Doctors - Information - Manual - PDO - EN - 1506 - Agh - v17 RZ

WORKBOOK FOR DOCTORS
LFL PDO
Protocols and combined techniques
Supported by Dr. Lukasz Preibisz
PDO_Manual_EN_1506_agh_v17.indd 1 22.12.15 15:22

PDO
BY GRAND AESPIO
BASIC SCREW BARB II

Introduction LFL (Lead Fine Lift) PDO threads 6
Advantages of the procedure................................................................................................ 8
PDO Threads – 3S................................................................................................................ 8
Areas of application .............................................................................................................. 9
Purpose and indications ..................................................................................................... 10
Contraindications................................................................................................................ 10
Possible complications ....................................................................................................... 11
1 PDO Threads Techniques

Sandwich technique ........................................................................................................... 14
Fan technique..................................................................................................................... 15
Net technique ..................................................................................................................... 16
Sewing technique ............................................................................................................... 17
2 Indication Technique Upper Face

Upper Face: Eyebrow elevation .......................................................................................... 20
Upper Face: Muscle relaxation – Glabellar folds (Botox-like effect) ...................................... 21
Upper Face: Eyelid elevation ............................................................................................... 22
Upper Face: Forehead ........................................................................................................ 23
3 Indication Technique Middle Face

Middle Face: Puffiness reduction ........................................................................................ 26
Middle Face: Straightening nasolabial folds......................................................................... 27
Middle Face: Correction superficial wrinkles ........................................................................ 28
Middle Face: Jawline definition ........................................................................................... 29

PDO
BY GRAND AESPIO
BASIC SCREW BARB II

4 Indication Technique Lower Face
Lower Face: Smoker's Lines / Lip contour .......................................................................... 32
Lower Face: Double chin reduction..................................................................................... 33
5 Indication Technique Body

Body: Superficial wrinkles Neck .......................................................................................... 36
Body: Décolleté .................................................................................................................. 37
6 Case Studies
Female, Age 35, Eyelid elevation, Cheek elevation .............................................................. 40
Female, Age 55, Jawline definition, Superficial wrinkles Neck.............................................. 41
Female, Age 43, Eyebrow Lifting, Jawline definition, Double chin reduction ........................ 42
Female, Age 40, Forehead smoothing, Eyebrown lifting, Jawline definition .......................... 43
Female, Age 48, Jawline definition ...................................................................................... 44
7 FAQs
FAQs - depending on location ............................................................................................ 48
General FAQs ..................................................................................................................... 50
FAQs complications / solutions ........................................................................................... 52
8 Product information
Product information ............................................................................................................ 56
Notice................................................................................................................................. 58
Notice................................................................................................................................. 60
Princess-App...................................................................................................................... 62

Introduction LFL (Lead Fine Lift) PDO threads
LFL is a premium lifting thread made of PDO (Polydioxanone) which is absorbed

after proliferating collagen and by stimulating fibroblasts. Everyone can experience
overall face contouring and skin elasticity. It brings a natural and dramatic effect to
face and body after a simple and safe treatment. The superior quality of the Ultra
Thin Wall Needle allows treatment to be straightforward, effective and painless.
The production process for the LFL product line is automated, modern and clean,
resulting in state-of-the-art technology.
Mechanism
Production of collagen in response to the presence and irritation of a foreign
body (thread) plus mechanical injury (by needle) stimulates blood flow and
increases metabolism in the treated area.
Technology
• Ultra Thin Wall Needle allows a thicker PDO thread to be inserted into the
needle
• Sharp and neat needle edge, achieved by special new grinding technology
• Special coating with less resistance enables the needle to be inserted into
the skin smoothly
Features
• Ultra Thin Wall High Quality Needle
• Qualified PDO thread
• Patented
• Medical Product - Class III
• CE Certification
Effects
• Lifting
• Skin rejuvenation (Tightening, Brightening)
• Wrinkle Smoothing

Benefits
• Safe
• Easy
• Effective
• Short downtime
Before the operation it is important to evaluate:

• Skin (dermatochalasis)
• Skin thickness
• The skin texture
• Skin elasticity
• The possible presence of permanent implants
• The possible presence of disease
• Any ongoing pharmacological therapy
The application possibilities shown and described in this document do not conform
to the existing medical indication and the intended use of the products
(surgical suture material) and are not meant to be instructions for use or application
recommendations and have a purely demonstrative and exemplary character. There is
a risk of complications and unintended side-effects if the products are applied
according to this document (for details and a suggestion how to address such
complications, please refer to the corresponding section in this document). All and
any application of the products are carried out at the sole risk and danger of the
applying physician. There are no clinical studies documenting the successful outcome
of the application. All shown application possibilities and complication handling advices
were independently developed by Dr. Preibisz (Sinusmedical, ul. Znanieckiego 16 c,
03-980 Warszawa, Poland). Therefore, CROMA and the manufacturer of the products
assume no liability for any damages resulting from the application of the products
or the handling of complications as demonstrated in this brochure.

Advantages of the procedure
Advantages
• Safe operation
• Simple to learn and easy to perform
• Quick procedure (duration about 20 - 30 minutes)
• Instant results
• High efficiency
• Lack of cuts and scars
• The effect is maintained for more than 1 year
• The thread is completely absorbed so procedure may be repeated
• Threads are not visible and are not felt
• Hardly any side effects and few complications
• Short recovery period
PDO Threads – 3S
• CE certificate
Safe
• Absorbable thread
• Short procedure
Speed
• Immediate result
• Non invasive procedure

Simple
• Very short down time

Areas of application
On the face
1
2 6
3
4
7
5
8
9
10
01. Vertical and horizontal forehead wrinkles 06. Glabellar lines

02. Brow lifting 07. Wrinkles on the cheeks
03. Lower eyelid 08. Marionette fold
04. Malar prominence 09. Submental fold
05. Pronounced nasolabial fold 10. Drooping cheeks and the area
under the lower jaw
11. V-Lifting
On the body
• Folds and wrinkles on the neck and chest
• Sagging tissue and stretch marks on the buttocks, abdomen, arms and legs
• Rugged terrain skin and subcutaneous tissue (especially after liposuction /

lipolysis)
• Treatment of superficial scars

Purpose and indications
Purpose
• Eliminate fine wrinkles
• Smooth deep wrinkles
• Improve skin colour, elasticity, texture
• Delay aging process and prevent sagging
• Increase of skin density, thickness, elasticity
Indication
• Recommended for the prevention and treatment of
involution changes due to aging
• Patients age group 30 - 55 plus
Contraindications
Contraindications
• Various acute infectious diseases of the skin (viral, bacterial, fungal)
• Other inflammational diseases of the skin
• Skin cancers
• Tendency to keloids
• Haematological diseases with bleeding tendency and blood clotting drugs
• Autoimmune disease
• Active granulomatosis disease (like sarcoidosis or annular granoluma)
10

Possible complications
Complications
• Swelling, erythema
• Occasional hemorrhage, hematoma

- a hematoma can last up to 2 weeks
• Temporary irregularities
- can take up to 7 days to straighten
- if irregularities are severe the skin should be smoothed immediately after
treatment to make it smooth
• Infection as a result of failure to comply with antiseptic procedures

- Infection needs medical treatment
- Irritation or allergy can also occur towards the antiseptic
• Translucence of thread in case of abnormally superficial introduction

- The thread is no longer visible after 2 weeks
• Painful to touch or pain on chewing

- can last up to 2 - 7 days after treatment but will then disappear
• Small bruise depending on individual reaction
• Formation of small bumps where the thread ends under the skin:
Treatment methods
1) Massage + Mesotherapy
2) Triamcinolone
3) Remove the thread
11

01PDO Threads
Techniques
12

13

1.1 Sandwich technique
Needles are inserted in the same direction but in different layers of the skin
Products: Basic; Screw

Effect: Smoothing of the skin by giving volume
Indications: Face but also scars and stretch marks
14

1.2 Fan technique
Needles are inserted in different directions into only one layer of the skin
Products: Basic; Screw

Effect: Smoothing of the skin, deep mouth angle,
marionette lines
Indications: Face and body
15

1.3 Net technique
Parallel insertion of the needles from two different directions
Products: Basic
Effect: Volume creation, tissue support, superficial
cheek wrinkle reduction
Indications: Face and body
16

1.4 Sewing technique
• Sewing by alternating in between hypodermis layer and deep dermal layer

• To see if deep dermal layer has been sewn from outer skin, we check if
dimple has been created
• If we sew too superficially, there will be much bruising and oedema
• Regarding hypodermal layer, do not go so deep as to reach muscle
Features of the sewing technique

• Can pull the skin towards whichever direction wanted depending on how
many times one sews the deep dermal layer
• Stimulate skin’s stem cell layer to drastically increase the production of fibroblasts
Products: Basic
Effect: Smoothing of deep wrinkles
Indications: Face
17

02Indication Technique
Upper Face
18

19

2.1 Upper Face: Eyebrow elevation
Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm
20

2.2 Upper Face: Muscle relaxation –
Glabellar folds (Botox-like effect)
Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm
21

2.3 Upper Face: Eyelid elevation
Product: Basic 31G / 30mm
Product:
Basic 31G / 30mm, 29G / 40mm
22

2.4 Upper Face: Forehead
Product: Basic 29G / 40mm, 29G / 50mm, 27G / 60mm
23

Middle Face
24

25

3.1 Middle Face: Puffiness reduction
Product: Basic 31G / 30mm, 29G / 40mm
26

3.2 Middle Face: Straightening
nasolabial folds
Soft lift
Product: Screw 26G / 60mm
Stronger lift
Product: Barb II 23G / 60mm, 21G / 60mm
27

3.3 Middle Face: Correction superficial
wrinkles
28

3.4 Middle Face: Jawline definition
Product: Basic 25G / 90mm
Product:
Men: Barb II 21G / 90mm
Women: Barb II 23G / 90mm
29

Lower Face
30

31

4.1 Lower Face: Smoker's Lines /
Lip contour
Product:
Basic 31G / 30mm, 29G / 40mm
Product:
Basic 31G / 30mm, 29G / 40mm
32

4.2 Lower Face: Double chin reduction
Product: Basic 29G / 40mm and longer, Screw 29G / 40mm and longer
33

Body
34

35

5.1 Body: Superficial wrinkles Neck
36

5.2 Body: Décolleté
Product:
Basic 29G / 50mm,
27G / 60mm, 25G / 90mm
Product:
Screw 29G / 40mm,
Basic small – medium
37

06Case Studies
38

39

6.1 Female, Age 35
Eyelid elevation, Cheek elevation
Treatments
• Eyelid elevation (9x per side Basic 31G / 30mm)

• Cheek elevation (4x per side Barb II 23G / 60mm)
before immediately after after two months
40

6.2 Female, Age 55
Jawline definition, Superficial wrinkles Neck
Treatments
• Jawline definition (2x per Side Barb II 23G / 90mm)

• Superficial wrinkles Neck (5x per Side Basic 27G / 60mm)
before immediately after
41

6.3 Female, Age 43
Eyebrow Lifting, Jawline definition, Double chin reduction
Treatments
• Eyebrow Lifting (2x Barb II 23G / 60mm) just one side to correct asymmetry
• Jawline definition (2x per side Barb II 23G / 90mm)
• Double chin reduction (12x Basic 27G / 60mm)
before immediately after
42

6.4 Female, Age 40
Forehead smoothing, Eyebrown lifting, Jawline definition
Treatments
• Forehead smoothing (8x Basic 25G / 90mm, Basic 27G / 60mm),

Eyebrow lifting (1x per side Barb II 23G / 60mm)
• Jawline definition (2x per side Barb II 23G / 90mm)
before after two months
43

6.5 Female, Age 48
Jawline definition
Treatments
• Jawline elevation (4x per side Barb 23G / 90mm, 1x per side Barb II
23G / 60mm)
before after two months
44

45

07FAQs
46

47

FAQs - depending on location
UPPER FACE
Forehead
• Does it matter from which side you implement threads to improve forehead
horizontal wrinkles?
There is no difference whether one introduces threads from the right to left or
vice versa. It is important, however, to administer them to the same depth and
parallel to the horizontal forehead wrinkles.
• How deeply one should implement the thread in order to achieve the effect of
Botox in the glabellar area?
In this case, the thread must be given directly into the frontalis muscle which is
below the level of the skin and subcutaneous tissue. The best product seems
to be a screw-type thread with a length and a thickness adapted to a specific
patient.
Eyebrow elevation
• What is the difference between the use of a screw-type thread and one with
hooks?
Screw-type threads are used to obtain a softer effect of eyebrow elevation,
while the barbed one has a much stronger effect. The lifting effect of one barbed
thread corresponds to the effect of at least 4 screw-type threads.
MIDDLE FACE
Cheeks - superficial wrinkles
• Which threads and how deep they should be introduced?

The best alignment of superficial cheek wrinkles can be achieved by using
the basic plain threads of medium length and medium thickness using the net
technique.
48

LOWER FACE
Jaw line
• How many threads are needed to raise a drooping jaw line?

It depends on how great the skin laxity is and the thickness of the skin of the
patient. Generally from 2 to 5 barbed threads a side will improve this laxity.
Double chin
• Which threads and what way to implement them?

In this case, the type of thread depends on the positioning of the sagging chin.
Consider the use of plain and screw threads of medium length; in some cases
the barbed threads can also be used. If so, the fixation point for the barbed
thread should be as high as possible above the jaw line though the other end
of the thread should curve below the jaw line to reach the double chin, this will
bring tension to the chin.
Neck
• What to do if a thread becomes visible through the skin on the neck?

Neck skin is very delicate and highly translucent; the blue colour of the thread will
not last and will dissolve in the skin after about two weeks. So one should wait.
Facelift
• Which threads to choose to obtain a lifting effect for a muscular/big man?

If the skin is thicker and slacker, the thicker the barbed threads should be selected.
Thread tension can also be increased by working from a single point using the
fan-technique. After removing the needle the tension of the threads can be
increased by pulling them together, rotating them before final cutting. This will
give additional lifting effect in such case.
49

General FAQs
• What to do if a thread goes above the surface of the skin?

One should cut the thread as close as possible next to the skin. Before the
thread is cut, the skin should be moved downwards by pressing along its
course towards the protruding end to obtain the maximum deflection above
the surface of the skin. Then cut the thread off. Finally massage the remaining
part of the thread in the skin in the opposite direction.
• Which type and how many threads to buy?

Choosing the thread type one should be guided by the characteristics of one's
own patients as well as the implementation technique in which you have most
experience and confidence.
It is worth having a full range of products, because you never know what the
expectations of the next patient will be.
If the majority of patients require lifting effect - increase the purchase of barbed
threads.
If, however, the majority of patients have dark circles under the eyes, in this
case, you should purchase more short, thin plain threads.
When summer approaches, women are more likely to take care of the neck/
décolleté - damaged and destroyed by previous exposures to sunlight. In this
case consider purchasing an additional number of medium and long plain
threads.
Of course, if you feel most confident in a particular procedure, such as eyebrow

lifts - you should obviously purchase the short barbed threads.
• Which threads bring the best outcome?

The best outcome is provided by the use of multiple parallel threads
implementation techniques in conjunction with HA and botulinum toxin, as a
complement to the thread treatment. This gives much greater satisfaction to the
patient and allows for regular and long-term planning over the years leading to
full patient satisfaction when looking in the mirror.
50

• How to calculate the cost of a thread treatment: by single threads or by full
treatment?
We need to know about the cost of the thread in the calculation of the entire
operation. Because the price of use of a single barbed thread and plain one
are definitely different. When giving the price for the procedure/treatment leave
yourself more options in the selection/adaptation of products in the course of
the procedure itself. If the price is agreed on the basis of a single thread and
during treatment the effect is different from that expected, it is not possible to
change the agreed parameters of the procedure. The patient will pay for the
expected effect rather than the number of threads.
51

FAQs complications / solutions
The most common:
• Hematoma, bruising and swelling after the treatment. These are symptoms
that automatically disappear. Swelling is gone within 1-2 days. Hematomas
turn into bruises and last up to 2 weeks. If such symptoms occur, topical
Arnica ointment and anti-inflammatory drugs like ibuprofen can be used.
• Asymmetry after the treatment are usually associated with oedema. Wait a
week and re-evaluate facial symmetries.
If the imbalance persists perform the correction procedure. If overcorrection

using barbed threads, then massage along a length of the thread to reduce
the tension force. If the effect is too weak, another thread needs to be inserted
in this area.
• Thread out of skin - should be cut as close to the skin as possible
• Elevation at the injection point of the thread. This is due to the suspension
of the thread and the pressure on the skin from the inside. The best solution
is a massage of the area1- 2 times a day for 5-7 days. Additionally, one can
perform gentle/small amount injection of hyaluronic acid.
52

The most serious:
• Infection at the injection site. Usually associated with insufficient antisepsis.

Symptomatic treatment as in the case of local skin infections.
• Allergy to threads - no data.
53

08Product information
54

55

8 Product information
LFL BASIC
LFL BASIC is made with Polydioxanone (PDO) suture,

which is widely used in skin rejuvenation and local firming
purposes for various body and face areas.
SPECIFICATION
GRIP NEEDLE FILAMENT

USP PACKAGING
Colour Gauge Length Length
31 G 30 mm 30 mm 7-0
29 G 40 mm 50 mm 6-0 5 pcs/steri pack,
5 steri pack/pouch,
29 G 50 mm 70 mm 6-0
2 pouches/box
27 G 60 mm 90 mm 5-0 = Total 50 PDO‘s
25 G 90 mm 150 mm 5-0
LFL SCREW
LFL Screw with a spiral shape suture can lead to

localised lifting and internal volumising. Due to the
shape of the thread, there is a higher concentration of
thread material in the applied area. This leads to a higher
collagen production.
SPECIFICATION

USP PACKAGING
29 G 40 mm 52 mm 6-0 5 pcs/steri pack,
5 steri pack/pouch,
27 G 50 mm 70 mm 5-0
2 pouches/box
26 G 60 mm 90 mm 5-0 = Total 50 PDO‘s
56

LFL BARB II
LFL Barb II with bi-directional cogs acts to hold the skin

like double hooks when the thread is tightened. It is the
most powerful option for any specific body and face
areas.
SPECIFICATION

USP PACKAGING
60 mm 90 mm
23 G 4-0 1 pcs/steri pack,
90 mm 150 mm 12 steri pack/pouch,
60 mm 90 mm 1 pouch/box
21 G 3-0 = Total 12 PDO‘s
90 mm 150 mm
57

Notice
58

59

Notice
60

61

Princess-App
All secrets about PDO and filler treatments.

Learn from experts in HD-Video online classes.
More than 40 videos online - wherever you are - get it now!
Web version available: www.princess-app.com
62

Lukasz Preibisz, M.D. specializes in the fields of
dermatology and venereology in Warsaw, Poland.
„PDO threads have created a new chapter in skin

rejuvenation for both my patients and me. You can
achieve long lasting aesthetic effects for difficult regions
such as décolleté, neck and middle/lower face.
Additionally, combining thread lifts with other non-

invasive procedures such as anti-wrinkle injections,
laser treatments and facial peels, is an effective way
to help improve a patient’s overall results.“
63

CROMA–PHARMA GmbH | Industriezeile 6 | 2100 Leobendorf | Austria
Tel.: +43/2262/68468 -0 | www.princess-lift.com
Distributed by:
CROMA–PHARMA GmbH
Industriezeile 6, 2100 Leobendorf, Austria I Tel.: +43/2262/68468-0 I Fax.: +43/2262/68468-165 I E-Mail: derma@croma.at
Patented and certified by:
GRAND AESPIO INC. MEDIFIRST DONGBANG ACUPRIME

610 Nonhyeon-ro, Gangnam-gu 1049-16 Charyeonggogae-Road, 1 The Forrest Units Gwangd
Seoul 135-830 Gwangdeok-myeon, Dongnam-gu, Hennock Road East
Korea Cheonan-si, Chungnam, 330-922, Exeter EX2 8RU, UK
Korea
33822 | PLPDOM000Aa

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WORKBOOK FOR DOCTORS

Protocols and combined techniques

Supported by Dr. Lukasz Preibisz

PDO_Manual_EN_1506_agh_v17.indd 1 22.12.15 15:22

BASIC SCREW BARB II

PDO_Manual_EN_1506_agh_v17.indd 2 22.12.15 15:22

1 PDO Threads Techniques

2 Indication Technique Upper Face

3 Indication Technique Middle Face

PDO_Manual_EN_1506_agh_v17.indd 3 22.12.15 15:22

BASIC SCREW BARB II

PDO_Manual_EN_1506_agh_v17.indd 4 22.12.15 15:22

5 Indication Technique Body

PDO_Manual_EN_1506_agh_v17.indd 5 22.12.15 15:22

LFL is a premium lifting thread made of PDO (Polydioxanone) which is absorbed

PDO_Manual_EN_1506_agh_v17.indd 6 22.12.15 15:22

Before the operation it is important to evaluate:

PDO_Manual_EN_1506_agh_v17.indd 7 22.12.15 15:22

• Simple to learn and easy to perform

• Quick procedure (duration about 20 - 30 minutes)

• Lack of cuts and scars

• The effect is maintained for more than 1 year

• The thread is completely absorbed so procedure may be repeated

• Threads are not visible and are not felt

• Hardly any side effects and few complications

• Short recovery period

• Non invasive procedure

PDO_Manual_EN_1506_agh_v17.indd 8 22.12.15 15:22

01. Vertical and horizontal forehead wrinkles 06. Glabellar lines

• Rugged terrain skin and subcutaneous tissue (especially after liposuction /

• Treatment of superficial scars

PDO_Manual_EN_1506_agh_v17.indd 9 22.12.15 15:22

• Smooth deep wrinkles

• Improve skin colour, elasticity, texture

• Delay aging process and prevent sagging

• Increase of skin density, thickness, elasticity

• Patients age group 30 - 55 plus

• Other inflammational diseases of the skin

• Haematological diseases with bleeding tendency and blood clotting drugs

• Active granulomatosis disease (like sarcoidosis or annular granoluma)

PDO_Manual_EN_1506_agh_v17.indd 10 22.12.15 15:22

• Occasional hemorrhage, hematoma

• Infection as a result of failure to comply with antiseptic procedures

• Translucence of thread in case of abnormally superficial introduction

• Painful to touch or pain on chewing

• Small bruise depending on individual reaction

PDO_Manual_EN_1506_agh_v17.indd 11 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 12 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 13 22.12.15 15:22

Products: Basic; Screw

PDO_Manual_EN_1506_agh_v17.indd 14 22.12.15 15:22

Products: Basic; Screw

PDO_Manual_EN_1506_agh_v17.indd 15 22.12.15 15:22

Parallel insertion of the needles from two different directions

PDO_Manual_EN_1506_agh_v17.indd 16 22.12.15 15:22

• Sewing by alternating in between hypodermis layer and deep dermal layer

Features of the sewing technique

PDO_Manual_EN_1506_agh_v17.indd 17 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 18 22.12.15 15:22

PDO_Manual_EN_1506_agh_v17.indd 19 22.12.15 15:22

Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm

PDO_Manual_EN_1506_agh_v17.indd 20 22.12.15 15:22

Product: Screw 29G / 40mm, 27G / 50mm, 26G / 60mm