Article
A female patient aged 64 had bitewing radiographs in February 2006 (Figure 1a and b) – no pathology or abnormalities were observed.
The patient was an irregular attender and, on returning for a check-up in January 2009, further bitewings were taken (Figure 2a and b). The patient had no complaints and, on examination, both intra-orally and extra-orally, there were no apparent abnormalities present.
Multiple wavy thin linear, but irregularly positioned, radio-opacities were noted superimposed bilaterally over the teeth, mandible, ramus and soft tissues. Intraand extra-orally there was no evidence of any ‘fibres’ which could be held responsible for the radiographic picture. Furthermore, these radio-opacities did not seem to bear resemblance to any of the more commonly found superimposed radio-opacities, such as calcifications of acne, phleboliths associated with soft tissue haemangiomas which are calcified, or miliary osteomas of the soft tissues.
The patient did not return for a further check-up until May 2011 when further bitewing radiographs were taken (Figure 3a and b).
The distribution of thin wavy radio-opacities was different from those in Figure 2a and b and assumed to be due to changed angulations of the x-ray tube during the exposure.
Only after prolonged discussion regarding the radiological picture did the patient disclose that she had undergone cosmetic treatment involving gold to improve her wrinkles while on holiday in Poland in 2006. Similar cases have been documented by Mizrahi and Scully1 and Alsaadi et al.2
The ‘Gold Thread Facelift’ is offered most frequently in Eastern Europe and Russia. It is often named ‘gold filament rejuvenation’, claiming to be a low impact and highly effective technique for improving youthfulness of the skin.
The main promotional points are that gold threads are inert materials that thicken the skin while simultaneously increasing its elasticity. Providers claim the most profound benefit of this treatment is found when used in conjunction with cosmetic procedures.
Gold thread implantation
Pathological changes have been identified post gold thread insertion. These threads are usually 0.1 mm in diameter, 99.9% pure 24 carat gold and inserted subdermally. Collagen production by fibroblasts is stimulated on insertion and a fibrous capsule is formed around the gold thread. Angiogenesis is also promoted in the implantation area and there is an increase in mast cells over time.
Shin et al3 state that this gold thread implantation is a prophylactic procedure which is intended to ‘slow the ageing process, achieve fine wrinkle elimination, smooth deep wrinkles and improve skin elasticity and reinforcement’. The ‘skin rejuvenation’ effects are reported to last 8–15 years4 and be at an optimum after 1 year.
Practitioners should be aware that there are multiple names for this procedure, including the gold thread procedure, gold thread rejuvenation, gold filaments, gold reinforcement and the gold face lift.4 It is important that GDPs are aware of the radiographic presentation of this so-called ‘Gold Thread Implantation’ so that an appropriate history can be elicited and a differential diagnosis made.