Q. Is just local anesthesia used? How long does the procedure take?
A. Oral sedation may be used first, then you may infiltrate along the planned path of the threads with Xylocaine with epinephrine. Alternatively, you could use nerve blocks, but I would still recommend the use of an adrenalin containing product along the needle path to reduce the risk of bruising. The entire procedure from the local to the end, is maximum one hour.

Q. Where are you doing this procedure, in your office?
A. Yes, it is an office procedure.

Q. How do you add tension to the thread?
A. The more you accordionize the skin over the needle before pulling the needle away, the tighter the thread will be. You do not gain anything making the thread too tight, since it will probably cause an indentation at first, and then eventually release itself. Caution not to make the thread too tight. Or, as one of my patients has termed it ‘pop a cog’ will occur. This could occur following the procedure if the patient smiles forcefully. With any extreme movements of the face, the barbs will release the indentation. I have termed this process ‘auto correction’ of the threads, because slight indentations will tend to release themselves with time.

Q. Are you infiltrating at the same level as you would for a face lift?
A. It’s actually deeper than for a typical needle, within the SMAS layer.

Q. Are there any contraindications?
A. There aren’t any significant contraindications except for active infection in area. In addition, you need to select patients that have reasonable expectations about what this procedure can accomplish.

Q. What do you recommend for the patients immediately following the treatment?
A. Ideally, patients should leave the tape on up to 5 days post treatment. Following this, men can do a gentle shave. A horseshoe (travel) pillow is recommended for patients while sleeping immediately post treatment to avoid them pushing on their face while sleeping.

Q. Are the spinal needles that are used disposable?
A. Yes. The other instruments will need to be sterilized in between patients.

Q. How do you charge your patients for this treatment?
A. On a cost per thread basis. For instance, if patients in our area are charged between $200 and $300 per thread. The total cost of a procedure where 3 threads are placed on either side of the brow for example (6 threads), would range from $1200 to $1800 plus taxes.

Q. During placement, can you criss cross the threads or should they remain parallel?
A. It is not a problem if one of the threads crosses over another.

Q. What effect does the thread have?
A. A biological reaction actually occurs around the barb that can be seen histologically. A capsular reaction ensues around the polypropylene thread. For this reason, the effect may be maintained after the first six weeks, even if the thread is removed.

Q. Is this procedure safe for us to try?
A. It is not a complicated procedure, and everyone will have a different comfort level about when they feel ready to do a procedure. For some individuals, me included, I want to see someone for hands on training before starting something completely new in my practice. However, if a procedure is only a variant of something I already do, then I may not seek the extra training. As plastic surgeons we are trained to cut and sew, so in comparison, this is very easy to do. I’d recommend Contour Threads as a synergistic procedure, to be used in concert with your other minimally invasive tools.