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COG Threads (Thread Lifts) - What to know! #insidersguide


We?ve had lots of questions come in about PDO Cog threads (aka. PDO Thread Lifts), especially how to differentiate between models and the suitability of a model for different areas of treatment. So, I?ve put together a little summary below to help further your understanding as well as rationalise the theory behind cog thread design.

Do feel free to comment or ask questions, we love to hear from you!



PDO THREADS AU

INTRODUCTION TO COG THREADS



What separates your THIN Thread PDO models (ie: monos, screws, doubles) from your COG Thread PDO models (Cog 360? & Molding Cogs) are the "barbs" (the little hooks) located along the axis of the PDO suture. The reason we can't technically "lift" skin with PDO Thin Thread models, is that when pressure is applied to these PDO sutures to lift the skin, a thin thread being "smooth" has no resistance when placed under the epidermis layer - there's nothing to "capture/hold/tow" the thread, to then allow the skin to lift. If you've ever tried pulling on a PDO Thin Thread post insertion, they more or less slide straight back out. They're great for placing under the skin, but NO good for physically lifting the skin.


This is why PDO sutures with BARBS exist (aka. COG Threads), these barbs are able to grasp a foothold under the epidermis layer of the skin, so when pressure is applied to the thread against the direction of the skin, the barbs create a resistance, which allows you to tow, lift and hold the skin in a fixed position.


There are TWO important considerations when selecting a cog thread model and variant (1) Barb DISTRIBUTION and (2) Barb DIRECTION

 


 




CONSIDERATION 1


Barb Distribution "the HOLD"

The efficacy of each COG thread is very much dependant on the ?placement? of the barbs along the PDO suture axis.

 GREATER distribution = GREATER adherence = GREATER tow = GREATER lifting potential


This is why 360? cog threads are considered to be the "golden standard" among cog threads. They have lots of evenly dispersed barbs across the ENTIRE axis of the PDO suture (if you run your index and thumb finger against the direction of the barbs on a 360? thread, you?ll feel them on all sides of the thread.

PDO COG Thread models that aren't as efficacious as the 360? threads is due to limited barb distribution - they?re limited to one axis (90?) or two axes (180?), as opposed to the entire 360? axis:

Order of efficacy of distribution "hold" (Highest Longevity to Lowest Longevity):

(360? 6-dimensional)         

(Bi- direction Double Sided)    

  (Multi-Direction Double Sided) 

(Multi-Direction One Side)      

(Single Direction One Side)      

 

 


CONSIDERATION 2


Barb Direction "ONE way or TWO way effect?

Think of the "ONE way effect" as lifting against gravity (aka. Tension pulling in an upward direction only) and the "TWO way effect" as lifting against and with gravity (aka. Tension pulling in both an upward and downward direction) - if you?re a previous physics student - think of the concepts behind force and tension ?!

 

Ie: (Two way effect)

 



When conducting a Thread Lift consultation, it's important to assess what's more important to achieving the results you want: CONSIDERATION 1 or CONSIDERATION 2. If the goal is to lift in ONE direction only (aka. Against gravity - ie: face, neck or eyebrow lifting - multiple barb directions doesn't matter as we want everything lifted in ONE direction "up"). In this instance, Consideration 2 isn't as important - we're less concerned about the direction of the barbs, and more concerned about Consideration 1 (the distribution of the barbs) to achieve that optimum lift effect:


= For Face Thread Lifting & Eye Brow Lifting, Consideration 1 supersedes Consideration 2, so our best option would be a 6-dimensional 360 barb suture (aka. Bijou Cog 360?).




Alternatively, if our goal is a TWO way direction lift (ie: Nose Lifting - where you want lift from both the bridge and the nasal tip - aka tension pulling the tip upwards while simultaneously keeping the bridge lifted) we'd be less concerned about the distribution of barbs (Consideration 1), and more concerned about the direction of the barbs (Consideration 2). To prevent confusion, most suppliers will simply name these types ?Nose? Threads, as they?re specially designed for a two way lifting effect.


 = For Nose Lifting , Consideration 2 supersedes Consideration 1, so our best option would be a Bi-directional Double Sided barb suture (aka. Bijou Nose Cog Cannulas)


NEEDLE GAUGE or USP?

A good cosmetic practitioner will consider BOTH Needle Gauge and PDO Suture USP. For those who are new to suture and PDO numerics, the general rules are as follows:


Needle Gauge: The LOWER the needle gauge size, the THICKER the needle is:

ie: 30G < 27G < 21G < 19G < 18G

(thinnest to thickest)



PDO Suture Size: The HIGHER the USP, the THICKER the suture is:

ie: 7-0 < 6-0 < 5-0 < 4-0 < 2-0 < 1-0 < 0-0 < 0 < 1 < 2 < 3 USP

(thinnest to thickest)



Some cosmetic practitioners go by needle gauge to determine cog thread suitability (ie: 18G, 19G..ect). However, we strongly recommend looking at BOTH the Needle Gauge and PDO suture USP. Why? Different PDO Thread Brands have different USP sizes for their respective Needle Gauge Sizes.



At PDO Threads AU you'll find for the same needle gauge size, the Bijou COG threads have a slightly thicker PDO cog suture when compared to other cog thread models. For example, while an 18G Molding Cog and a 18G Cog Master Type II both possess the same 1-0 USP suture thickness, this is very different from an 18G Bijou Cog 360? that has a much thicker 2 USP. The same goes, when comparing 19G needle gauges, a 19G Molding Cog has a 2-0 USP, but a a 19G Bijou Cog 360? has a much thicker 0 USP.  


DOES A HIGHER USP MEAN ?BETTER?? 

While yes, a thicker PDO suture for a variant will have greater ?hold? and ?lifting potential? - the thicker the PDO suture, the more tenderness some patients notice post treatment. 

Ideally you want to find that perfect balance between ?Maximum Potential Lift? WITHOUT compromising patient comfort. 

Additionally, depending on ?how? much and ?where? the lift is needed, some practitioners find that instead of using 2-4 thick 18G Bijou 360??s on each side of the face, they?ll instead revise their approach and use 4-8 21G or 19G Bijou 360?s (more threads = more lifting from different areas = and smaller USP = decreased risk of tenderness post treatment).


Many of our clients, including medical practitioners use either and the 19G/21G Bijou 360?'s or 18G/19G Epline Molding Cogs, and most will use between 4 to 8 cog threads depending on which areas are being treated. To put things into perspective, we only have three doctors at the moment who are using the 18G Bijou 360?'s, one of them is a partnered trainer and the other two completed PDO Thread Lift training courses with Plastic Surgeons in South Korea. And even still, these doctors will often resort to 21G and 19G 360?'s, leaving the 18G's for a very narrow window of patients.