The Art and Science of Thread Lifts Ft. Giovanna McCarthy of PDO Max

0:00Hey guys, welcome back to another episode of Skin Anarchy. I'm really excited about our episode today because we're going to be talking about the world of aesthetics and techniques that have been around. And we don't really get to speak about much on the podcast. So I'm really excited to introduce you guys to PDO Max. And we have the founder here with us, Giovanna McCarthy. Welcome, Giovanna. I'm so excited to host you. Thank you, Dr. Acta. I'm very excited to be on here and to speak all great things aesthetics. Yeah, and I'm really excited to dive in with you because you've really seen this industry.

0:29You've been kind of a trailblazer here. I'd love to learn more about your journey and what really got you into the world of aesthetics, like to begin with. Well, interesting story. My mom was burned as a child. So my whole life, we dealt with her having surgeries, plastic surgeries for her burn on her face. So I got introduced really young to plastic surgery, cosmetic surgery, and how to mitigate scars and things like that. and that really built my love for skincare. Plus we're European and if you know anything about Europe, they're much more into skincare. In this country, we are just now starting to see the younger generation really get into skincare, but we were always into skincare there.

1:13So I did a lot of my research through the European market back in the days when they were doing mesotherapy. I studied up on that way before there was any type of quote unquote medical aesthetics in the United States. I fell in love with it in Europe. Wow. Yeah. You opened the first day spa in 1990, right? It was a while ago. You really seen the industry before it became trendy. Well, there was no medical. I mean, I go to these conferences and I see all these injectors and we're not realizing is the whole injector world is relatively young. It's medicine of aesthetics is young. So when I'm at these conferences and you're hearing science-based this science-based that the reality is we're here today because of what was done in europe and asia for years and you're talking there was no real medical aesthetics until fillers came along right we had botox and back in the day really at in aesthetics as the physicians we could do lasers we could do all that stuff as it became more medical and became more regulated as it should have been, not saying it shouldn't have been.

2:26And that's when I went from a day spa to a med spa and had to bring in a medical director and all that stuff. So no, I have literally seen the field from day one. And there's not a lot of us that are that OG old school aesthetics. Yeah. Honestly, it's crazy because even for me, when I look at it from the consumer side right and it's like exactly what you said before people started talking about fillers a lot more about botox a lot more about just a lot of injectables we didn't really know much about the aesthetics field as general consumers i mean it wasn't out here in the open and so you would hear that someone went they visited their dermatologist or they did that but it wasn't spoken about at all so this is no one thing to me yeah in fact you know i tell the story all the time i worked pretty close in hand with some surgeons here in syracuse so i would refer all my skincare clients to a specific surgeon.

3:24And one time I remember sitting with him, he came to one of my open houses and he saw how many microderm packages I sold. And he literally looked at me and said, and we're talking 20 years ago, right? Where I was one of the only, I had my microderm machine imported from Italy because you couldn't even get one here in the United States. And it took me a while to get it through the FDA and couldn't do deeper than a certain amount because I was in aesthetics, yada, yada, yada. And he looked at me and goes, I can't believe you're getting$250 for microdermabrasion, but we can't sell that service. And I'm like, well, I can tell you why.

4:01Somebody back then was coming to you and paying$7 ,000 for a facelift. They expect their skin to look good. People didn't even correlate that bad skin gave bad surgical outcomes. Now we're seeing that all these plastic surgeons are integrating lasers, other skincare services before they even do a facelift. That was not the thing back then. They would just cut out the skin and snatch you back and you still had terrible sun damaged skin. And the reality back then, not the success rate, because obviously the surgery was good. It wasn't that the surgery was bad, but when people looked in the mirror, they still saw bad skin.

4:44So they did feel that their facelift did what it needed to do. But what they weren't understanding is just taking away extra skin doesn't make the skin better. You'll find that people who maintain their skin quality throughout their life are less likely to get a facelift young. Yeah, no, that's actually huge. That's a huge topic that you've brought up. And I think now we've also seen this burst of like post-treatment care, pre-treatment care, All these skincare lines that have popped up because of this idea that you need to do something. You should be taking care of your skin. You need to actually understand that your skin is the way it is.

5:22And whatever you get done to it, it's just, it's going to enhance it, but it's not going to like take away the core problems that you're facing. So, I mean, that's a very, very interesting concept. Kind of wrap our heads around. Because I think oftentimes we do go in, if we're looking for any procedure, just go in thinking this is a quick fix. I'm just going to fix all my problems. But you still, your skin is your skin at the end of the day. that is what it is yeah and that's the people i referred out to for surgery because i was taking care of their skin pre-surgical and then post-surgical i would wait the month then mitigate their scars with microdermabrasion stuff like that those patients by far were happier than with their results than patients that didn't get that and he noticed that i hate to say us some of the love that estheticians don't get.

6:10They really can prepare a person for great surgical result versus mediocre surgical result. And the constant back and forth isn't what we need. We need to work together to keep the patients and clients happy. Absolutely. Now I want to learn more about PDO threads because I've heard about obviously threads in the past and like think vaguely we hear about their use, but I'd love for you to kind of dive in into some of maybe the myths or the misunderstanding that's out there or anything that you've noticed that maybe is a space where people don't understand the true purpose of using something like threads.

6:48Well, I started the thread company back in 2014 and we go back to why did I start this company? When I saw what Threads did for skin quality, I used to call them Threads on Crack because you see such, and we're talking PDO Threads. I'm not talking PLLA permanent threads. I'm talking PDO sutures that dissolve within a year and are out of the body. They just create some good quality turgor to the skin. And the problem is in the trainings. As a company, we have really focused more on training than just selling a product. We find that clinically competent injectors get fantastic results. With that being said, somebody who's not clinically competent that isn't doing a great job gives a disservice to the industry.

7:39And that's where you see all the TikTok stuff. You don't see the great results out there because at the end of the day, they're subtle. We're not removing skin. We're just making skin quality better. but after being in i'm 60 now i've been in the industry 43 years i've been in the industry since i was 17 and when you see something that changes skin quality to the extent that threads can it's too bad that the plastic surgeons and i get it threads not in the proper plane can cause maybe issues if somebody goes to get a surgical intervention but if everybody would wait a year after any procedure, whether it's sculpt or threads, that would cause less problems.

8:22But there are a lot of surgeons. We've trained surgeons. We have plastic surgery offices that use our products. So threads are a great adjunct in aesthetics. They're not the end-all, be-all, but they're a great tool in the toolbox that adds to filler services, Botox services. The reality is even back in 2014 when I got into the threads, I could see that we were going to be killing the filler industry because there were so many overfilled faces. And what we liked about threads is how natural people looked after they had a procedure. I mean, you can go out the night after you've had it done, if done properly.

9:00Yeah. Now, what do you mean when you say done properly? I want you to really dive into that because you've worked so closely with surgeons and you've worked with the, even on this training side and you've seen this world. Where do you think we're lacking when it comes to understanding how to do a procedure involving threads? I will tell you right now, when we first started, I'd see all these big 20, 30 people in a class. There's no way you're going to get clinically competent by going to a training where there's two or three instructors training 20, 30 people. We're pretty big on a small group training.

9:34We prefer your first training to be completely one-on-one, eight-hour day, really diving into understanding the plane you need to be in. we've gotten so good at our trainings that i very rarely get complications from the people we train anymore it's no different than a filler nodule or something you're gonna have times when things don't go 100 no different than anything surgical but the really important thing with threads is to be in the proper plane that subdermal plane that subdermal fascial plane that repositions that tissue nicely without puckering the thread and those types of situations.

10:12It's really just about understanding where you need to be in the tissue to get the results for those results to last and to not be where you shouldn't be when they're going in to get surgery. We shouldn't be deep. We shouldn't be below the muscle. We shouldn't be in that level seven plane where we're in the area surgeons are trying to get a clean cut in. So it's really about education. And most people who become really good thread injectors are the people who want to work at it. It's not the same as Botox and filler. It is a definite skill set. I always say that I look at Botox and fillers more as treatments nowadays, but this is not surgical, but it's a skill set.

10:57Yeah, it's very, very precision based like at the end of the day this is what's fascinating to me is that they're self-dissolving sutures so like what are some things that people should know about when you get them done and then if you want to get any other procedure on top maybe not surgery not something like a facelift but if you go and you get botox you get an injectable should you be even be doing that or what is the education around that so our philosophy as a company is if you're going to do a tox, you want to do it about two weeks before you get your threads. Filler, we say two weeks after you do your threads.

11:34And why? Because if there is an issue, we want to know, is it the thread or is it the filler? So I'm not a fan of doing multi-modalities in one day. So let's say somebody gets an infection. Was it from the filler? Was it from the thread? I'm not going to know if I've done two procedures in a day. So mitigating adverse events is easier if we separate the procedures but I definitely feel that threads should be done before filler and why you're going to use less filler you're going to use your filler more to contour rather than reposition tissue because you can't lift with filler we all know that and the little bit of repositioning of tissue that we do we try to go into the fat pads and put those back where they were one of the misconceptions and I hear this all the time I hear it in every conference I go to I hear it from doctors where they say fat pads descend.

12:25Well, fat pads don't descend. They're not, there's not a pocket that opens up and the fat drops down, right? It's more that that fat pad herniated out. There's no structure to the skin. So it's weak and that fat pad is sort of pushing out. That's what we're seeing. So we like to go into those fat pads. And what happens when you go into the fat pad is you literally tuck it back in. It almost creates like a scaffold to hold a fat pad in. So we're putting the fat pad back. So now you don't need as much filler. That makes sense. Yeah, that's really fascinating. So it's almost like you can use threads in so many ways then as adjunct also, right?

13:02Oh, 100%. Yeah, 100%. It's creating, when we talk about what they're for, is they're there to create structure, to put back almost like restrengthen the ligaments that have over time weakened. It sort of brings their blood flow back to that area. It reinforces those ligaments. And when you know what ligaments you're working on in which area, when people get their thread lifts, they'll talk about hearing pops. And that's what it is. We're going through those ligaments. And by doing that, we're reinforcing the ligaments to hold everything back in place. Yeah, that makes sense. And I think this is very interesting because when you think about aesthetics, rarely does this conversation come up where you approach it from a very structural viewpoint where it's talking about anatomy from this structural framework where you have to understand your anatomy does if you're going to get drastic procedures done there needs to be something there to help support what you're getting done it's reinforcement that is exactly it we want to bring back turgor to the skin so if you do plastic surgery on somebody that has bad turgor That's not going to look as good as doing plastic surgery on a patient who has really good turgor.

14:22And what do we mean by that? We mean the skin isn't sharp. I call it Sharpay. Sharpay, a lot of wrinkles, a lot of lapsity. That doesn't look as good as lifting skin that has a nice thick dermis. Right. And you know that, I don't know if you can explain this, because a lot of times when people get facelifts done, at first it looks great. In the beginning, it looks amazing. swelling perfect but then you start seeing those lines especially around the cheekbone area you start seeing the lines you start seeing where the skin is pulling almost like too taut that's what i always say it looks like it's too taut and then they look great because of the swelling right because they'll even say that about threads oh it looks really good at first because of the swelling yeah that's the point when that skin looks plump it looks good but yeah six months down the road if they didn't have good skin quality to begin with, or you didn't start them on a good skincare regimen.

15:19So you cut them up, you lifted them and you washed your hands with them. They're not going to get the same results as somebody that maintains or teaches their patient how to take care of their skin. Absolutely. And I want you to dive into maybe some of the cellular benefits of getting PDO threads, because we've talked so much about structural, like what is something that people can expect from this exact point you brought up someone with a thicker dermis is going to have better end results is this something that we can help happen in terms of like collagen production or whatever that's exactly what they do they create my microvascularity so what you're doing when you're doing a thread lift a you're doing mechanical damage a cannula is going in you're getting a little bit of mechanical disruption so the body has to heal that then the threads in there and really think about the thread almost we call it sugar molecule so the body's eating that thread up while it's eating that thread up it's laying down collagen and elastin and it's hydrophilic so it's bringing hydration to the area so those are the mechanisms of actions of threads interesting that's very interesting yeah because i think that's something that yeah you don't really hear about what you can do.

16:35I mean, I know topically there are solutions and people have created great skincare lines. You know, I know Elastin is one of them. They tell you use this continuously and you want to support topically, but there's not much you can do topically, to be honest, in terms of deep dermal regeneration of tissue or like just plumping. Well, and that's where PDO Max is a company. We have been studying that and we have segued into microneedle products you can microneedle in or put on top of the skin post microneedling, post laser, post any procedure that will help the body absorb topical agents. We came out with a PDO Glow and our practices that use it will tell you that if they were microneedling before and added either PDO Glow or Lumenve to their or mixed the two to their protocols, the clients see the difference.

17:26Perfect example is my son is a late adopter. And when I first introduced PDO Glow, he probably waited three or four months to bring it on to his practice. When he did, he just added it in as a gift to the client. And the clients were actually calling in saying, oh my God, what did you do last time that we didn't do previously? Because I see the difference. And that's my goal with anything I do in our company is for the clients to see the difference, to feel the difference, to look in the mirror and see that their skin is changing back in age. Right. No, I mean, that's the goal, right? With aesthetics is like, this is why the field is so fascinating because you actually do get the results, the drastic result, the really game changing results.

18:09And that's where I feel like this industry has been so vague for someone looking in because a lot of times people will go get stuff done and I'm like, I don't even know what you got done. I can't tell. I can't tell. And you know what? In good aesthetics, starting young, I hate to say it, that's the way it should be. When I hear surgeons talk about before and afters in the aesthetic injector realm, well, it shouldn't be drastic. We should have been maintaining all along. We should look as good at 40 as we do at 60 skin quality wise. So it should be like I just said that the client calls my son and says, I know that there's a difference, but it's not mind-blowing.

18:49It's not back in the day when they did full CO2. I mean, talk about how the industry has changed. When you talk about, I've been around a long time. I remember when they were doing full ablative CO2s that were scary. People looked like a burn victim. And yeah, their skin looked crazy, sort of good afterwards. As being working in my spa, though, I noticed that when we do too much too fast, their skin ends up looking like vinyl. I don't know how to explain it. It looks shiny, rubbery. I'm really starting to worry about what's happening in the industry of, I'm all for stacking treatments, but if we're stacking so much that we're breaking down that collagen and elastin to the point of making people look vinyl, that's not good.

19:37Because as what I've seen, as those people age they get they don't have i don't know how to explain it but they have deep wrinkles yeah it's destroying your it's destroying your tissue very deep and you can't repair that that's trauma that's yeah when they traumatize it to the point that i'm like so we see how in the last 20 years things have changed we've gone to more of a fraxel uh fraxelated thing but what i'm seeing happen is people stacking four or five things and it's like do we want to over inflame the skin to that point but that is why we brought out lumenbi i know that you're probably aware of the whole pdrn yeah salmon sperm the reason i love it and the reason we introduced it we were one of the first companies to introduce it not as an injectable as a post-service product because it was it really is great so the studies have been done in burn clinics and things like that if you can help burn skin right and again we go back to my reason for being in the field was my mom's burn so I've always really paid attention to what goes on in the burn units and pdrn helps revascularize the skin it helps make the skin healthier after you've had a procedure it doesn't have to be injected to get the results.

20:58That's what's really mind blowing. Because as you can see in the industry, everybody's going back and forth about injectables, not injectables, doesn't need to be injected to get the results. It just needs to be put on skin that's been disrupted, not injected, necessarily. Yeah, I mean, in every other country, they're injecting it, we can't because it's not FDA cleared here. Yeah, but I think it's it's kind of absurd to be injecting it, if you ask me, from the immunology perspective, if you what you're doing to your body's immune response, when you do something like that is kind of insane. I mean, PDRN, I think what you said is very valid.

21:30If you have something that, and this is across the board, if you have a skin that's already compromised, you put something on top of it, it's going to absorb it pretty much in the same capacity that it would if you injected something into it because everything's open. So the whole skin is, it's open to receiving anything that you put on top. I've worked with burn patients in trauma care. I've seen this results go from like, before we had nothing that we could do from them, go to like within a day or two you're healing serious serious yep yeah exactly and it's because of the skin because of how receptive it is yeah so it's almost counterintuitive to inject because if it's healthy tissue what are we doing so it has to be used into unhealthy tissue that's why you want to use it as a topical and it works the results we're getting the downtime reduction in laser is pretty mind-blowing.

22:21So everything's here for a reason. And when you do things because of your passion, you don't want to make people worse. You want to make them better, right? So that is the goal and has been my goal. And I don't know, I've seen skin for 40 years, and I can tell you that we have some really great products nowadays that actually work. Yes, we used to clean skin. We used to massage skin. But now we have topical products that are changing the industry. Now, what do you think about all of the PDRN lines that have popped up, like MediCube and like all these different lines? I mean, we go back to so much of the studies were done in Asia.

23:02You know what? PDRN, there's a difference. There's farm-raised and there's wild. Our line is wild salmon. and being somebody who likes, I'm not crunchy by any means, but I'm a farm to table girl. You can't tell me the thing to do is find out if you're the product you're using, if either farm raised or wild raised. There's definitely more benefits from the science of wild PDRN versus farm raised for the same reasons that there is why I choose my salmon from Norway versus a farm raised salmon. There are differences. I think they're all probably good if they are from a good lab that is ISO certified, has all the Korean, Korean FDA is pretty advanced.

23:50They keep their eyes on stuff. It's hard to judge because nobody's going to put the money for testing. Unless you're trying to save somebody's life, nobody's putting that kind of money into testing skincare products. Right. No, no. I mean, they don't simply. They don't. They don't. Yeah. It's hard enough to get funding to test things that save lives, let alone something that's... Exactly. Yeah. No, the NIH is the infunding oncology research is what I was going to say. Right. You know, we're not funding important things. We're not... In the medical community, let's face reality, aesthetic medicine is considered frivolous.

24:27That's why the inviting between the surgeons and the injectors, it's like, but there's a place for everybody. and unfortunately most of the things in aesthetics are correlation versus testing we've used these things for years in korea they're proven safe let's see how we can use them topically right right no i think it's interesting the craze around pdrn the way it's been i don't doubt that the efficacy because the concept it cellularly makes sense but i do have my doubts about every single skincare line out there that's selling a pdr and serum that's where i'm just kind of like i don't know because it's a whole different world what you're talking about right like you're creating something that's supposed to be used in a clinic and you're you're using it in a in a setting where it's supposed to be used but then if you're selling things over the counter that are not i don't even know where they were manufactured i don't know where your lab was that kind of thing that's where i get a i get very like reluctant as a consumer so that's very interesting and that's where we were from the medical side and we've come over.

25:32So we make sure anything we bring to market has that clinical efficacy, even though it doesn't need it. Right, right. Now, what does, if you can kind of educate us on like, what does PDRN actually do? What are the results we can actually realistically expect from this? Well, it's been used in burn units for to revascularize, to use in my cardinal perfusion. So it's definitely opening up those blood vessels. And what happens the minute you open up blood vessels, it creates healing. You get that healing cascade. And to your point, they're now injecting everything and anything. You're never going to get that tested for FDA approvals because it costs hundreds of millions.

26:16So why inject something when you can create it to work on disrupted skin and help you. Yeah, that's very true. I mean, it's interesting because I think that's the main missing piece is to figure out where should we be pairing treatments? You've brought this up where you said people are stacking treatments, and I agree with you. It's very difficult when you do that because you don't know. If something goes wrong, you don't know where it stems from, and there's a huge gray zone that you've created now in terms of like, where did your results actually come from? If you get good results, same thing so what should we realistically if someone comes to you and is asking like what should i get done i want to maybe not something drastic you want to just look better you want to look more youthful what would you recommend some treatments yeah it all depends on how much downtime you want so if i have if today is monday and i had a wedding on saturday i would probably my favorite stackings are a microdermabrasion or hydrodermabrasion and then an IPL right over it okay that I know stacks well I sure as heck wouldn't be doing infrared deep infrared IPL and a fraxel they're going to need about two weeks of downtime and my problem with all that much heat is if somebody's a really major histamine reactor they're going to swell up like a balloon The more you do, the more they're going to, I'm a histamine reactor.

27:40Let me tell you, if you saw pictures of me doing a chemical peel, you'd be shocked. I mean, I have to go on steroids after getting a chemical peel. So what's crazy to me is how people will think something as innocuous as a chemical peel is safe. I'd rather do laser. I know that it's a heat treatment. I'm going to quote unquote, get a slight burn. I know it's going to heal. I'm healthy. I know it's going to heal. But to me, microneedling with a PDRN, post-PDRN or post-PDO glow, the results are stunning. Softens fine lines. It just gives the skin such a youthful glow. My other thing that is driving me crazy, I'm all about glass skin.

28:22But holy cow, lately I'm seeing such glass skin that it's like, is it oily? That's literally, I was going to say. Or is it? Yeah. I just want hydration. I'm not into this crazy glass skin that looks like you put olive oil on your skin and you took a picture. We go to such extremes in this industry. It's insane to me. I'm not a makeup wearer. So my big thing, Dr. Ecta, is to make sure whatever I do makes my skin look good. It doesn't have to look like an oil slick for it to look good. So there's a lot going on that I just sit back and go, great, it looks great on Instagram, but how is it really for an everyday approach to walking down the street?

29:12No, but I, you know what, it's crazy to see this because I remember even like 10 years ago, we had a huge plethora of makeup products launch just to combat oily skin. We went through this. So now to see everybody is like, oh, I want glass skin. No, you just want a bunch of shine on your skin. And we went through, I mean, we went through so many things as a beauty industry or like before where we were like, we want to avoid that. Well, it's, you know, it's all cyclical in this industry. And like I said, my biggest worry right now is when I see these extreme stacking procedures, people going to Korea and getting 10 treatments at once.

29:51Like we just said, how do we know that one of those treatments wouldn't have given you all those results anyways? life exactly you know that's a really really valid point and i think i mean i also am very reluctant i mean for me as i can't speak for anyone else but for myself as a patient as a consumer when i go and get anything even with skincare i'm like this i don't know how many people can relate but i want to see what this thing is going to do so i give it at least a week give yourself a minute you know like let your skin react to it i think people are just chasing fast results so much now more so than ever that we have forgotten that the human body has it has it has to heal it has it has and it has to heal so if we're creating trauma on top of trauma on top of trauma i can tell you like i said i've been in the industry 40 years not five not 10 i can tell you that sometimes like i said we saw it with the full co2 ablation they look great for a few years now i see those patients back and their skin has these deep wrinkles that aren't no they're not normal they're from having degraded that elastin and collagen so much it doesn't even know how to reform anymore see that is the body's not natural reaction when you inflict a certain like there's a threshold i always say this i've said it before on the podcast even about skin care like you don't have those ridiculous acid treatments that are over the counter and you just i could bring them time I see these 30 % AHA treatments or whatever they are.

31:19And I say, I'm like, your skin's going to get to a point where it's going to say, I can't take this anymore. And so the body's response is, okay, how do I shut this down? How do I stop it from happening? That's when you get scar formation. That's when you start going and kicking into those, that kind of tissue remodeling where your body is now not remodeling for healing, it's remodeling to protect. And so the protection is the scar. And so that's where I think the education is very much lacking in the aesthetic space. Patients are not being told, listen, this is how the skin works. This is how it reacts.

31:51This is the limit, et cetera, et cetera. We don't do that. And I would love for you to speak on this a little bit towards, especially for any, all of my estheticians listening in that if you do work with skin and you are seeing this day in and day out, what should they know and how should they prepare for their own practice so that they can really prep people for whatever's coming next, for them in the aesthetics world? I would say, like I said, I would limit the amount of heat-based treatments if they're seeing their patients swell and swell to an extreme. I would definitely, microneedling to me is the gold standard.