The Art of the 17-Gauge Thread Lift
Let me tell you about a treatment that looks far more intimidating than it actually feels. We are working with a standard three-vector lift today, using 17-gauge threads, specifically the Arte 3. Now, this is a perfect example of how these threads can be a bit tricky compared to, say, a 19-gauge option. The principle is simple: the thicker the gauge, the more difficult it becomes to navigate through the tissue, but the reward is a significantly better hold and a stronger lift. That thicker thread gives you a superior result, but it demands more finesse from the provider.
The 17-gauge thread also comes with a larger anchor at the bottom. This anchor is what grabs the tissue and creates the lift, but getting it to engage exactly where you want it can be a little art in itself. There are a few specific tricks to make this process smoother, ensuring you achieve the proper depth and ideal placement every single time.
Numbing the Entry Point
We begin by numbing the area with 2% lidocaine, using a 22-gauge cannula. The patient has had threads twice before, so she is familiar with the sensation. It is not painless, but it is far more comfortable than it appears on camera. Patients often come in having watched videos, looking terrified, but I always assure them it is not as bad as it looks. It is a relatively comfortable procedure when done correctly.
The Trick to Engaging the Big Anchor
As I insert the thread and reach the bottom of my vector, I use a gentle but deliberate technique. I place my hand over the insertion site and perform a small twisting motion. Sometimes I end up rotating a full 360 degrees, but it really depends on the feel. I place my hand there and just twist back and forth, very gently, until I feel it pop into place. This ensures the anchor grabs the tissue at the very bottom of the vector, rather than halfway up, which would compromise the final result.
I constantly check my depth. With one hand guiding the cannula and the other feeling the tissue, I repeat the twist and retract. You can almost feel the anchor seat itself underneath your fingers. This tactile feedback is your "smart hand" — it tells you that the thread is engaged correctly. If you pull back too early, the thread will engage too superficially, and you will lose the lift.
A Second Vector and a Smoothing Out
We repeat the same process for the second vector. Because the patient has had previous treatments, her collagen is very nice, which actually makes the cannula glide a little differently. I wiggle the cannula back and forth until I feel that pop again. Once all three vectors are placed, I pull back slightly to confirm everything is engaged. You can see a small pucker at the insertion site, which is perfectly normal. We will smooth that out momentarily. I clean the area one more time with an alcohol swab, throw a Band-Aid on it, and we move to the jawline.
The Jawline Vector and a Depth-Correction Trick
Now we choose our jawline vector. I place a little more lidocaine with epinephrine at the insertion site to help control bleeding. I notice she is starting to bruise there, so I adjust my entry point slightly behind it. Before inserting the thread, I make a pilot hole. And here is a fantastic trick for anyone questioning their depth: attach a 3cc syringe to the end of your cannula.
Think of it this way: if you are using a thread without anything on the back end and you pull back, it will engage immediately. If you are too superficial, it will engage superficially, and you will see the thread under the skin. By attaching a 3cc syringe, you can navigate the thread around a bit, change your depth, and make sure you have a nice, smooth vector all the way across before you commit. There is absolutely no harm in backing up and correcting your depth. It causes a moment of short-term discomfort for the patient, but that is far better than leaving a superficial thread that will be visible for the entire duration of the treatment.
This is a perfect example. I attached the 3cc syringe right to the end of the cannula. I was slightly too superficial near the corner of her mouth. She flinched, but I did not want her to have any risk of seeing that thread afterward. So I adjusted, performed that same gentle twist until I felt it engage, and moved on.
The Final Lift and Reflection
That little twist is a trick I really only use with the 17-gauge Arte 3 threads. As I said, that anchor is much bigger, and sometimes it just needs a little coaxing to engage fully at the bottom. Once it is set, the lift is remarkable. You can see one side versus the other, and the difference is clear. The cheek gets a beautiful, natural lift, and the jawline is defined. It is all about patience, feel, and knowing when to trust your instincts and when to use a little extra technique.