Dr Shiva Aesthetics

Cellulite isn’t always a fat problem.

You can be slim, active, and young, and still have it. That’s because the dimpling often comes from fibrous bands sitting between the fat, tethering the skin down while the soft tissue around them pushes up.

So before treating, I ask one question: are you happy with the volume of your thighs?

If yes, we release the bands, sometimes under ultrasound guidance, then support the skin underneath.
If not, it’s a different plan entirely: release, contour, and stimulate collagen together.

Same complaint. Two different problems.

Most thread complications aren’t technique problems. They’re patient selection problems.

Very thin skin, little fat, little connective tissue, a very expressive face, heavy lifting at the gym. That’s a face where threads have very little to hold on to.

This patient came to me months after her threads. On ultrasound, the hook was tethered right under the skin. The fix was simple: release it with subcision, then add a skin booster as a barrier while the thread absorbs.

Thread complications are rarely an emergency. But they shouldn’t be ignored either.

Threads are a great tool. Just not for every face.

We really do live in such a small world, especially in aesthetics.

Something so funny happened to me today at MEIDAM.

I was sitting in د جمال جمعة - Dr Jamal Jomah جراح تجميل lecture and he showed a patient who had previously had nose threads and later went to him for rhinoplasty.

He showed the threads he removed during surgery and said, ‘Actually, the threads were nicely placed.’

And I’m sitting there thinking… wait a second. Why does this patient look SO familiar? 😂

So after the lecture I went up to him and asked, ‘Was this patient someone I treated?’

He immediately started laughing.

Turns out… yes. Those were my threads. 🤣

And the funniest part was that he had already complimented the placement before he knew they were mine.

Such a small world.

When I say dissolve, most people hear collapse.
So — the enzyme breaks down hyaluronic acid. That’s the whole job. Not collagen, not fat, not muscle, not bone. None of the structure holding your face up is hyaluronic acid.
Your own tissue has it too, and yes, the enzyme finds that as well. The difference is yours gets replaced constantly. Filler is cross-linked so it can’t be — which is exactly why it lasts, and exactly why an enzyme is needed to remove it.
Which is why dose and placement matter, and why I want to know where the product actually sits before anything goes anywhere near it.
Nothing collapses. What you’re looking at afterwards is the face that was under the filler.

Every third or fourth time someone comes to me for lips, I take out what I put in.
Nothing went wrong. It’s just that I can’t correct what I can’t see.
Filler doesn’t always leave when it’s supposed to, and it doesn’t always stay where it was put. Years later there’s still product sitting there — sometimes nowhere near where it went in. Invisible from outside. Obvious on a scan.
Add on top of that and you’re not fixing the asymmetry. You’re feeding it.
Nobody adds much. Everybody adds a little. And nothing ever comes out.
Dissolving isn’t undoing my work. It’s how I know what I’m working with.

Hello September. One of us enjoyed the bath.