What are PDO threads?

Loss of skin elasticity is a common sign of aging skin. As long as facial treatments have been around, different minimally invasive procedures continue to develop to maximize aesthetic enhancement and minimize downtime. One of such procedures is the PDO thread, an increasingly popular option for treating signs of aging on the face.

According to clinical research, “thread lifting with polydioxanone (PDO) sutures is a cosmetic procedure where lax tissue is lifted and repositioned trying to create a more youthful-looking facial contour (Cobo, 2020).” The procedure uses injectable dissolvable surgical sutures to rejuvenate the facial tissues across the temples, the forehead, nose, cheeks, under-eyes, and chin, based on the specific need of the patient.

It is a popular option for patients looking for a lifting or contouring treatment without the extended recovery time of a surgical procedure.

What do they do?

Threads are absorbable sutures made of proteins, usually used during surgeries. During the PDO procedure, these threads are placed under the skin to tighten and lift loose or sagging areas in various parts of the face to help reduce the effects of aging and rejuvenate the face. PDO threads are also FDA approved and have been used extensively in surgical procedures.

Different types of threads:

Three main categories of threads are available for treatments. These are polydioxanone (PDO), polylactic acid (PLA), and polycaprolactone (PCA). They are designed to stimulate collagen production to rejuvenate skin. The PDO is the oldest version and most popular. PDO is subcategorized into three main types: mono, cog, and screw threads.

• Mono threads are smooth without barbs. They mainly tighten the skin and provide a small amount of lift.
• Cog threads do have barbs to support and lift the sagging tissue.
• Screw threads have one or two intertwined threads and deliver volume restoration to sagging areas of the skin.

What are they used for?

Depending on the specific need area of the patient, threads can provide different treatment options for facial lifting or facial rejuvenation. During a consultation, a trained practitioner will consider a patients specific needs, treatment indications, and what they are trying to achieve before deciding what type of thread to use:

• PDO mono threads provide the most support for tightening or rejuvenating the skin whereas the PDO cog or screw (with barbs) provides a general facelift appearance.  

• Different areas of treatment: the treatment can be used in any part of the face and neck to treat sagging. These include the brows, nasolabial lines, vertical and horizontal forehead wrinkles, drooping cheeks, marionette lines, sagging jawline, plus wrinkles and folds on the chin and neck.

What is a treatment like?

• Before placing the threads, the face is disinfected, and a local anesthetic is injected under the skin if necessary.
• Using a needle, the nurse practitioner then creates a hole on the surface of the skin to feed the cannula and thread through.
• The PDO thread is pushed through to achieve sufficient anchoring between the thread and the periosteum (this is the area that protects bone and helps to rejuvenate when damage occurs).
• The treatment creates immediate results, enhancing the skin’s appearance. The results continue to improve over the following two weeks as the PDO stimulates and produces collagen into the skin. The PDO threads tighten and firm the skin, while simultaneously reducing fine lines and wrinkles.
• The entire procedure lasts an average of 15 minutes.

Post-treatment care:

After treatment, a PDO thread will be absorbed by the skin after about 6 months, however, the lifting effects can remain for another year or more. Research has shown that patient satisfaction was peak at about 6 months after treatment and declined after a year. It is important to note, however, that the efficacy of the treatments and consequent results are also dependent on the elasticity and tissue volume of the patient, so proper skin care is highly recommended.

Research indicates that patients with less sagging and a high volume of soft tissues, saw results last for more than a year. On average, as compared to the PDO threads, the PLA or PCA threads deliver a general facelift, results of which also last for between 12-15 months on average. Patients looking for a general facelift treatment may consult with their aesthetic provider about either of those options.

Potential side effects or complications:

As with many minimally invasive surgical procedures, side effects are expected. Possible side effects and complications for this treatment may include:

• Pain
• Sensitivity
• Bruising
• Allergic reactions
• Infection
• Thread protrusion
• General pulling of the skin

Patients should take care to follow care instructions after the procedure to maximize results. “If they are prepared well [on after-treatment care], most patients know these effects are normal,” says Dr. Blake.

Patients should then pay attention to the following:

• Taking pain medications to ease discomfort; an over-the-counter pain med like Ibuprofen can be taken as needed.
• Take care to not place excessive pressure on the areas of treatment.
• Avoid anticoagulants for a period of 7 days or as recommended by the practitioner.
• Avoiding other facial procedures for a period as recommended by the practitioner.

Cost:

For people looking to use this treatment, Dr. Blake says, “the costs of threads are a pretty broad range, but with a remarkable effect.” Patients can expect to pay anywhere from $500 to $6000 for a treatment. This is however dependent on the clinic and practitioner administering the procedure, and the specific needs of the patient. Some clinics do offer a payment plan to subsidize the cost, as most insurance companies are unlikely to cover the cost of threads.

Practitioners like Dr. Blake do have open conversations about the cost, and “have to control the conversation on cost,” to make sure their patients understand before proceeding with the treatment. In some cases, he said, “patients may have to come back to continue the procedure at a later time, which is perfectly acceptable”.

During the consultation, Dr. Blake recommends showing patients before and after pictures, to show the extent of treatment available.

Who can administer PDO threads?

• Not every medical professional is trained to deliver a PDO thread treatment. For this reason, choosing a specific practitioner will depend on a number of factors including a being board-certified medical professional and being trained to administer threads.
• Patients are encouraged to verify that a practitioner is trained and certified to administer this procedure.  

Who is a candidate:

PDO threads are a great option for patients with good soft tissue volume, less facial fat, and a small amount of skin to be lifted. This provides the best benefit from a thread lift treatment.

Who is not a candidate:

Threads lifts may not be suitable options for patients with excessively saggy skin or for patients with very aged, thick, or damaged skin. The procedure is not suitable for patients who are pregnant or currently breastfeeding, or patients with allergic reactions to medication used in the procedure. For patients with compromised autoimmune diseases or diabetes, it is advisable to consult your aesthetic provider first.

Overall

The PDO threads procedure is a quick and mostly pain-free facial rejuvenation treatment for sagging skin. They have been used extensively in surgical procedures for decades, and are FDA approved. Although the outcome and final results are dependent on some of the points discussed above, it is a completely safe procedure and presents minimal to no risk for patients who are looking to rejuvenate areas of the face.

Sources

• Cobo R. Use of Polydioxanone Threads as an Alternative in Nonsurgical Procedures in Facial Rejuvenation. Facial Plast Surg. 2020 Aug;36(4):447-452.

• Hanging by a thread: Choosing the right thread for the Patient. ResearchGate.

• Wong V, Rafiq N, Kalyan R, Hsenriksen A, Funner A. Hanging by a thread: choosing the right thread for the right patient. J Dermatol Cosmetol. 2017;1(4):86-8.