Who Is the Best Thread Injector?

This is part 2 of a 2-part series

Part 1: Threads as ‘Injectables’

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.”

Threads in the Toolbox

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.”