Threads, Skin Boosters, and the Newer Stuff

This is the chapter where I get to be the most honest with you about what the industry is selling versus what the evidence supports.

The procedures I'm going to discuss in this chapter sit in a different category than Botox and traditional filler. Some of them have solid science behind them and just haven't reached the same level of household awareness. Others have aggressive marketing budgets and weaker evidence. A few have so much hype around them right now that you'd think they were revolutionary, when really we're still figuring out what they do and how well.

I'm going to walk through each one and give you my actual clinical perspective. Not the marketing copy. Not the influencer talking points. What I'd tell my sister if she asked me whether she should try it.

PDO Threads

Threads have been around for decades in their original surgical form. The modern aesthetic version uses dissolvable threads made of polydioxanone (PDO), polylactic acid (PLA), or polycaprolactone (PCL). Different materials have different properties and dissolution timelines.

There are two general categories:

Smooth or mono threads. Thin threads placed in a mesh-like pattern under the skin. They don't lift. They stimulate collagen production over time as the body responds to the threads being there. Sometimes called "skin quality threads."

Barbed or lifting threads. Threads with small barbs along their length that grab onto tissue. These are placed in specific patterns to physically lift sagging skin, particularly in the cheeks, jawline, neck, and brow areas. They provide an immediate lift effect that softens as the threads dissolve, while leaving behind some collagen stimulation as a longer-term benefit.

What threads can do:

For barbed lifting threads, provide a real but modest lift to mildly sagging tissue. Particularly useful for early jowls, mild brow descent, mid-face laxity, and neck softening in patients who aren't ready for surgery but want more than skincare and Botox can offer.

For smooth threads, contribute to skin quality and collagen support in treated areas over months.

What threads can't do:

Substitute for a facelift. Patients with significant skin laxity won't get the lift they need from threads. The most common reason patients are disappointed in threads is unrealistic expectations.

Last as long as the marketing suggests. The lift effect from barbed threads typically lasts six to twelve months, sometimes longer with newer-generation threads. The collagen-stimulating effect can persist beyond that, but the dramatic lift itself fades.

What good thread work looks like:

A subtle improvement in the position and crispness of facial contours. The cheek sits slightly higher. The jawline looks cleaner. The neck is a bit more defined. The patient looks like a refreshed version of themselves, not a lifted version of someone else.

What bad thread work looks like:

Pulling or pinching at the entry points where threads were placed. Visible thread shadows under the skin if placed too superficially. Asymmetric lift if one side was treated differently than the other. In rare cases, palpable or even visible threads that didn't fully dissolve or weren't properly placed.

Risks:

Bruising and swelling. Common, usually resolves in a week or two.

Pinching or tightness sensations at entry points. Usually settles over weeks.

Visible threads or dimpling. Sometimes resolves on its own, sometimes requires manipulation or removal.

Infection. Rare with sterile technique.

Granuloma formation. Rare delayed inflammatory reaction.

My honest take on threads:

They're real procedures with real effects, but the marketing has consistently overpromised what they can do. The "non-surgical facelift" branding is misleading. Threads are not a facelift. They're a moderate intervention that fits between non-invasive treatments and surgery.

Good candidates are patients with mild to moderate skin laxity, who understand the temporary nature of the lift, who have realistic expectations, and who are using threads as part of a broader strategy rather than as a standalone solution.

Bad candidates are patients with significant skin laxity who really need surgery, patients expecting dramatic transformation, and patients who haven't been honest with themselves about what they're hoping to achieve.

If you're considering threads, find a provider who does many of them, ask to see their results, and ask specifically about the realistic expectation for someone with your degree of laxity. A provider who promises you a facelift-equivalent result from threads is selling, not consulting.

Sculptra (Poly-L-lactic Acid)

I mentioned Sculptra briefly in the filler chapter. It deserves more attention because it operates differently than hyaluronic acid fillers and serves a different purpose.

Sculptra is a biostimulator. It doesn't add immediate volume the way HA filler does. Instead, it triggers your skin to gradually produce its own collagen over months. Results build slowly, typically requiring two to three treatment sessions spaced four to six weeks apart, with full effect developing over six to nine months.

What Sculptra can do:

Restore volume gradually and naturally over a wide area. Particularly useful for overall facial thinning that affects multiple regions, like the cheeks, temples, and jawline together.

Improve skin quality and thickness over time, not just volume.

Last longer than HA fillers, with results often holding for two to three years.

What Sculptra can't do:

Provide immediate gratification. You won't leave the appointment looking different. The results unfold over months.

Be undone. Once the collagen is built, it's there. There's no reversal agent the way there is for HA filler. This is why provider experience matters so much with Sculptra.

Address localized concerns precisely. Sculptra works best for diffuse volume restoration rather than precise sculpting of specific features.

My take on Sculptra:

It's a real and useful product when used appropriately. The challenge is that it requires both provider skill (proper dilution, reconstitution time, and injection technique to avoid nodules) and patient patience (commitment to the multi-session protocol and the slow result timeline).

It's not the right product for someone who wants to walk into a clinic, get a procedure, and leave looking different. It's the right product for someone willing to invest in a longer-term collagen restoration strategy.

Side effects to know about: small nodules can form if Sculptra is placed too superficially or not properly diluted. These can be persistent and frustrating. This is one of the procedures where provider selection really matters.

Radiesse (Calcium Hydroxylapatite)

Radiesse is another biostimulator with a different mechanism. It provides immediate volume like HA filler, then stimulates collagen production over time as the calcium-based microspheres are slowly absorbed.

Used for:

Deep volume restoration in the cheeks, jawline, and temples.

Hand rejuvenation (where it's particularly effective).

Improving skin texture and thickness when used in hyperdilute form (mixed with saline and injected superficially in a different pattern than standard Radiesse).

What Radiesse can't do:

Be dissolved. Like Sculptra, this is not reversible. If you don't like the result, you wait for it to gradually resorb, which can take a year or more.

Be used in delicate areas. Not appropriate for lips, tear troughs, or other superficial high-movement zones.

My take on Radiesse:

In experienced hands, particularly for deep cheek and jawline support, Radiesse can give beautiful and lasting results. The hyperdilute Radiesse technique (sometimes called "skin booster" injections) has become popular for overall skin quality improvement and can produce subtle, lovely effects.

The lack of reversibility is the main caution. If you're considering Radiesse, you need to be highly confident in your provider's skill and judgment.

Skin Boosters (Profhilo, Restylane Skinboosters, Others)

This is a category of injectable that's gained significant attention in the last few years. Skin boosters are hyaluronic acid products designed not to add volume but to hydrate the skin from within and stimulate collagen and elastin production.

The most well-known is Profhilo, which is widely used in Europe and increasingly available in the US. It's injected in a specific pattern of small deposits across the face that then spread and integrate to improve overall skin quality.

What skin boosters can do:

Improve skin hydration, glow, and quality over a series of treatments.

Address mild texture and fine line concerns.

Provide a subtle "lit from within" quality that's hard to achieve with surface treatments alone.

What skin boosters can't do:

Replace traditional filler when actual volume restoration is needed.

Provide dramatic transformation. The results are subtle by design.

Work in a single treatment. Most protocols require two to three sessions spaced weeks apart to see meaningful results.

My take:

Skin boosters are a legitimate category with real, if subtle, effects. They're often misunderstood by patients who expect filler-like changes and instead get gradual skin quality improvement. For the right patient with the right expectations, they can be wonderful.

If your skin looks generally good but lacks that quality of plumpness and glow that's hard to define, skin boosters might be worth exploring. If you have specific volume or structural concerns, they're not the answer.

Polynucleotides

This is one of the newest categories. Polynucleotides (sometimes marketed under brand names like Ameela, Plinest, and others) are fragments of DNA, typically derived from salmon, that are injected into the skin to stimulate regeneration and healing.

The marketing claims are significant: improved skin quality, collagen stimulation, healing of damaged skin, anti-aging effects.

The evidence is genuinely promising but still developing. Studies have shown effects on skin quality, particularly in challenging areas like the under-eyes and neck. Korean and European clinics have been using polynucleotides longer than the US, and their experience is informing wider adoption.

What polynucleotides may do (based on emerging evidence):

Improve skin quality and texture in specific areas, particularly the under-eye area where they're commonly used.

Support healing in damaged or compromised skin.

Stimulate gradual improvements similar to other biostimulators.

What we don't fully know yet:

How they compare directly to other biostimulators in head-to-head studies.

The optimal treatment protocols and intervals.

Long-term durability of effects.

My take:

I'm cautiously optimistic about polynucleotides. The mechanism makes sense, the early evidence is encouraging, and the safety profile appears good. But the marketing has moved faster than the data, and patients are often presented with polynucleotides as if they're a settled, miraculous treatment when we're still figuring out their best applications.

If you're considering polynucleotides, particularly for under-eye concerns where they show the most promise, work with a provider who has actual experience with them, not someone who just added them to their menu last month. Expect gradual results over multiple treatments, not transformation in a single session.

Exosomes

Now we're getting into the territory where the marketing has dramatically outrun the evidence.

Exosomes are tiny vesicles released by cells that contain proteins, lipids, and genetic material. The theory is that applying exosomes to the skin (typically post-procedure, like after microneedling or laser treatment) delivers regenerative signals that improve healing and outcomes.

The science is fascinating and genuinely promising in research settings. The clinical reality is messier.

Current concerns:

The FDA has not approved any exosome product for cosmetic use. Products marketed in aesthetics are typically positioned as cosmetic adjuncts or topical applications, not regulated medical treatments.

There's significant variability in exosome products from different sources. Without standardized regulation, what you're getting in one clinic may be very different from another.

Some exosome products marketed in aesthetics have been associated with adverse events, including infections from contaminated products.

The evidence base for the specific aesthetic claims is thin compared to the marketing volume.

What I tell patients:

Exosomes might be the future. They might also be the next product category that gets cleaned up after regulatory attention catches up with the marketing. Right now, we're in a Wild West phase where products vary widely, claims are aggressive, and the actual evidence for aesthetic use is still being established.

If a provider is heavily pushing exosomes as a key part of your treatment plan, especially at significant added cost, ask specific questions. What product specifically? What's the source? What's the regulatory status? What's the evidence for this specific application?

A skilled provider may use exosomes thoughtfully as part of a broader treatment plan. A less skilled one may be marketing them as the new miracle while charging $300 to $800 per session for unclear benefit.

PRP and PRF (Platelet-Rich Plasma and Platelet-Rich Fibrin)

These have been around longer than the newer biostimulators and have established places in aesthetics.

The procedure involves drawing your own blood, processing it to concentrate the platelets and growth factors, and either injecting the resulting product or applying it during procedures like microneedling.

What PRP and PRF can do:

Support healing and outcomes after procedures like microneedling, laser treatments, and hair restoration work.

Provide modest improvement in skin quality and texture over treatment series.

Be used for under-eye concerns, where some patients see real improvement in skin quality and color.

What they can't do:

Provide dramatic transformation in a single treatment.

Replace established procedures with stronger evidence bases.

My take:

PRP and PRF have legitimate uses in aesthetics, particularly as adjuncts to other procedures. They're also frequently overhyped and overpriced relative to their actual benefit. The "vampire facial" marketing in particular has made these treatments seem more revolutionary than the evidence supports.

If your provider is offering PRP as an add-on to microneedling at a reasonable price, that's a defensible choice. If they're offering it as a standalone $1,500 treatment promising transformation, you're paying for marketing more than results.

Mesotherapy

A category of treatments where various substances (often vitamin cocktails, amino acids, hyaluronic acid, or other ingredients) are injected superficially into the skin to improve quality.

This is widely practiced in Europe, South America, and Asia. Less common in the US.

What it can do:

Provide gradual improvement in skin hydration, texture, and tone.

Address specific concerns like under-eye circles or skin laxity with formulations targeted to those issues.

What it can't do:

Provide dramatic results.

Substitute for stronger, more established procedures when significant concerns exist.

My take:

Mesotherapy occupies a middle ground in aesthetics. It can be lovely as a maintenance treatment for someone whose skin is generally good and wants to keep it that way. It's not the right treatment for major aesthetic concerns.

The challenge is that mesotherapy formulations vary widely between providers and countries. You may be getting an excellent, evidence-based formulation. You may be getting an aesthetician's idea of what works. Provider selection matters.

Microneedling RF Combinations (Morpheus8, Vivace, Secret, Others)

These deserve their own category because they've become so popular and represent some of the most useful newer technology in aesthetics.

These devices combine microneedling (which creates controlled injury to stimulate skin remodeling) with radiofrequency energy delivered through the needles into deeper layers of skin. The result is more dramatic tightening, collagen stimulation, and skin quality improvement than either treatment alone.

Common brand names: Morpheus8, Vivace, Secret RF, Genius RF, Sylfirm X. They have different technical characteristics but operate on similar principles.

What they can do:

Tighten mild to moderate skin laxity, particularly in the lower face and neck.

Improve skin texture, pore appearance, and overall quality.

Address acne scarring in some cases.

Provide more dramatic results than traditional microneedling alone.

What they can't do:

Substitute for a facelift in patients with significant laxity.

Provide immediate dramatic results. Optimal results develop over several sessions and several months.

Be appropriate for all skin types without consideration. Patients with very darker skin tones need specific approaches and settings to avoid pigment complications.

My take:

This category includes some of the most exciting non-surgical technology available. When used appropriately, in the right patient, by an experienced provider, the results can be remarkable.

The cautions: marketing has positioned some of these devices (Morpheus8 in particular) as transformative in ways that overpromise. Results vary significantly based on patient anatomy, age, and skin condition. Multiple sessions are usually needed. And the technology requires real skill to use effectively. Not every clinic offering Morpheus8 has providers using it well.

We'll discuss this in more depth in Chapter 14, which is dedicated to microneedling and radiofrequency treatments.

A Final Word on the Newer Stuff

The aesthetics industry is constantly introducing new products and treatments. Some are genuinely innovative. Many are repackaging of older concepts with new marketing. A few are problematic enough that they end up withdrawn or restricted by regulators.

Here's my framework for evaluating anything new:

How long has this been used in clinical practice, including in countries with different regulatory environments? A treatment that's been used in Europe or Korea for ten years before reaching the US is in a different evidence category than one that just appeared.

What's the actual published evidence? Not the marketing materials. The peer-reviewed studies.

Is the regulatory status clear and appropriate? An FDA-approved product with specific indications is different from a product marketed in a gray area.

Who's recommending it? An injector who's been doing thoughtful work for fifteen years has a different perspective than someone who adds the latest treatment to their menu every six months.

What's the worst-case scenario? Newer treatments often have less data on long-term effects and rare complications. The risk profile may be incompletely understood.

I'm not telling you to avoid newer treatments. Some of them are excellent. I'm telling you to apply healthy skepticism, ask hard questions, and not let the "new and exciting" framing override your ability to evaluate whether something makes sense for you.

The next chapter focuses on lasers, peels, and resurfacing, which are some of the most established and powerful tools in aesthetics for actually changing skin quality. After that, we'll dig deeper into the microneedling and radiofrequency world.