Dr Anil Rajani discusses combining a range of Novathreads with complimentary treatments for optimal results

In my practice I try to focus on offering the most natural, three-dimensional overall rejuvenation to my patients. To achieve this, I am continually evaluating the utility of the “tools” that are available and of the innovations that come to market.

Over the past 20 years, practitioners in this country have been able to broaden their aesthetic tool box with a variety of neurotoxins and dermal fillers as well as laser and light sources. Then PRP — and most recently PRF (Platelet-Rich Fibrin), Microneedling and flexible fillers have shaped our practices. Despite these advances I was still missing a great way to lift and shape the lower face, strengthen dermal planes and assist PLLA in more difficult cases where skin damage was excessive and dermal thickness lacking.


Then came the Novathreads PDO (polydioxanone) threads and over the past 3 years I have developed protocols (and continue to do so) for combination treatments involving PDO, fillers & PRF to obtain optimal facial rejuvenation and my patients’ guaranteed satisfaction! Combination treatments are increasingly popular as they reveal the most dramatic and natural results while also making practical and economic sense for clinics.

Novathreads work well in combination with fillers, energy-based devices, neurotoxins blood products and PLLA, making them very versatile. They can be used for the face and body with allergic reactions being extremely rare. Patients love the fact that polydioxanone (PDO) resorbs so there is no permanency, while the effects can last for years. Once comfortable with an initial treatment most clients go on to treat multiple areas including the face, neck and body. Those patients who do not want fillers or fear a ‘fake’ look seem very open to PDO threads and even fancy the concept. There is no risk of overfilling or the dreaded ‘puffy’ look achieved when adding too much volume for the sake of lifting. In fact this exact phenomenon is what the threads prevent in facial applications.

Smooth and ‘twist’ Novathreads

Figure 1 Shows (A) before and (B) after Novathread treatments on the neck, cheek and jawline. Photos courtesy Dr. Anil Rajani

The so-called ‘smooth’ and ‘twist’ Novathreads are very quick and easy to deploy. They are perfect for those starting out with threads and looking for add on procedures with great patient satisfaction. Almost all patients can benefit, side effects are rare and patient tolerance is extremely high. Smooth threads deploy a single filament while the twists have PDO suture coiled along the needle or cannula. I use twists where I need more thread for collagen formation or where I want a little added volume. Lip vermillion borders, necklace lines and smile lines are great starting points. I like that I can add on these two thread types in just a few minutes so I do not need to reschedule another appointment for the client. This efficiency not only make sense for our clinics financially, but patients appreciate multiple treatments during each visit, maximizing their time as well. There is no risk of arterial occlusion so I can use them in vascular areas I may not want to use fillers. I also popularly add them where I do not want to use neurotoxins but patients request smooth skin such as above the brow where toxins can lower the brow and filers can create vascular issues. Fillers and neurotoxins can also be layered together if the area is appropriate aesthetically and anatomically.

Barb Novathreads

‘Barb’ or cog Novathreads are all the rage and everyone wants to learn these to ‘lift’ the face. Prior experience with microcannula injections and navigating longer planes will aid in learning this technique. In my experience both smooth and barb threads create a lift albeit to different extents. Barbs have the added benefit of appealing to those wanting instant lifting gratification. Application in the neck region is fairly quick and an easy add-on procedure whereas facial threads I will often book as a separate session or give myself added time should I be using them in combinations. Most will be counseled on needing combinations with fillers, PLLA and resurfacing if they have not had those prior but barb threads can be a staple of this protocol or used as a standalone if appropriate.

As fat descends, and the chin area tends to look more square and wide over time. While filling the lines successfully, dermal filling can have the unwanted consequence of augmenting this aging aesthetic angle. The addition of barb threads has allowed me to fill the lower facial region less and less. Aesthetically this has led to much more pleasing results. I depend less on my fillers and neuromodulators in this dynamic region which catches the eye of observers. The lower face is a focal point and must pass the scrutiny of onlookers regularly. Using barb threads, especially in this lower region at the melomental fold, is now a foundation of 3D facial rejuvenation. Pulling the fold upwards and building collagen around the threads in an upward plane reduces the absolute depth of the fold. Droplets of flexible HA filler can be added for support in small amounts that are not visible as filler but provide support to the commissure. PLLA and PRF in combination can then be layered to tighten and thicken the dermis without creating volume. This also minimizes the need for neuromodulators allowing for natural motion in a very dynamic area.

Figure 2 Shows (A) before and (B) after Novathread treatment on the knees. Photos courtesy Dr. Anil Rajani

Threads have evolved in the last few years both in our application methods and in their technology. Side effects such as bruising, thread visibility and irregularities are greatly reduced now. Novathreads PDO are resorbable so while these side effects have always been short lived, they were deterrents for some physicians historically. Our social media society demands limited to no downtime and instant results. Our quest as practitioners is always to accommodate these needs as much as possible. The economics of our practices and our staff tend to favor treatments that lend themselves to these qualities. With newer thread technology, cannula applications for even the smallest PDO threads  and much easier side effect management I feel we are now able to meet patients’ expectations.

Interest in Novathreads PDO is at an all time high. Patients are requesting them and practitioners want to learn the latest techniques. They have been used for many years around the globe and their addition is an invaluable tool for my practice. I continue to find new applications and combinations.

For more information on Novathreads, visit: www.novathreads.com

To receive training on the use of PDO threads and on Combination Therapies from the American Institute of Aesthetic Medicine (AIAM) please visit: