PDO Threads

PDO, or polydioxanone, is a biocompatible product commonly used in surgery as an absorbable suture. PDO are not permanent when placed under the skin and will be reabsorbed over about 4 to 8 months. PDO sutures eventually are broken down in the body ultimately ending up as water and carbon dioxide.

There are two (2) basic types of PDO threads – monos (smooth threads) and cogs (barbed sutures).

Monofilament threads (monos or smooth threads) are thin lengths of PDO that are preloaded onto a thin needle which are inserted into the skin. The needle can hold single flat threads, threads wound in a spiral (screw, twisted, tornado) or multiple threads braided together (mesh). The more PDO material in the thread, the more collagenesis is created and biostimulation expected. Mono threads are usually completely absorbed within 4-6 months.

Cog (barbed) threads are thicker lengths of PDO that are loaded onto a cannula which is then inserted into the skin. These threads have little cogs or barbs which will engage the skin and can lift up sagging skin in different areas of the face and body (cheek, jowl, arms, knees, or brow etc.) when the thread is pulled upwards. As they are stronger than mono threads, cogs (barbed threads) can obtain more lifting and contouring. Cog threads are also fully absorbed between 6-9 months.

How do PDO Threads work?

PDO, or polydioxanone, has been shown to stimulate new collagen within the skin. The newer technologies utilizing free floating (no fixation points) PDO Threads allows for much less risk of complications such as scars and nodules that are seen with the older threads that were either permanent or fixed under the skin.

Common treatments such as lasers, peels, RF, or even PRP treatments, cause a wound healing response and a stimulus for new collagen at one point in time. In contrast, PDO threads have an advantage as they can stimulate collagen over a longer period of time (at least 12-18 months).

What can PDO threads do for patients?

A PDO thread lift treatment can help improve skin quality (smooths and rejuvenates), create tissue integrity, and tighten sagging skin on the face, neck and body (arms, abdomen and buttocks). Depending on the indication to be corrected you will use monos (smooth threads), cogs (barbed threads) or combinations of threads.

As a general rule, mono (smooth) threads are suitable for younger patients who are not yet experiencing sagging skin, loss of skin volume, and want to maintain their skin quality. Mono (smooth) threads may help tighten the skin in some areas or to prepare the skin to receive cog threads in the future.

Cog (barbed) threads are generally suitable once there are signs of sagging skin, such as the cheeks or chin area and typically for patients in their 30s onwards. All types of PDO Threads stimulate collagen under the skin where they are placed including the Mono (smooth) or COG (barbed) threads.

Which is contraindicated concerning thread lift procedures?

There are both relative and absolute contraindications for the thread lift procedures, though the following illustration may seem like there are many contraindications it is very safe in most of your patients:

Which anatomical areas are most requested by patients concerning thread lift procedures?

The face is the most popular and requested area for treatment. Most patients request lifting around the jawline since the aging process in the face tends to accumulate additional fat around this area and we lose that youthful “V-Shape” to the face. By the age of 40+ the effects of gravity start showing within the face as fat in the cheeks will descend resulting in a flatter, upper part of the face.

Eyebrows are also very popular as well with females as they prefer that the eyebrow be at least 1cm above. Most patients want to fix their eyebrows because they are lower than the desired look. Similarly, as we grow older, it is one of the first noticeable parts of the face that begins to sag and lower. Even as you reach 30+ years of age, your lateral eyebrows will already start to droop and those who opt to lift their eyebrows.

Other facial areas for threads include the neck area as well as narrowing the tip of the nose and correct the tip of the nose creating a high nose bridge. It is a 30-minute procedure with zero downtime and very good results.

What are the Post Procedure Care associated with Thread Lift Procedures?

Patients need to be very careful and use common sense in the areas that were treated. For example, facial procedures using cog (barbed) threads, patients need to avoid manipulating the treated area and if necessary, avoid direct pressure in the area whether it demands a change in sleeping habits or physical activity such as for body thread treatments. While the threads are not going to break patients believe the treatment is then asymmetrical while actually uneven swelling is causing one side to be more swollen than the other.

With regards to skin type, are thread lifts safe for those with skin conditions such as hormonal acne?

If they have Acne fulminans (AF) or serious inflammatory acne demonstrating that there is some infection with bacteria in their skin then it would be contraindicated. Practitioners will treat the skin first—not necessarily for the acne to completely clear up, but it shouldn't have infected pustules or Moderate to Severe (Burton Class 3+) acne.

For some acne (such as dry, sensitive or dry and irritated acne), the skin will improve after thread lifts. After a new collagen is produced and hyaluronic product is introduced, the dryness and the sensitivity will reduce immediately reducing inflammation.

What are the most common aesthetic complications associated with the cog (barbed) thread lift procedures?

Bunching and Dimpling: is caused by the skin being pulled too tight and “bunching” around the barbed threads. Thread was not perpendicular to the skin during insertion and “dipped” in the skin before readjustment causing a small internal ripple or dimple.

The solution is to adjust the cog (barbed thread) by pulling the thread in opposite directions. If the barbed thread has not been cut then hold the exposed thread with one hand, anchor skin with other hand and push skin down while exposed thread is pulled up. A “popping” sensation will occur as the barbed threads disengage. Once bunching or dimpling has resolved, reactivate the barbed threads by sliding the thumb along the implanted thread toward the point of insertion.

Migration and threads visible under the skin: is caused by the thread was placed too superficially under the skin and has migrated to just below the epidermis. The thread is visible under the skin when patient smiles, through animation, or tissue is at rest.

The solution is if migration is observed before thread has been cut, remove the thread by simply pulling it out. If thread migrates after the thread is cut, thread must be removed. Isolate the location, numb with Lido/EPI and make a small pilot hole with a 18g needle. Hook the thread using a small sterile phlebectomy hook and pull the thread out through the pilot point. Apply ice to area.

Thread is Exposed at Insertion Point: This is caused by the thread not being cut properly and not flush to the skin. Excess thread is pushing against the skin causing inflammation, discomfort, and/or possible infection.

The solution is to numb the area where thread is pushing against the skin with Lido/EPI. Make a small pilot hole with 18g needle. Expose the tip of the thread by pushing it out of the pilot point or by using a small sterile, fine tip forceps to pull the tip of the thread out of the skin. Pull gently on the thread while cutting the exposed end with a sterile scissor.

There are other cosmetic complications that can occur such as asymmetry in not placing the threads at the correct position but similar to injectables can be corrected by placing additional threads in the area.

What are the most common facial procedures associated with Thread Lifts?

Thread lifts can be used almost everywhere for the face, but the following represents some of the most common uses: