1. What is Treadlifting? Threadlifting is a minimally invasive procedure in the intimate area that has been gaining popularity in the last few years. It is also known as mesotherapy of the genital area. It consists in placing resorbable sutures under the vaginal mucosa and/or subcutaneously on the external genital organs through a special surgical technique. The sutures are made of polycaprolactone, polydioxanone, poly-L-lactic acid, hyaluronic acid. They are constructed with a special design – a certain length, thickness, shape, and some of them have additionally made small spikes that support the correct placement and standing in the treated tissues. 2. Under what conditions is treadlifting suitable? The procedure is suitable for women with complaints of mild stress incontinence, vulvo-vaginal atrophy, vaginal relaxation, to correct anatomical changes of the genitals. Stress incontinence is the involuntary leakage of urine when abdominal pressure increases – for example, when sneezing, coughing, laughing loudly, running. It’s a common complaint in menopausal women – whether it’s natural or medically induced. It is due to a drop in estrogen levels and a change in the quantity and quality of collagen and elastin fibers in the vaginal walls – the fibers become thinner and break easily. This, accordingly, leads to a change in the normal anatomical position of the anterior vaginal wall, the urethra, the bladder and creates conditions for the release of urine. Stress incontinence occurs in almost 40% of the general population of women of reproductive age – especially after a more traumatic vaginal birth. Vulvo-vaginal atrophy is also a consequence of the decline of estrogens, which is expressed in the thinning of the vaginal mucosa and a decrease in its elasticity. These changes lead to a feeling of vaginal dryness, pain during intercourse, burning, easy vulnerability of the vaginal mucosa, frequent and repeated infections. Vaginal relaxation is a feeling of a relaxed and dilated vagina. It occurs after pregnancy and childbirth due to a change in the structure of elastin and collagen fibers – they become thinner and longer. There is a lack of pleasure from the sexual act and the inability to experience orgasm. Sometimes the vagina is so relaxed that with standard movements in everyday life, air can enter it, which, when the abdominal pressure increases (laughing, suddenly standing up or twisting in a lying position, coughing), leaves the vagina, combined with the release of an unpleasant sound. This is known as “vaginal flatus” or “vaginal wind.” Vaginal relaxation can be a cause of stress incontinence. Anatomical changes of the intimate area. Threadlifting is suitable for correction of loss of volume of the labia majora and their sagging, appearance of asymmetry and irregularities in the intimate area, skin defects after childbirth resulting from tissue tearing. 3.How Does Treadlifting “Work”? Threads applied to the tissues of the intimate area lead to the formation of a fibrous capsule of collagen for the entire period of its degradation. This improves the static (standing) of the vaginal walls and, respectively, affects stress incontinence and vaginal relaxation. Poly-L-lactic acid, which is a component of the threads, causes neocollagenogenesis (formation of new blood vessels). This, together with hyaluronic acid, is important for better moisturizing of the vagina and relief from complaints of dryness, burning, discomfort. 4. How does the procedure work? Treadlifting must be carried out in sterile conditions. The woman takes a gynecological position – as for a standard examination by a gynecologist. Anesthesia can be with a local anesthetic or through a short intravenous anesthesia. A small opening measuring 4-5 mm is made on the front and back vaginal walls, immediately behind the hymen. The sutures are successively applied submucosally through a special cannula, which is inserted into the created opening. The cannula is similar to a needle – long, but with a blunt tip. Through it, the sutures are placed using a special technique describing the shape of an unfolded fan surrounding the vaginal walls. The duration of the procedure is between 30 and 60 minutes. After it is performed, it is necessary to observe a regimen – no sexual contact for about 3-4 weeks, no visiting saunas, steam baths, jacuzzis, swimming pools, no sports activities related to pressure in the genital area – for example, riding a bicycle. 5. Are there any contraindications? Like any procedure, there are certain limitations. Treadlifting is not applicable for: Infection of the vagina and bladder; Autoimmune diseases; Pregnancy; During menstruation; Taking anticoagulants. 6. Does the treadmill interfere with a future pregnancy? The procedure has no contraindications regarding the onset and wear of pregnancy and childbirth. Threads begin to decompose from the 120th day after their application and completely disappear within a year and a half. 7. How long does the effect last and can it be reapplied? The effect of the procedure can be evaluated in the first or second month at the earliest. Time is needed for local impact of the threads in the tissues and formation of a fibrous capsule around them. With a registered effect on complaints, treadlifting can be carried out again after a year and a half from the initial application. 8. Is it suitable for women with cancer? Treadlifting is suitable for women with cancer. An important condition is that the oncological disease does not affect the vulva, vagina, rectum, bladder. Judging when and exactly where to place the sutures is within the competence of the gynecologist. References: 1. Advances in Plastic & Reconstructive Surgery (APRS) Journal, 2019 2. Sulamanidze M, Sulamanidze G. APTOS suture lifting methods: 10 years of experience. Clin Plast Surg. 2009 3.Comparison of the Influence of New Generation Threads P(LA/ CL) HA And P(LA/CL) on Convalescence and Clinical Effects in Patients Undergoing Minimally Invasive Anti-Aging Treatments/ Authors: Dr. Bożena Jendrysik, Dr. Albina Kajaia, Dr. George Sulamanidze, 2020 4. Aptos Methods’ Guide, 2019