinner from the decreasing number of elastic fibes and collagen deposition. These are replaced by fibrotic inelactic collagen.  In addition, there is a decrease in the amout of glycosaminoglycan, proteoglycan, extracellular matrix and number of blood vessels in the skin. Hence, the skin (demis) becomes less elastic with less strength. This is known as elastosis and is more noticeable in sun-exposed area.

With a reduction in supportive tissue in the skin, blood vessls become more fragile, leading to easy bruising under the skin.

Oil gland ( Sebaceous glands ) produde less oil resulting in dryness and itchiness.

In the outer layer of our skin ( epidermis ), the number of cell layers remain unchanged but the number of pigment cells  ( melanocytes ) decreases. The remaining melanocystes increase in size forming large pigment spots like aged spot, liver spots, seborrheic keratosis in the sun exposed areas.

Another main factor of ageing appearance is ” gravity “, causing a downward drooping of our facial fats creating hollowness of the mid face and area below the eye. In addition, the jaw line becomes obscured by the drooping skin and fats.

What is thread lift?

Threadlift has been popularized over the past decades because its technique and procedures is less invasive, less costly, has less downtime, faster recovery time and much safer with few complications.

Threadlift involves insertion of thread below the skin without any long incision and is feasible to operate on the patient using local anaesthesia. The threads insertion points are usually located along the hairline to ensure no visible scar immediate post procedure.  They are usually guided along the fatty layer of the face as this layer has no sensation, ensuring  a painless experience.

Once in place, the thread grab and hold onto the skin tissue. The operator will usully push the skin upwards along the inserted thread, allowing the thread to lift up the tissue.

Tension in the thread and tissue will be converted into chemical signals such as growth factor production ( GGFB 1,2,3 ), inhibition of matrix metalloproteinase reducing collagen breakdown and indiction of wound healing effect. This will in turn ensure a prolonged lifting effect.

What happen in the skin after threadlift?

By day 6, fibrobast (collagen producing cells ), will be the major cell type along the thread. They will be producting collagen rich granulation tissue along the track.

Another key change willl be angiogenesis. As vascular endothelial growth factor (VGEF) is produced , new blood vessels form deep under the skin. They will ensure good supply of nutrition improtant for succcessful skin rejuvenation.A

By 2 months, homogenous supportive structure will be formed around the thread, resulting in a sustained facelifting effect.

Kurita et al stated the capsule like structuce are found surrounding the threas at one, three and seven months (1). Key findings are

1) Myofibroblast , collagen and other cellular component are found around the capsure.

2) Dilated vessels and a new vascular genetic activitiy are found in the fibrous capsule.

3) Greater thickness of dermal papillae indicating collagen growth.

Savoia A et al stated a histopathological examination performed two months after the procedure found a ring of connective tissue tissue ring  with thickness of approximately 70micrometers around the cavity of the thread (2).

Gamboa and Vesconez also stated that fibrosis was found around the polypropylene knot and cone of threads six months after the threadlift proceudre (3).


What is Cannula PDO Multidirectional Cogged Thread lift?

PDO refers to Polydioxanone. It is a biocompatible material that is completely absorbable. A cogged thread refers to presence of barbs along the thread 360 degree. The fact it is multidirectional means the barbs point in all direction. directions.

The presence of barbs ensure the thread is able to clinged onto the tissue after insertion. A cogged thread ensure all the tissue around the threads are clinged on. The multidirectional nature of the barbs ensure it has a firm grasp on the tissue.

Cannula refers to the tip of the delivery system is blunt and does not cut like a needle. This ensure the thread stays only in the required skin layer and minimalize the risk of injury of nerves and blood vessels.

Advantage of PDO Multidirectional Cogged Threalift.

✓ Excellent & long-lasting effect
✓ Easy insertion
✓ No risk of thread contouring
✓ No risk of thread prolapse
✓ No risk of skin deformation
✓ No side effect


Is the procedure painful?

The procedure is minimally painful. Pains occur mainly during the injection of local aenaesthesia at the insertion points of the thread.

How many mulidirectional cogged threads do I need?

Depending on the severity of the drooping as well as the number of areas that need to be treated. Lower face usually requires 3-4 multidirection cogged thread on each side. Mid face will require 2-3 threa on each side. Eye brow lift will need 2-3 thread on each side. Double chin will require 2 thread on each side.

What can be lifted using PDO Multidirectional Cogged Threalift?

1) Eye brow

2) Mid face

3) Lower face

4) Double chin

5) Neck

Who is not suitable for PDO Multidirectional Threadlift?

1) Excessive laxity of the facial skin that requires removal.

2) Require immediate result.

3) Require excessive lifting like in traditional lifting.

4) Advanced cutaneous and muscular prolapse.

What are the risks and complications of PDO Multidirectional Cogged Threadlift?

Immediate and transient risk and complication

1) Minor asymmetry of the face and rippling effect on the skin

2) Edema and swelling

3) Bruising

4) Allergic reaction

5) Early extrusion of the thread

6) Dent at insertion point of the thread

Late of persistent complication

1) Thread migration or partial extrusion ( easily corrected )

2) Persistent pain

3) Numbness in the treated area

4) Injury to blood vessels, nerve or salivary gland.

5) Chronic inflammation reaction

6) Persistent infection in the treatment area

7) Overcorrection or undercorrection




1) Kurita M, Matsumoto D, Kato H, Araki J, et al. Tissue reactions to cog structure and pure gold in lifting threads: a histological study in rats. Aesthet Surg J. 2011 Mar;31(3):347-51.

2)  Savoia A, Accardo C, Vannini F, Di Pasquale B, et al. Outcomes in thread lift for facial rejuvenation: a study performed with happy lift™ revitalizing. Dermatol Ther (Heidelb). 2014 Jun;4(1):103-14.

3)  Gamboa GM, Vasconez LO. Suture suspension technique for midface and neck rejuvenation. Ann Plast Surg. 2009 May;62(5):478-81.


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