Mastering PDO Threads: A Deep Dive with Denise & Michelle

Join Michelle from Les Encres and Denise Merdich, a Nurse Practitioner specializing in non-surgical aesthetic procedures, as they delve into the transformative potential of aesthetic threads. Denise shares her extensive experience in the industry, discussing the evolution of threads, patient selection, safety protocols, combination treatments with other aesthetic procedures, and the return on investment for practitioners. They also address common misconceptions, highlight the importance of proper training, and share practical insights for achieving optimal results in aesthetics.

Transcript

Hi, my name is Michelle. I am the owner of Aesthetic Nerd and I am a National Director at Les Encres. I am here to talk with Denise about everything in aesthetics. You want to introduce yourself? Hi, I'm Denise Merdich. I'm a Nurse Practitioner. I work in plastic surgery and I do all the non surgical approaches in aesthetics.

And I also own a own and operate a teaching platform, educational platform for injectables in the Tampa Bay area. How long have you been doing aesthetics? It's, I hate to say years because it really ages me, but 24 years I've been in the industry and I've  started off with Botox and evolved into fillers and all the other non-surgical approaches. 

So you've seen it, you've seen it quite a bit.  I've seen a lot of evolution in every single aspect of our aesthetics.  And, but it's exciting. And we just, the more that we learn, the more that we can do. And It's just amazing. Some of the non surgical things that we can do. Yeah. I truly believe in the same.

What is so what's your experience? What has you, has been your experience with in particular, because I'm one of the methodology experts at PDO, but 

Denise's Experience with Threads

 What has been your experience with,  in general. So I started my journey with having threads and that was about 12 years ago and I had threads from a plastic surgeon in facial plastic surgeon in France and we were Playing in an office and he put like about 100 threads in my face and we the Les Encres market wasn't really known at that time

and we didn't even bring threads to the United States yet.  So I had threads and I had every complication that one could have.  It was great for us as an injector to experience those complications and know that they're self limiting. And so the, after I got over the humps of, and all the little hurdles of all the side effects, I discovered that, wow, Six months later, four months later, I was like, loving my face.

I was like, wow, this is amazing. And I had the experience where one side of my face wasn't so good. So we had to take the threads out. Four months later, I discovered my neck on one side looked amazing. The other side did not. One side of my face didn't look so good. The other side didn't and I realized I proved to myself that, wow, threads really work.

Okay. And because I was doubtful in the first four months going through all these complications that this is not for me. And at that particular time that company gave me all the threads to use and they, I had a whole kitchen full of threads. And I was about ready to throw them in the garbage. And I didn't, I put them aside and I thought, we'll just see time will tell, right?

And I'm patient. And so I'm very grateful that I did because I soon learned the power of threads. And then I figured out, you know what, I have to figure out how to get this right and to overcome the complications. And once I did, my practice grew and grew. 

Understanding PDO and Other Materials

When I got thrown into the industry, I didn't know anything about polydioxanone and I started in nuclear medicine, which is a completely different field altogether. Is diagnostics.

And I, The more I started learning about it because I'm a molecular scientist.  Going into the science and into it. I really did discover the power of PDO and a lot of people, when I got into the industry they either are completely afraid of the product. Or they just don't know that it's been used for forever and all the modalities.

You're using it in OBGYN OBGYNs use it to, for cesarean sections, cardiac surgery for wound closure. And I was unaware of that as well. And I'm I came into the field and had it to read all these white papers, working with plastic surgeons, working with nurses and just getting all this information. Was It's quite overwhelming, and at one point you just want to put it aside and not like you want to think about anything else that's easier or just let me just think about Botox or filler, but PDO. And plastic surgery I've been around long enough in plastic surgery to realize that, we've been using PDO structure that composition in suture material for a very long time.

And it's safe. And They've developed other procedures in and around that composition. So  they are taking the materials that we are using for suture and making forms of implants and forms of things that are inside the body that are staying. We know because it's a safe material.

What we're doing with this building collagen is just a little element of that. And, any suture material, I tell people that any suture material that's outside of the dermis and maybe laying on the outside of the skin is not going to be well. And so our epidermis doesn't like that.

So placement of threads is very important. All right. And you work you, you're primarily using Les Encres. So you work with all the other materials. What is your experience with working with the different materials? Since they have the filler threads and PCL threads, PLLA threads, what's your experience with the different materials? 

So it's interesting.  PDO is still my workhorse of lifting and I always go to that for lifting of skin. I also use PCL and PCL works great for different areas that I may want to stay away from. I don't want to see the thread, and then I will lift with the PCL. When it comes to collagen building, I use a combination of all three threads, all three different types, which is PCL, PLLA, and PDO.

I combined those materials, and I have not had any problem with combining those materials, creating hashtags in skin, and that will actually build collagen for a longer time. And patient selection, depending on what the problem is and if it's crepey skin, if it's thin skin, whatever, I may be choosy upon which material I'm going to choose, but I'm not afraid of any one of those materials and I've used them in combination with huge success and.

 Before and after photos.  I am very diligent about taking before and after photos. Plastic surgery has taught me very well that, you really have to take your good before and after pictures, make sure that it's the same lighting and all this sort of stuff. We take pictures at every four months with people that have threads.

That is a protocol. And we want to see what is building. If I discover that somebody is not building on PDO, then I'm going to switch to maybe some PCL and combine PCL with PLLA. Or I'm just going to try PLLA.  I just know that Different people respond to different things, just like all of our other aesthetic modalities like Botox. And, we have five different Botox is on the market. Maybe somebody will respond a little bit better to one versus another.  So maybe changing that path in doing a PLLA or a PCL may be a little bit better for the patient.  I think that and you touch upon people reacting completely different to certain things.

They're like Botox and the, our metabolism working better with one over the other and it really jumps into I, I would say safety. What do you think is a protocol because they are like PLLA is very similar to the Sculptra product  as a bio stimulator and then you have PCL, which is a longer lasting, but they're differently, they're different altogether.

What is your protocol for safety on those things? 

Safety Protocols and Techniques

 When it comes to safety, number one, placing a thread is not going to occlude something, and it's not going to cause any sort of necrosis to the skin.

Okay. So right away, I can, I've decreased the sculptor rep does not like me very well because. I took Sculptra and you was using a lot of Sculptra down to about zero because I use Sculptra threads instead, right? So the safety for me that I don't have to worry about injecting 10 cc's of Sculptra into a patient to build collagen.

Now I just create a hashtag that maybe consists of 20 to 50 threads. into a face and that I'm getting the collagen building and that one treatment is staying for two years. So the safety of that  right off the bat allows me to sleep at night so that I don't block any blood vessels. I don't have to inject into a blood vessel.

I don't have to worry about any necrosis. I don't have to worry about all of the other scary things that dermal fillers could actually happen. In, in even if you're aspirating, I'm using a cannula, all that sort of stuff comes into play when it, when we're injecting a face, whether it's a dermal filler, whether it's a thread, right?

So the threads the the safety for the thread factor, just talking about threads in general,  we want to make sure that they're in the dermis, in the right place of the dermis.  We're building collagen  down in the bottom of the dermis, in the mid to bottom of the dermis. So all the reticular spaces and all the fibroblasts are in that area.

So if we're wanting to trigger collagen building, we need to get it in the, in that proper plane. If we go too superficial, the skin is not going to like it and then the skin is going to cause some side effects. To avoid those side effects, depth is very important.  Side effects that you're going to get from Sculptra or a Sculptra thread is going to be the same.

The epidermis is not going to like it. When it comes to safety, I think the overall is the occlusion of compared to dermal fillers, the occlusion, you have no occlusion with a Sculptra thread. I place Sculptra threads.  underneath eyes, above lips, around the lips, in, in those areas where I cannot play Sculptra.

Forehead, right? So those are the areas that you really are, have a more positive outcome and a no risk profile. Yeah. So that is a go to in, in Sculptra threads. In my eyes,  are going to build a little bit more volume and it gives you a little more modality than just putting a PDO thread  if somebody needs that extra collagen building, they are going to need something more than maybe a PDO that will dissolve in four to six months. We want it to dissolve over a year period and then we want it to build collagen for up to a two year period. So that's going to be the benefit of that and take the risk out of it.

Yeah I agree. This is one of the reasons why I did choose this company. And I'm not sure if that's one of the reasons what brought you over here too, because well, the variety of threads that Les Encres has Is you're a kid in the candy store. And so I'm, I find it exciting that, Oh my gosh, I can choose such that variety.

And Les Encres was the first company to come out with the blunt threads around the lips, blunt threads around the eyes. We, this was like evolution to the finest because when threads came out, we were putting sharp threads underneath the eyes, so people were getting bruised. For like weeks, right?

We couldn't help it because it's a sharp needle. Being, Developing the blunt threads have just been has, have just been amazing. So now somebody can get those little lip lines fixed without having any bruising. So that was just so good that evolved that way. I I remember when I first started and and I started teaching and I had to teach the representatives and then I started teaching nurses and doctors on the placement of the sharp needles and I'm telling them that they have to be extremely careful in vascular areas because you could go too deep, you could go too superficial. It was definitely something that was had a nuance to using at the time. I think  a lot of people were having bruises and I can, I probably can contribute that to a lot of the scare of using threads, but we have cannulas now we do have the, more blunt cannulas, the sharp ones.

 Les Encres was on the forefront of developing all those threads. Other companies will follow suit, but it's interesting that Les Encres has had so many different varieties of threads, both sharp, both barb and the other companies still don't have that. So it's just amazing. And that's why I choose, I chose Les Encres because  as a, from Astra Institute,  stop, Oh God. And we're getting off of, Oh, I'm like, I'm not even, I'm not, I,

Through Astro Institute, we actually train I wear many hats and not only do I put in threads and patients every single week but on the educational realm, I definitely need to make sure that practitioners that learn threads do not have side effects and so forth.

If we had so many side effects and we teach say a class every other month, if we had so many side effects, that's all I would be dealing with is side effects. So safety and injecting correctly is all utmost importance and we teach you how to use these different threads and what are the best threads to actually use for what area and so a lot of that is is will shine through in any training that you take. 

Patient Selection and Customization

 What are some of the safety and protocol techniques that you really like, use? Or to get the optimal results?  So To get optimal results patient selection is very important. And we are, Do they want smooth and twist threads? Do they need that in the beginning to build collagen?

Then we'll put, go to say a barb thread later to actually lift skin and pull. What does that patient need? What is that patient selection looking like? We, of course, as injectors injecting in the proper depth, injecting so that we're not pulling skin too much to give a side effect that was going to last for two, three months, we don't want that.

We want all the threads delay in the skin, nice and smooth. Give that lifting effect. For the most part when it comes to safety is making sure that the patient's comfortable, making sure that you're using lidocaine. I use lidocaine with epinephrine so that it blanches the blood vessels so that I can go in and do what I need to do safe and not placing the threads too deep because if you placing the threads too deep, you're going to irritate the nervous system.

So we don't want to actually have any sort of motor nerve system, or we don't want any sensory, we don't want the threads to sit too superficial to have any sensory feeling. All of this is important when you're learning technique. And so forth. We definitely focus on avoiding some of the nervous system and not placing too deep into the nerves and, or around vessels. 

I know that you are, one of the sought out trainers for Les Encres. Is this something that you spend time teaching? Aside from me injecting and loving how to inject these and it gives me a different modality in my practice.

It really offers a great a great  outcome and happy patient, happy results, so forth. And it's fun for a practitioner to do. So when I'm training and on the educational platform, I, everybody can see the passion that I have for threads. Threads are just exciting. They're like, let's paint a picture and let's do it this way.

And The practitioner has their ability to paint that picture however they want that day. We focus on all the hands on and we give you at least three to four patients to actually get your hands on to actually do the putting in the threads, putting them in the different fashion.

There is protocols for this. It's not that I always know when somebody has watched YouTube and that's been their intro to threads because they just stick threads any old way and they're just sticking them everywhere and they're half stuck out of the skin and they're not even in the skin and there's issues with that.

So  we don't need to use thousands to get the results. Although Les Encres as a company would like that probably but we, there is only so many threads  that you can put in the skin before you end up starting to have problems. So we, there is there is a art in this, and there is protocols in order to get results.

We have a lot of white papers. Most of them was recent within the last year or so. That actually proved that, putting threads in a different fashion in a certain fashion actually produces more collagen building. So we're starting to get more and more studies out there that actually are, is available through Les Encres to actually show you that, oh, this is why we do how we lay it down.

This is. This is the process of why we lift in a certain plane, why we're building collagen in this area and laying it down in a certain fashion.  I think one of the things and you brought up YouTube,  our YouTube injectors, which I really got the experience with over the years. Ever since COVID happened we had this new plethora of people on social media and and YouTube videos that pretty much explain what you should and should not do and these are yes and no's and inject this way I even see Botox inject all these other special ways and I'm like, oh no, I have a lot of videos from people but this is the era of these really easy procedures that they They contemplate us as easy, but in the, in the thread world they view it very, something like, I don't want to touch is super taboo.

We have a lot of people that are influencers that say it's just stay away from threads are the worst things on the planet. They're so scary and they don't work. What is your take on that? So it's probably One of my hardest things to do is both in the patient and the educational platform is to on the patient end, patients do come in and when I recommend in a consult, they're getting younger and younger by the way, but  they come in and they want natural results. They want a natural product. They want, they don't want to go to fillers yet. So threads are, is up for conversation, right? So I do exosomes. I do it all and, but I've got to put all these modalities in that's going to be appropriate for that patient.

So for the patient that wants natural results talking to them about Threads, and right away I'll say oh, okay, so Threads is a great avenue for you to go.  Right away, I will be, they're gonna, they're gonna go, Oh no, not Threads! Oh God, I've seen that and it's so scary! And I'm like, okay. What's scary for you, right?

So I'm answering their questions as they're coming at me. Oh, those things I heard, they stick out of the skin and they cause problems. I heard that they have lumps and bumps. So whatever that is, I say, listen, you're going to see a lot, whether it's Botox or fillers, whether it's anything on the market, you are going to see some side effects.

Because people try to learn it too quickly and they don't learn it in depth and they just go out and do it. So That is where the problems lie. Yes. Do we have problems? Can we battle those problems? Yes.  You get a lump in a bump. I know how to handle that, right? So as an, as a, from a training aspect, I train everybody.

If you have a lump in a bump, we're going to just create a little star over the lump and a bump with a smooth thread little ones, and we're going to push it down because it's trying to poke out of the skin. So there's ways of battling a lot of it, but there is a lot of myths out there. Negativity of, Oh no threads. I, and I don't know why that the, that it's out there with negativity. Maybe, it's there with everything but because I do so many threads, I get a lot of consults and a lot of the consults are coming in for, Oh, I don't like superficial lines. I don't want to go to filler yet.

What are my options?  I lay it out there and I tell people all the time you can laser. We can combine the threads with any of these modalities. So I may laser somebody first and three weeks later I'll put in threads right underneath the lasering, right? I may wait four months and then if they're still not happy, I may put a little HA, artificial HA, a little light filler over it.

So while we're waiting for the collagen building to happen. So We may put all these modalities together to make it work and again, all of them are safe modalities, it's just the matter of trying to make that, that, that patient happy at any, whatever point they are in the journey and that journey may change and that's why we have to change as injectors. to start adding things in. Threads, I speak about threads and I say the word threads probably at least 50 times a day because all the consults are like, Oh, she's going to talk about threads. My, My MAs probably hate it because I talk about threads a lot.

Where some Dermal fillers like underneath the eyes don't, is not for everybody.  That's an area that can be a hot mess sometimes and I see a lot of hot mess under on the streets. And some people just are not candidates for dermal fillers. The skin is too thin. I put under eye threads in there. That is my hottest treatment and that is where it's like a multi level marketing. You change one person's under eye threads. They're going to tell five people about it. Those five people are going to come to you. They're all coming to me for under eye threads. That's the number one treatment.

That is my favorite treatment and to change that lower lid, even before surgery, if somebody wants it, they're improving that skin, their surgery outcome is going to become better. In the end.  I think the contributing factor to all these people being, Oh, I'm afraid of this this treatment and all these bad results.

I believe it's actually coming from those YouTube learning clients or practitioners that just learned on YouTube and they just want to do something and then they make a terrible mistake and a lot of people too, when they are getting into it's a it is an art. It is a practice like Botox, like filler, you can make a mistake, but that doesn't mean all of a sudden, Botox is terrible and it doesn't work. We all have to adjust and learn a different technique or learn a different way and everybody's different. So our anatomy is a little bit different. I think that we can make a mistake and try to just learn how to do better.

But for, I think For the ones that do learn on YouTube, where they think that they could just bypass training altogether, and then they give the bad name. If you were a patient looking for threads what would you look for? 

S

Importance of Before and After Photos

o right off the bat, our patients are really savvy now. I have a volume of I bring my iPad with me and I have a volume of before and after pictures because before and after pictures are very helpful to see what does this look like at four months? What does this look like at a year? What does this look like at two years?

I have a patient that's out eight years with under eye threads, two sets.  And then, and she spent $1,600 and now she's had it settled for eight years. So This is a long term journey with and sometimes with threads. So these People want to know, Hey, is this going to hurt? Is this going to be painful? No, I'll Lidocaine so that nothing is going to be painful.  The only pain you're going to feel is the Lidocaine, not the thread. So they want to know that is comforting. They want to know that injector is confident about what she's done. And when I say that I've done it for 10 years and I've worked with all companies, I had problems with some other threads.

I don't have problems with Les Encres. I have been using Les Encres now for I, I want to say six years. And I'm just using that off the top of my head. But For the last six years, I don't have to battle complications.  So if I do have a complication, I know how to fix it for you. So there's several different things that actually, even in the education and through Astra that I teach people here's how to fix things.

We're not going to, We're not going to slice open the skin and take the thread out. Okay. There is a way to fix everything  and make it very comfortable for the patient. We don't want lumps and bumps. We don't want threads coming out of the skin. We don't want all those complications. So therefore I'm going to teach you how to not do those complications and number one, number two, if we do get a complication, which we do, there's all sorts of and we're going to fix those relatively quickly so that person doesn't have a negative behavior. Also our testimonials on threads are very important. So people have had threads. Oh, this is what was my experience.

People need to read those. And With that being said, with the reputation, they're seeing the before and after pictures. Usually by the end of the consult, people are like, sign me up. What do you have an appointment tomorrow? They, You've got to go through that process with them. I've talked to quite a few practitioners. They find it. They tell me that it's quite difficult to get before and after photos and it's hard to get the testimonials. How difficult do you find that in your practice? In the beginning, they maybe are reluctant to share their face or that area of the of their face because somebody else would see it by the end of the journey.

Once they built college in their face, looks better. They're like, Oh, by all means, share it, use my picture. They're happy to do that. So the taking the before and after pictures are important. When I do it I don't make the patient come back specifically just for that thread before and after picture.

I'm taking it when I'm doing something else to them. Usually when I'm doing their toxin every four months, three to four months, I take a picture at that time. That way I get all pictures of every single patient through their journey.  It's funny because I've suggested For some practices, because a lot of practices have IM shots they, they have B12, they have their CoQ10, they have glutathione.

I tell them, hey, it's 5 for a B12 shot for the cost of the practitioner, or less than that, it's like 2 for a shot. Just tell them to come by, we're gonna give you, your shot, just a little boost of energy, and then you take your before and afters in three weeks. Three weeks actually really shows a beautiful, just a transformation that there, it's palpable that they get to see that, that transformation.

and that's just within three weeks. It shows them that it's actually beneficial, because we're with ourselves every single day. I also have used PDO, but just the liquid version  and even for myself, I didn't think that there was going to be that big of a big, difference and when I took that before, and I took that after three weeks later, I was with myself every single day.

 I'm like, wow, I can't believe it's done what it's done and I've, with a lot of people that I've seen those three week images. For a B12 shot For a B12 shot that costs like nothing for us. They came back, they do the little before and after.  When you say I want you back so that we can look at it to make sure that it's perfect for you and you're customizing that treatment for them.  So many people don't get before and after pictures on other things, even Botox, fillers, laser, whatever facials and that is very important.

That's our CYA, and that shows us, it's also going to show us if a patient isn't responding, maybe you need to turn the page to do a PLLA or a PCL, and maybe you need to change the path of their of their journey and we all want results, and I don't want a patient to go through a year and not have results.

I want to discover that. At the three month, the four month, whatever. So I explained that to the patient and they're like, Oh yeah. Okay, and I'm like, you have to have patience and they're like, I have patients. So they already know that they need to wait for that, right? Yeah. When it comes to the barb lifting threads, I take a picture immediately because you can see that lifting and it may relax a little bit and then they come back in a month and then we take before and after pictures then, and then we take them again. At a four to six month period. So We're seeing that lifting a little bit more instant gratification. Then some of the other stuff that we do. That's a very good tool and it makes the patient feel very good that you're following up on them and you're concerned about, are they going to build collagen?

Is this crease or crack or whatever we're fixing, is going to be fixed?  Do you feel like it also protects your practice from the clients who say, Hey, nothing happened. I spent all this money and there was no results. Do you think that it also protects you taking those before and after photos to be like,  yeah, absolutely and it also leads to that patient seeing that one without area and then they want threads everywhere. Where else can I use it? Oh my gosh. I was focused on my neck. I think I need it in the neck. Oh, I want it on the, I want it for my creepiness on my arms and top of knees. And it's just like a thread craze.

So my thread users start with one area before, and it would be really interesting to do that study to see what happens to them along the way. But They've all done at least two to three areas in a year because they start branching out to other areas.  Oh, Can you do this? Can you do that? Can threads do that?

That is something that it sets me apart in my practice because nobody else is doing threads. So now People are coming to me just for threads. It's Oh, go to Denise. She's the thread gal, right? It's they'll be like, Oh, the thread queen can answer that. So it's just that I can't get by in my daily practice of non surgicals without the use of threads, and and it's it's such a wonderful asset for us in so many ways and we haven't talked about ROI yet and we will talk about that, but if I'm there and I'm doing something very helpful for that patient,  It is rewarding, but I also wanted to be rewarding in my pocketbook.

I'm not standing there for free every day. So that is for another conversation but it's a win. Threads are a win in so many different ways. Yeah, and 

Combining Modalities for Optimal Results

 So I like that you do have so many different mixes of modalities that you teach that's in your background too. So I love the fact that there's all of those things that you do teach and you probably, and we do have if they're not getting collagen and building, I'll enhance them with the drink, right?

Collagen and drinks, I enhance them with. Oh, we need to do in four weeks, a micro needling and then we're going to put topical threads on it to help it. So there's so many different things that we can put in the mix. These people are buying skincare off the street. They're buying procedures. We want to sell them procedures that work. And, When you talk about our. are topical threads versus injectable threads, you're only helping you're baking the cake with the injectable threads, you're putting the icing, which is the, and the fertilizer with the topical threads.

So that's an easy procedure to do in four weeks, and you know what, we're going to enhance this and we're going to give it the best outcome that we can. Give it. And You may need more than just injecting threads underneath the skin and sitting back and waiting. So we're adding these other modalities in with it.

If it's laser, I laser them first and then I put in threads. So we're allowing that dermis to build collagen at many different avenues.  That leads to great success. I love that you brought up the topical threads. I'm obviously a huge fan of the topical threads, what have you got to see with like before and afters, the results that are people that are, that they're getting this because they're either too afraid of using the actual threads that you want to put in the face and they're just like, Oh, just microneedle and then they fall in love with it and you're like, Hey, I can also do a facelift with that same material. Have you gotten to see that it's easier to sell it that way or just even in general results?  I think that we, for me, I've used it more of texture and surface to remodel and the micro needling is adding some alone, and then you're putting the bonus of the Threads and you have 1000 threads is being smeared all over your face, you're not just doing one area. So for them In my practice, we're doing a couple different areas and so they need an overall a rejuvenation and that's where the topical threads come into play. So I use it with laser, I use it with micro needling, anytime that we can get that topical on is going to be better.

So that is just the bonus. And I think the, it's hard for me to say that, Oh, I've had these before and after pictures just with topical threads because I don't use just topical threads alone. I use it as a adjunct to other procedures and then you want to rejuvenate that top layer of your skin, we need to do that with the threads.

So we need to help that weathered skin that's on the top. While the cake is being baked with the actual threads and I've always used those analogies because I think it's relatable in your head that, Oh, okay. We're baking that cake. Now we're putting the icing on it and we're just trying to help that, that the topical realm of the skin.

I like that. You think it, think about it on a multi layer.  That's to be multi layered. Yeah. I do, I've used it all, alone because I really haven't really needed to use too much of anything else.  Truly I really think it's a great innovation of PDO now in the industry.

But I like that it's a new innovation, it's something that it's so different and I, I can't wait to see where threads go, and again, you can use that as in a combination. If you want to use it with some PRP, use it with some PRP. I think exosomes are better. So I'm going to use it with a PRP engineered product and then I also use it with exosome. So if I want, the list is ongoing of what you can do and we have those clients that, Hey, listen, I'm not coming in here and doing just a microneedling. I need something better than that. Yeah, I need, we're not doing a fufu facial, like a spa a ful, facial relaxation facial is good for what we want it for, right? Yeah. We want to see outcome results, long term results and that's where we're putting all this other stuff into play and we may have to use the combination. It's very hard to say that you can do one modality and make it work. I talk about under eye threads, I put them underneath the eyes and it fixes that underneath the eyes for sure but am I telling them that they still have to use an eye cream? So we're always layering things, right? That's why we have hyaluronic acid in makeup and so we're, we want that benefit and that's what people have to. Not put one procedure in, into just, oh, I'm just going to do that and sit back and wait. Everybody's skin is different and where do they fall at that baseline? So they may want, you have to offer them all this here's the array of stuff. Now what do you want to do? I like the thing that when I speak to some practitioners, they ask me, why didn't I put, if this is something that is so great, why didn't you just put glutathione and niacinamide and throw some growth factors and because I truly believe that if it's PDO pure, it's just pure. If you wanted to use it all by itself, but it gives you the opportunity of exactly what you just said. It's tailoring your treatment exactly for that particular client. They could be allergic to any amounts of things, especially since we have, the creation of all these skin boosters, there's a countless amount of skin boosters.

So many skin boosters with all these different ingredients and, even just with creams on your face or sunblocks or different things that we just do topically That some of that irritates some of those materials can irritate. Some of the alcohol can material, irritate the skin. Some of the salicylic acid can irritate certain skins, depending on how potent it is. Just adding more material can irritate a client. So I think having it very pure and allowing the practitioner like yourself, who's I want something specific. I want exosomes with this growth factor, specifically with just PDO.

And it's going to be a very clean treatment that I know it's only these two particular things. Or I want it with PRP that I know it's very safe and there's absolutely no reason why that person should be having any reaction whatsoever and that's a very sensitive client that I'm afraid. could have anything reacting to them. Yes. And and you can stage all this, right? Because Some people want to start at a very natural realm, then they want to progress, so educating them and laying out everything that they've had.

Now, our consults are more and more a they want to know what they can do over the next year and they don't want to know, Oh, okay. I'm just coming in and doing this procedure and that's it. They know they're ready and they're prepared that they want it all laid out. They want to plan for you to turn around their skin.

So it's our job as providers to give them everything that they could have. Not They may not be able to afford all that in two settings. It may take a year to do this, right? And the putting threads intermittently into their actual plan over the next year is something that they appreciate and they're wanting.

We've changed, I've changed my whole consults. Platform around  compared to what I was doing years ago, so it's and people love it. They're like, Oh, okay. Now I know I need $6,000 to get all this whole, whole plan done over the next year and you know what, I'm going to be doing this in four weeks and I'm going to be doing, so they know the timeframe, they know what you want to do.

It's very important.  I am glad that we got to talk about the combination of treatments really. I think it's by far the most important thing. People ask me all the time okay, when do I do laser? When do I do threads? How, when do I do microneedling after I do threads? 

So we have it laid out that we say when we laser,  as long as your skin is healed, usually in about within a month, we go through and we do threads, right? Because you don't want to laser over a thread because then you're going to melt it and make it go away. So that's important that you're going to put that laser first and then you do the threads, right?

Thread Procedures: Timing and Precautions

In other sequences, when you do threads, you don't want to come back and microneedle two weeks later or a week later. You're going to move around that thread. That thread isn't had stand ground in the skin yet. So you need to let that rest and let the skin do its job first and then you can come in and microneedle and add threads and that we always say four weeks later.

So there's a time frame for all of this that one may want to do. You're putting them barbed threads and you're lifting face and neck. You definitely don't want them to do a facial within a within that four week period because you don't want to move around those threads. We don't want an electric toothbrush buzzing around all of these threads on the inside that you just put, right?

So there's certain things that we actually  have to educate a little bit, but sequence of events is very important for the project, for the injector so that you know what you can do and what you can't do.  I think 

Combining Botox and Threads: Best Practices

What's your take on using Botox and threads, which are to me the best combination, but what is your, how do you go about that combination treatment?

So I do a lot of threads, particularly in the forehead. And so I want the, my muscles to be relaxed when I have the threads in there so that they like don't move around the thread. Whether it's a barbed thread or a small thread. So I usually am doing the Botox and then two weeks later I go in and I put the threads in.

Or I'll start with the threads, two weeks later I'll do the Botox. Now the only reason I do it that way is because I told you I don't like to hurt a patient. So I use Lidocaine and I use a lot of Lidocaine. So I don't want to put the Botox right behind the Lidocaine or else it's going to give it a bath to spread everywhere.

For And then I'm going to have some bad results with the Botox, right? So I always say any kind of toxin I pose it two weeks before, two weeks after, and it has to be in the equation. So that way a thread is not moving around and is particularly around the mouth or in the jowl area or whatever. We want to use the toxin with that and to control our environment when we're putting the threads in.

So it's very important. Yeah. Yeah. 

Versatility of PDO Threads

I explained to a lot of practitioners too, because heat is the catalyst for PDO so heat activates PDO, that's why when a lot of people are like hey can I go into a hot yoga right after treatment well unless you want the results to be short lived it's gonna do it break down that thread faster, heat breaks down threads. And i And When I explain about Botox, is using Botox prior, which is the two weeks that you perfect protocol to two weeks before it does freeze that muscle creating less heat, that our muscle contraction comes with heat;

starts the catalyst, less heat, longer results. So you're just prolonging the results. I love the combination of Botox and PDO. And they've invested in threads. So they want to make sure that they're not eating away that thread in whatever they're doing and going into a sauna and going into working out right after is only going to probably heat up that skin and then you're going to get more bruising, right?

So if you want more bruising, go for it, but we're trying not to do that. So we, that's why we recommend a little bit of ice on the area afterwards, let your skin rest, let it do its job. Why ruin what you just paid for? Anyways. So for since we talked about combination treatments, we talked about a little bit of protocols when it came to Botox, versatility, how versatile do you think PDO is? I, for  a lot of the consults, a lot of the patients that are coming in, I can use them for building collagen.

I can use them for changing scars. So I work in plastic surgery and we have some people that, want to give it the best effort to make a scarless procedures. And Some people do make scars for whatever reason and so we're helping them out with, I put threads underneath scars and it changes that whole structure of scars.

I've changed old scars something that's been in a face for a good 20 years and I put threads under there and have  made the scar almost non visible. It is amazing the versatility that you can do.  Also, the versatile use of the thread. What I'm doing for the eyes, I may see that somebody has a really creepy skin and I may have to use an eye thread, a small thread in that area because their skin is too thin and we may see a thread.

So then I'm shifting, the versatility of while now I'm doing it underneath the eyes. It's really you have to think about gauges of the thread and where to put those in the skin. So the versatility of a 30 gauge thread can be used in so many places. The versatility of a 26 gauge thread can be used in so many different places.

Something that I'm using for the upper lip, I may use for the neck and I may help neckline. So The versatility of that is just so open and that's what creates our, the artist in us is wow, where am I going to use this thread? And it's exciting, and you're like, I got a new use for a broom thread or a specialty thread.

It's amazing.  It's the excitement that creates for the injector, and then it's also, you have to think outside of the box. So many people get used to using the same filler for the same area, using this same toxin for this, right? So we've got to think now the thread world is now open to a lot of versatility.

We can use different threads, different areas. We can mix them up. We can use them together. We can use them separate. We can put combinations in so that, that makes it much more exciting and better outcomes as well. 

Cost-Effectiveness of Thread Treatments

 Do you think against, with the rising cost of everything, the economy and all of that, out of a lot of the different treatments that are just skyrocketing in price, do you feel like it's still cost effective to even add this treatment to your, to a practice?  So for the most part, for the most part, I think that  when you're purchasing threads, they're not as expensive as some of the other modalities that we use.

Toxin goes up every year. Fillers go up every year, laser goes up every year. So those costs and to buy those are sometimes more expensive than threads. My threads that I order for the ones that I order.  Are cheaper than ordering my dermal fillers and I'm getting several patients out of them.

So my ROI for that is huge. I think as when we talk about our threads affordable, they're affordable to buy as from the practitioner and then for the patient to receive has become more affordable and I think it's like anything else when it 1st comes out people didn't even know about threads 10 years ago. So the cost of the thread procedure was maybe a little bit higher.

And We've gotten so many uses for them. So now it's just not Oh, we're doing a thread lift and that's all we're doing. So we actually, as the procedures have evolved and the threads have evolved, the procedures have gotten a little more affordable for those certain areas. We are doing threads in areas.

So we charge, so much for nasolabial folds, so much for marionette line as patients experience it and get the win.  We, as practitioners, we say, oh let's do this area for a little discounted price. Our margin for threads is higher than anything in the aesthetic margin. So We have the ability to move the price accordingly, but I think the more popular it's becoming and other countries are blowing up with threads, right? So all the other countries are talking about it, oh, I went to Korea and I got this now, there it's becoming more common in the aesthetic market. So now the cost is really more affordable for patients. If you're ready for a facelift is going to cost, depending on your location, you're Anywhere between $20,000 and if you go to California, it's $100,000. Okay I could do a somewhat of a lifting procedure for a fraction of that. It's not we are making it affordable for an opening that patient population, whereas before it was such a closed little niche. Close little niche. 

Now it's opening up. We've got more companies coming out. We've got more patients wanting threads. That's more of a positive event. We it's the battle of positive versus negative, because we still have a lot of negative that we need to battle through and miss and, and social media that gets on there and just makes it a bad name.

So you've got to see through some of that, but as practitioners, we want to keep positive thoughts. We want to you just need to keep it affordable for the patients. I'm in an area in the Tampa Bay area, and we've got threads everywhere here, and so it's very common, somewhat like Miami. We've got people that are really high cost, right? You're going to get a facelift thread lift for $10,000, right? You're, and then in other areas, it's more affordable. So I don't rob the patient. I want you to have results. Clientele that have spent $6,000 on nothing but threads, $10,000 nothing on a side, just threads alone. So the market is out there and we just have to battle just like we do any other.

We've got bad Botox, we've got bad fillers, out there. We've got bad threads, and in the more important thing is it going to a trained individual that knows what they're doing, has a reputation. You can see that on social media. You can see that when you look at my social media, which is Faces by Denise, you're going to see nothing but three quarters of my social media is threads. 

And you're going to see the before and after picture.  I like that. And you said you work with plastic surgeons.

Threads vs. Facelifts: A Plastic Surgeon's Perspective

Do you feel like threads actually make it harder for you to do a facelift later? Or are we helping? Are we, because that's one of the hot topics of on social media that is giving that negative light. What's your take on that working with plastic surgeons? I've worked with plastic surgeons for 24 years and they love it because some they get a lot of consults and patients just aren't ready for a facelift. They go through the process and they think that they're ready and the neck is thrown him overboard and they really, they're like really want it, but  they're just not there yet.

They have another three years, another five years. They just can't do it. My plastic surgeon will walk that patient over to me and say, okay, here, She, if I'm available, you know what, this is Denise. She does the non surgical lifting and she can lift her face until you're ready for a facelift. So there's a market for that.

There's also a market for, people that have had a facelift and then it's relaxed a little bit  for whatever reason and over the years, five years later, now you could put a couple threads in and lift them back and get them back to where they were when they had a facelift. So there's different, There is definitely a market for non surgical lifting.

Is it a facelift? No, and I tell people all day long. We, I'm not going to compare, Our results, although if you look at some of my before and after pictures, they look pretty darn good. Like they could be a facelift, but you actually will see that lifting is significant and if they're not ready for a facelift yet, this is going to be a better price a, And we can get you lifted for about a year and a half to two years. Most people that I do because the thread quality is so good that we get, I get lifting for about two years. In that one particular area. So I don't have to worry about the lifting outside of that. Yes, they may want other areas in those two years.

I'm not worried about putting my patient the procedures out two years and I'm never going to see them. No, they're moving on because they like what they see. So they're going to do more. But there's always going to be a place with plastic surgeons and, I, in our through Astor Institute, we teach and facial plastic surgeons thread lifting because thread lifting has evolved years ago, we used to have contour threads and they were terrible. So every plastic surgeon hears the word threads and they're like,  yikes. We're, we don't want to do that. Like I took more threads out than we put in. That type of behavior.

For the most part, if they're put in right, you don't have to take them out. Okay. These are all dissolvable. They're reabsorbable. So if you get a thread that is even not right and you can't do anything about it, it's going to absorb. We, and We could laser over and it'll go away faster. So there's things that we can do, and patients love that interim in a plastic surgery world. They're not quite ready. You know what? I'm a year out, but you know what? I like the idea that I can go get a lifting effect and on the face of the neck and put me out another year and a half. So there's definitely a market for that.

And The plastic surgeons that I work for endorse the use of threads. It's not taking money outta their pocket. It's helping them to give that niche market that doesn't, it isn't really ready for the facelift yet, or the neck lift.  So do you and that You hit right on the mark here. Where I hear that they take out more threads and they.

Do you feel the same that they are at least not starting from square one when they, before they got threads, they're starting from a new point? And they've built a better quality skin. So when you do lift that. I was a case where I use threads up until the day that I was like, okay, listen, I'm going to need a facelift and so I told my surgeon, like I went in for something else and I said, you know what? The facelift is more important right now. I have over 250 threads in my face and he was like, so that's fine and it ended up being that during the facelift, we didn't, he didn't hit one thread, at all, not one.

And I had them everywhere from lifting to sitting in my skin in the dermis, they're pulling it at different levels. I joked with him saying, you're going to have you are going to run into all these threads and you're going to have to take them out.

And He's I'm not going to take them out. I'm going to leave them in because this is going to help the healing phase. I ended up with two bruises one of my face, one of my neck. My healing was second to none. I was back to work in five days. I was looking, yes, a little pulled, but my healing was over the top.

He was like, I don't know what you did in this healing phase and I'm like think about it. I had 250 threads all throughout my whole face before you started at least two months before, three months before he started. It's amazing. Our healing, what we see is the healing phase, which you should  because we're helping the dermis.

So in that reticular dermis, you have threads maybe a little deeper in the deeper planes when we're lifting, but they're all building collagen.  So that's only going to help you in the healing phase. You talked about your getting a facelift and definitely, none of them having to be removed and you having better results. Do you feel again, going into the cost of it and the return on investment, what do you feel like that looks like? That looks like to you because you've gotten so many threads and what that looks like for a patient.

Let me just give you some examples of if I do a marionette line, I'm going to be using about 12 threads, right? The cost of that thread is like $6.00 a thread. Okay. And so My cost is $72 for that area, right? That's my overhead. And then the, I'm charging $758.50 for that area. So that's just one example.

Underneath my, Underneath the eyes, I told you I do everybody in the Tampa Bay area for underneath the eyes. Yeah, hottest. area, right? Again, Marionette line takes me 15 minutes, underneath the eyes takes me 20. I'm putting approximately 12 threads  total per eye and my cost is $144. Now I'm charging the patient $850, and that's in a 20 minute session. So the return on investment for threads,  When filler is down, when the market is down people are like Downscaling their stuff because bread is cost too much milk cost too much. Whatever there they try to downscale some of their  procedures.

This is a procedure where okay. I may not have much filler this week in my schedule, but I definitely made money on threads, right? So the money, the return of investment on threads has kept me in the market and kept me making more money than an average injector because I am, my return on investment is so huge.

When we put a syringe of filler in it's $400 it's approximately depending on what filler it is. Okay. If I'm doing Sculptra, it's $457 per vial and I'm going to do two vials. And I'm also, it's also going to take me a good half an hour, 45 minutes to do all that product, right? So that return on investment for me is just not there.

It's my time is valuable as an injector as much as it is our overhead, but for threads, it's a win because it's easy. It's fun. It's quick. I can put an area of smooth and twist threads in a matter of 15 minutes. We give them a little lidocaine, put it in there and you're done. People are like, wow, this is done already.

They were anticipating such a drawn out long process and it's very quick. And so that For an injector, it means that, oh, I can make that money in a day and put on so many procedures in that day that's going to, that's going to take my loss in many other areas. The Botox your downswing or the filler downswing.

Now you can bring it up and get rewarded with threads. 

When you're doing threads, you don't want to rush and you want to make sure that you're getting them in there correctly but for a new injector, it's going to take them. Maybe half an hour to do one area that's putting the lidocaine in and then doing the act of the thread. The act of placing the threads when you know what you're doing, even for a new injector knows where she he or she is going in the skin.

That still doesn't take very long. It's still a quick, the smooth and twist threads are like, okay. really easy. The more difficult barb ones take practice and that practice is going to yield some good results because the more practice you have, the better outcomes you're going to get, right?  But for the most part, those, that takes a little bit more of a skill level than placing the smooth and the twist threads.

That's why Through Astra Institute I have courses where I start you out and we do just the smooth and the twist threads and we get the benefits of that. We show all the benefits. We show how easy it is to place those smooth and the twist. What combination to use so you get that skill level down.

Then we start learning how to do the barbs and then we do the lifting and then we separate those two and it's become huge, successful, right? Because if you're going out and I'm going, and I'm looking at your portfolio of threads as an injector, I'm going to be overwhelmed. Oh my gosh, where do I begin?

What do I order? How do I do this? And The company is real good at putting them. In packages for new beginners, and here, this is what you want to order. But you've got, you have to crawl before you can take off running and so you've got to just practice and do them proficiently and take your time. To do them.

So it is going to be slower in the beginning, but you get faster, the more that you do them, and the ROI is always going to, as a new injector is always going to be smaller. Okay. But you know what, you know that carrot in the end, you know that when you keep doing and you keep practicing, you're going to get quicker and you will, your rewards are going to pay off a lot more. 

Handling Side Effects and Patient Education

Side effects, some challenges with side effects that you've gotten to deal with and how do you handle those challenges?  So side effects, When a patient calls stating that, okay, they have rippling or they have a bump or they have something, or they have hurt. 

First of all, I want to see them because I want to see what's happening with that thread. You can get a lot of visual. Yes, you can have them send a picture, but I have them come in so that I can see what the problem is. If it is a bump or a lump, I can strap it down and I say, strap it down. I put a couple.

Mono threads in there at a star level or a hashtag over a bump and I can push that down because what's happening is the bump is the actual thread that's coming up through the skin. So if I can level that out and push that down, that'll be fine. That takes about a week process. So I just reassure the patient and it will go away.

We, it's just going to need time to push that down and give it about a week. Most people are okay with the side effects, knowing that you can do something about it as a practitioner. they feel much better with that. If it's a kink in the thread, you may have to make a nick and you may have to pull it because maybe you placed it too superficial or too deep or  something with that barb thread.

So there's ways of, you can just nick the skin with an 18 gauge needle and get in there and handle it. Worst case scenario is that we have to take a thread out. And you know what? We can do that very easily. We have skills and you take it out and then you place another one at another time, there's.

It yields, if I really have a, mostly it's maybe lumps and bumps that are going to occur because as movement happens with skin, those threads are going to move as well. So that's why I say facial rest after you have threads, because you don't want to keep moving that thread around until it's set in the skin.

So all these little things I develop, I have a technique where I use a cannula. So if a thread sticking up or it's wavy. I push it down with a cannula so that we can get it to lay down a little flatter. So there's always things that you can do with this. It's laying right underneath the skin, so it's not like anything major that's going to do harm. So there's not any longterm, major side effects. It's only the short term of, hey, we need to conceal this little lump and bump or this waviness and you can most likely use your small threads to actually do that. And that's what we teach in our courses, not only how to place them, but we need to teach what are we going to do if we have a side effect?

And this is how we're going to fix it. 

I think when as injectors, you want to go into doing threads and picking that patient selection should be key. If you know that patient is a picker,  Then I'm going to be very cautious about doing threads, or I'm going to do the PDO threads that are going to not last so long so that they will dissolve in the skin faster.

I'm not going to use a PLLA or PCL. If you have high mobility in a mouth area, then I'm going to use maybe a smaller thread, not a bigger thread. So those things need to go into your patient selection has to be good before you actually engage into the procedure. So you're not having the side effects afterwards. If you know a patient is going to go out and play pickleball an hour later, and she's going to be potentially whatever ex exercising, she's going to bleed. She's going to bruise, bleeding, bruising, swelling moves threads. Okay. Activity moves threads.

Nothing with your mouth wide open. So we go into all these, things post treatment with patients before they leave. I don't, I also give a little drop of steroid and that helps some of the swelling go down a little bit faster on a lifting patient. But for the most part, for the most part, talking them through with that and educating them that facial rest is very important.

And this is why it's important because when they come back for those side effects, okay, now what do I have to do? Now I've got to see where that thread is. Try it. Did it move? And people get crazy about, yeah, I'm going to move my face. You know what? That's fine. And the thread's going to move too.

Who cares? It's still going to build collagen. It's still going to pull. You didn't ruin the thread by yawning. Okay. So it's one of those things that just goes back to you're putting it in, It is laying underneath the skin. It is going to have a little bit of movement and it's okay. It's all right.

It's not detrimental. It didn't break. It didn't move. Yeah. 

Choosing Quality Threads and Training

I had the privilege of going through the first 10 years of my career of doing it. The first five was threads were breaking all the time. We put them in a cheek and they didn't end up down by the neck. We would end up putting it in cheek and it come out the nose.

This is craziness. So that was the, that's the importance of picking a good company. When you're laying down the threads, and as a practitioner, you want to make your choices wisely so that you don't have those side effects in the end, but they can all be taken care of. I do think that's actually leads into my next thing too, because, our. But I it's crazy.  You've experienced quite a few threads. Actually. One of the things that you and I got to meet on is multiple different companies that I worked with. That you and I got to meet in those companies. You tried them all from my experience. You've tried them. You are not one to, to not physically try a thread or see how those threads and you talked about threads breaking, which is where I advocate for thickness of thread. Because they.  What's your experience with trying all these different companies? And I'm sure that's what brought you to Les Encres at the end, but what's your experience with using them? I think that made me a it actually drove my passion even more because I knew that it wasn't my technique and I knew that I could put it in and wow, how could this happen?

Type of thing. So I soon realized that's why I went and actually looked at companies and how it's manufactured, because that the way that it's laser cut and the way that those threads are cut in the position of those barbs mean everything. How many barbs do you have on it? What are they positioned?

How deep is that cut? Is that cut not going to be deep enough to where it's going to grab onto skin? That's the whole purpose of us. doing the procedures to grab onto that skin and be able to pull up. So that was very important and the companies that I did, they were crumbling. Some of them were crumbling before I could get them in the face.

And I'm like, okay, that I know that I took care of that thread. I know that I did everything that I could possibly do. As in the proper storage and so forth, and we discovered over the years, we they were just coming out of normal packets to begin with and now we've evolved as to the packaging actually enhances the longevity of the thread. But we, The threads were all over the board, and it mainly it was the laser cuts weren't big enough to actually create those the college and Bill. Create the actual pull and that pull was actually happening in the beginning and then all of a sudden it wouldn't. They would be sliding around everywhere.

And so then we soon discovered that. Oh maybe. Just having the barbs on one side, and maybe we should have them on both sides and then it evolved to, oh, now we're going to go around 360, we're going to put the barbs 360. So This whole industry has evolved over time. What I was doing to my first 100 patients,  I'm just so glad that they stuck with me 

and now the threads are so much better because they remember, they laugh about it now. It wasn't too funny in the very beginning, but that's what we had to deal with. We only had one company for the longest time and we had to deal with them. Yeah. And I taught with them. So I was, Teaching all injectors with us in the very beginning.

In the beginning, it was such a hot thing that everybody wanted to learn. Then we didn't have the good threads that, that really made us look good and we could do all the skills, right? But the thread wasn't correct.  So  thank goodness that the research and the development and the process that Les Encres has been over the last, how many years.

Has just evolved into the best quality threads that one could get. And I, that's why I say I act I work for the company every single day. I don't, I use these threads, but they are the best threads on the market and they make me look good. It's my skill, then the good thread and voila, we have a good outcome. 

Yeah I believe in the same thing. Let me You're an educator, you're a private trainer, what do you offer as a private trainer? With all of these good tidbits that you've given us so far? For the most part, I look to see  what you want to learn, what is your goal, and we will take it according to that. The training is customized according to your skill level and to what you want to do. In the areas.

Some people want to dive in. They're like, I want to do everything. I'm like, listen, we have to take it little and baby steps. I've even evolved. When I first started teaching for threads, I had one, one course and we did everything in one course. I was exhausted in the end. People were so overwhelmed and they, I think that they, there was still a fear factor, right?

The goal is for you to come out, not to have that fear factor to be, wow. Okay. Maybe you went into it as a fear factor. with some fear, but you're coming out of it, like I've just done four patients and yes, I seen the difficulty of how to place a long thread versus a short thread and overcome how to do that.

I teach you techniques on how to place them so that you're not hills and valleys in the skin and it's nice and smooth, right? That prevents side effects. So everything that we go into that teaching is to prevent side effects. Number one, number two, The goal is to get you very comfortable, whatever level you're at.

So We keep the courses very small and some are private trainings because people want that one on one. And I want to do five patients all day today with you and I want to learn all different tits tidbits that has to do with threads.  And some of them are a small group with no more than five and then you just keep changing and you're injecting all five patients.

It's you're placing maybe three or four threads and then letting somebody else do it. So your goal that day, whatever that is, if it's a private training or if it's a group training, we want you to be totally comfortable with it. In the end. And that takes that, Hey, I'm going to give you two hours of. An hour and a half to two hours of didactic and we're going to go through how to place these threads the proper way and maybe in what combination.

Give a little bit of background and then we're going to go in and we're going to do four or five patients and that doing makes sense. Everybody has told me that it's come to the course that's taken other courses. Oh yeah, I took a third course. Yeah, I learned about it and then I went in and placed two threads.

And I'm like, what? I'm like, You placing two threads is not gonna, I'm sure that didn't make you comfortable and they're like, I don't even know what I was doing. Yeah. I don't even know if it was in the proper plane. I've heard that so many times. I only put two threads. I'm like, what?  And two threads are nothing.

And we have expert injectors over you so that we're working right there. So when you're putting that thread in, we're giving you tips along the way and before you know it, by the end of the day, you know what you're doing. You can place an order and you can actually specify, Oh, you know what? I like this thread, I like that thread and I definitely want to order these threads. So they know by the end of the training in that eight hour period that, that what threads are used for what areas and what threads I'm going to use, what threads am I going to like? and  we try to offer as much variety in the training so that you get to see a little of each thread and what areas that would benefit.

So I think that comfort level of having that hands on is everything and when you're done, you're fine. We focus it as in we're doing smooth and twist threads in the beginning. You know what? We only have 50 different threads to use now. So this could become difficult, right? So we simplify it for you.   

Final Thoughts and Advice for Practitioners

And I think to conclude, because I've taken a lot of your time already, to conclude, what is your ultimate advice for everybody?

 A, don't be afraid. Don't listen to some of that negative connotation, right? Don't be afraid, dig in and do. And when you do, When you start doing it and you start adding it to your practice, you are, you're going to get more comfortable and you're going to get more comfortable talking about it.

You're going to get more comfortable showing your before and after pictures, but you can't sit around and think about it and go, okay, yeah, I'm going to do this, I'm going to add it. I'm going to, yes, it's the highest profit margin of any aesthetic company. So any aesthetic modality.

So we, You want to get there, but it's like you can't sit there and think about all those things. You've got to get your hands on, you've got to do it. You've got to be comfortable and don't be afraid and know that there's little side effects. There. You, they do it. Most practitioners have trained in so many areas.

They're putting in art lines, they're putting in really taking some, they have a great skill level in so many ways and these are only going in the dermis for God's sake. It's the easiest thing to do. We just have to put it in there correctly, this is easy. So the, the takeaway is just get in there and dig in and do it. 

All right. Thank you so much, Denise, for your time and for your expertise and. Everything and all your advice. And I appreciate talking to you and I hope to see you soon.  Okay. Thank you. I love threads and I can talk all day about threads. Bye. Have a good day. You too.