25 Things You Need to Know About Thread Lifts

Q. What is PDO thread lift? What is PDO thread treatment?

A polydioxanone (PDO) Thread Lift is a minimal invasive cosmetic technique using dissolvable sutures that are implanted into the skin to keep it from sagging. PDO Thread Treatment is intended for facial rejuvenation (filling in wrinkles, fine lines, adding volume to areas) and/or providing a similar effect to a face lift.

Q. How does thread lift work?

In general, a Thread Lift procedure works by implanting special dissolvable thread(s) into the subcutaneous skin layer (innermost layer of the skin made of connective tissue and fat) which stimulates the production of new blood vessels that encourages collagen  production as the thread(s) dissolves with time. Depending on the thread type and variation, it can fill in wrinkles, give a facial rejuvenation or the same effects as a face lift.

Q. Who should get a PDO thread lift?

Patients with relatively mild to moderate skin drooping or sagging skin are considered good candidates for a Thread Lift. Eligibility to the procedure will depend on (1) the age of the patient, (2) their skin type, (3) if there’s enough thick soft tissue volume, and (4) if they have less facial fat. Patients who have very thin, very aged, very thick or extremely damaged skin, and/or excessively saggy skin are unsuitable to undergo a Thread Lift procedure.

Q. What are the threads made of?

There are now different thread types and subtypes used for Thread Lift Treatments, and differs based on absorbability, texture and can come either as mono-directional or bi-directional:

• Polydioxanone (PDO) thread – longest, synthetic biodegradable polymer. There are also variations to the PDO threads since they can vary with: barb or cone length, direction & angle, spatial distribution, time for it to get absorbed in the skin and its ability to stimulate collagen.
• Polycaprolactone (PCA) thread – is the latest bio-absorbable, monofilament synthetic (caprolactone-based) suspension threads.
• Poly-L-lactic acid (PLA) thread – also known as a Silhouette Soft Thread is made of a biocompatible polymer from lactic acid used also for other surgical procedures

PDO Thread				PCAThread	PLAThread
	Monofilament	Cog	Screw threads
Use	For skin rejuvenation & skin tightening; not much tissue lifting but can avoid puckering of the skin	For mild to moderate skin lift, facial tightening, and rejuvenation		For mild to moderate texture improvement and skin lift
Suitable for	Younger patients who require minor repositioning and tissue revitalization without providing lift	Patients that need more skin lifting	Patients that need skin lifting and needs more volume restoration to sunken skin	Patients that require a small to moderate facial lift	Younger patients that would like minor facial lifting
Description	smooth without barbs, usually placed superficially, and would need to be anchored in one point (face/scalp)	Barbs that hook to skin and encourage collagen growth providing support that lift sagging tissue	may have 1-2 braided threads intertwined around the needle	Has a more long lasting effect since it Influences Type 1 & 3 collagen	Uses cones to hook tissue and improve saggy areas
Sub-types of thread	Braided and monofilament	Unilateral, bilateral, spiral, unidirectional, bidirectional, z-type, cutting barbs, moulding barbs	–	–	–
How long thread lasts in tissue	6 months	6 months	6 months	12-15 months	12 months

Q. What is the procedure in a PDO thread lift?

The whole procedure can be completed in under 30 minutes (including the prep time), and the patient will be allowed to go home after. When it comes to the step by step process, each patient will go through:

• First, the patient’s face will be marked where the threads will be placed, based on the desired aesthetics of the patient (if they just want some wrinkles filled or a face lift, etc.)
• The cosmetic surgeon will then select the right thread for the patient, based on the desired outcome. The type of thread that will be used is heavily dependent on the location where it will be placed, the patient’s skin/face conditions and the technique they’ll use to insert the thread.
• The area will be disinfected and a local anaesthetic will be applied/injected. The amount of anaesthesia will depend on what area needs to be worked on, how much work needs to be done, and the patient’s pain tolerance.
• A cannula (long needle syringe) holding the thread is guided under the skin from the marked entry point all the way to the end point (repeated at least twice for each thread). This is done because the suture can only run in one direction, and can’t be pulled back the other way.
• Once the Thread Lift procedure is complete, you’ll be given a list of post-care instructions of things to do and not to do.

Q. What happens to the threads that are inserted?

In essence, what happens to the thread during the procedure is that it will break down and get absorbed in the skin on its own over a certain amount of time.

• Polydioxanone (PDO) thread – breaks down within 6 months by hydrolysis and lets fibroblasts produce collagen.
• Polycaprolactone (PCA) thread – regenerates collagen longer than PDO and PLA threads by creating a fibrotic reaction leaving a collagen structure to tighten the skin and prevent sagging. This happens because as the PCA thread breaks down, it induces the skin to produce collagen and hyaluronic acid, thus giving the skin a more long-lasting result.
• Poly-L-lactic acid (PLA) thread – is made of a biocompatible polymer from lactic acid used also for other surgical procedures.

The thread used will affect the overall effect of the procedure (as explained in the previous questions). The PDO thread variations will affect the skin differently for each person once it’s inserted in the skin since the barb or cone length, direction & angle, spatial distribution, time for it to get absorbed in the skin affects the ability to stimulate collagen. Examples below show how the thread types and subtypes can affect the skin during and after the procedure:

• If the barbs are too long and flexible, it won’t be able to lift facial tissue, but if it’s too short, it won’t be able to hook onto the facial tissue either.
• If there aren’t enough barbs on the thread (low barb density), it also won’t be able to lift enough tissue (in terms of volume or heavier tissue) for a face lift compared to a high-density barb thread (which will also restrict practitioner to work on smaller areas of soft tissue).
• The barb angle also influences the effect because if the angle is too small it won’t be able to lift the tissue, but if the angle is too big it may break since the barb may dig into the thread (reducing the thread thickness).

Q. What is a PDO face lift?

Similar to any PDO Thread Lift procedure, a PDO face lift focuses on lifting sagging skin on the face. Because Thread Lifting is a minorly invasive procedure, the effects of a PDO Face Lift will not have the same effect as an actual face lift, and any improvements are temporary, lasting up to 3 or 4 years (depending on the threads used, skill of the surgeon and proper post-care instructions).

Q. What areas of the face or body can you do PDO thread lift on?

PDO threading procedure has been done for years for other applications (gynecological disorders, suturing incisions, etc.) but for cosmetic treatments, PDO thread lifts can be used to correct/modify:

• “Marionette lines” (wrinkles near the mouth from smiling)
• “Crow’s feet” (wrinkles near eyes)
• Eyebrows / brow line
• Cheeks

• Undereye area
• Nasolabial folds
• Naso jugal folds

• Jawline
• Jowls
• Neck

Q. What is a thread lip outline

Also known as lip threading, a thread lip outline uses dissolvable threads to smooth out fine lines around your mouth.

Q. How soon will you see results from threading? (How long do PDO threads take to work?)

There’s a moderate degree of improvement which is often immediately seen after the procedure. But take note that it will take time for collagen to build on its own around the inserted thread (which is also dependent on the type of thread used). Overall results can last 12-18 months long, but they’re not permanent.

Q. Disadvantages of thread lift?

One of the biggest disadvantages of a Thread Lift is that the results are not permanent, where some results range from lasting only a few weeks to almost 3-4 years. This can be heavily dependent on the skill and knowledge of who did the procedure and the threads used. Despite being a minorly invasive cosmetic procedure, it can be quite painful especially if not enough anaesthesia is used.

Q. How does thread lift compare to fillers or other procedures?

Compared to other filler procedures, Thread Lifts are:

• Fast procedure – can be done in 30-45 minutes or less
• Minor invasive – general anaesthesia not required
• Faster recovery time with minimal downtime (some can go back to work right after the procedure)
• Cheaper than a traditional surgical face and/or neck lift
• Relatively low risk since complications are rare, and if they ever occur it’s manageable.
• No visible scarring or severe bruising/bleeding
• Can be done in combination with other minimally-invasive cosmetic treatments (botox, dermal fillers, laser or chemical peels, etc.)

Q. What are the side effects of thread lifts?

Although side effects are rare, depending on the thickness of the thread and how sensitive the patient’s skin is, some threads can be felt under the skin and may even be visible (can be fixed if the thread is cut back). Some patients may experience irritation or infection, especially if the post-care instructions are not followed.

Q. What are the risks or dangers to PDO threads?

Because Thread Lifts are a the minorly invasive procedure, there is little to no scaring, bruising, bleeding or any other complication. Even if the risks and dangers to PDO Thread Lifts are rare, there is a possibility:

• that there could be redness or swelling
• the thread might move/migrate or break if not cared for properly after the procedure (making the skin look oddly lumpy or notice bulges on the skin)
• Some may experience irritation
• An infection or any other side effect that will definitely still be manageable. But just to be sure if the patient experiences any of the following, make sure to call the doctor immediately:

• Any kind of coloured discharge (green, black, brown, red) in the area of the procedure
• Swelling that’s more than 48 hours
• Constant headaches
• Fever

• In the hands of an unskilled practitioner, there may be a possibility that the face lift can become asymmetrical.

Q. Complications of PDO thread lifts?

As mentioned, any complication during and/or after a Thread Lift is rare, but not impossible. In the hands of an unskilled professional doing the Thread Lift, some of those rare incidents may include the possibility of facial nerve damage, blood vessel damage, and facial paralysis. There have been also rare cases reported it could triggered HPV and folliculitis. Allergic reaction can occur to the threading material, and also visible dimpling/pulling in the area where the threads were inserted.

Q. Who can perform PDO thread lift procedures?

Depending on the country, doctors and other medical professionals who have completed courses or has previous qualifications in injections, dermal fillers or Botox, can be eligible to take and complete the PDO thread lift course.

Q. Can you feel the threads after getting threading?

Ideally you shouldn’t see or feel the threads if the procedure is done correctly and the highest quality threads are used. It is possible to feel the threads after the procedure since it can depend on the thickness of the thread used, how sensitive the skin is and if there’s still any swelling or bruising. Even if the threads may be placed more superficially for it to be felt, it will be temporary since the threads will dissolve and are absorbed by the skin.

Q. How long do the effects of threading last?

In general, the results of a PDO Thread Lift are subtle and non-permanent. Depending on the type of thread(s) used, it can take 6-15 months for the threads to dissolve/get absorbed by the body and at the same time allow the skin to build collagen in the area. This means the results are usually more visible after six weeks, and with getting enough fluids, diet, sleep and proper care, the procedure’s effects can last around three years (maybe even up to four years with a touch-up treatment).

Q. How do you sleep after PDO threads?

Post-care instructions advise patients to sleep face-up and in an elevated position. This should help minimise the risk of putting unnecessary pressure on the operated area, infecting it or breaking the thread.

Q. How long do PDO threads last?

Depending on the thread, it will take around 6 – 15 months, sometimes longer due to the collagen that develops along the implanted thread.

PDO Thread				PCAThread	PLAThread
	Monofilament	Cog	Screw threads
How long thread lasts in	6 months	6 months	6 months	12-15 months	12 months
Tissue

Q. What do I need to do before my thread lifts? (prepping)

Pre-care starts at least one week before the procedure and you will be advised how to prepare for it. These are important steps to help your skin stay hydrated:

• Inform your surgeon if you’re taking any medications
• Avoid stress and try to get enough sleep before your appointment
• Avoid any known food allergies, or anything that can trigger inflammation
• Avoiding alcohol and smoking at least 1 week before procedure
• Avoiding certain medication (blood thinners, NSAIDs, Ibuprofen, etc.)
• Avoiding certain food and supplements (omega fish oils, Vitamin A, E, teas, garlic, etc.)

Don’t wear any makeup (any makeup will be removed before the treatment). Arrive at least 10-15 minutes before the appointment to do any related paperwork and discuss the treatment.

Q. What kinds of activities can you not do after PDO thread lift?

No matter how minor the Thread Lift procedure was, it’s very important to follow all the post-care instructions to make sure no complications arise. The collated list below may be extensive, but always double check with your surgeon to make sure:

• No makeup for the first 24-48 hours
• Avoid touching, wetting, washing face for the first 12-24 hours
• Avoid swimming for the first 12-24 hours
• No pulling on the skin (avoid extreme facial expressions, no face massage, no facials, scrubbing or exfoliating for at least 3 weeks) – you can still wash your face, just make sure to be very gentle cleanser
• Avoid smoking and drinking alcohol – elevates blood pressure and flushes out excess water and nutrients
• Inform your doctor if you’re taking any blood thinning medication (NSAIDs, MAOIs) and supplements (Vit. A, C, E, fish oil, gingko biloba, garlic supplements). Only your doctor can advise what medications & supplements you can actually take during the one week recovery period.
• Strenuous physical activity / no exercising
• Avoid saunas and walk-in freezers – avoid too much body temperature changes
• Avoid overexposure to direct sunlight
• Avoid sleeping face-down. Patient’s are advised to sleep face-up and in an elevated position.
• Avoid any dental treatment at least for the first two weeks after the thread lift
• Any straining or putting pressure on the face (to avoid thread misalignment)
• Avoid drinking with a straw for at least a week to lessen any facial muscle straining. Be aware that they may suggest drinking liquids or consuming soft food during the week you need to heal.
• Chewing gum should be avoided (at least two weeks)

Q. How many threads do I need?

Depending on the area that needs to be treated, the number of threads that can be used can range between 2 to 20 in one session. But note that this will also depend on what other procedures the patient may want has to also take into consideration the type of thread that will be needed. For example, the average threads used for a standard thread lift would be 8 threads total. That’s 4 threads on each side of the face = 2 on the cheekbones and 2 on the lower face. This isn’t always the case because other patients may need more, or less, depending on the state of the skin, their age, etc.To determine exactly how many threads you’ll need, your cosmetic surgeon will check on the following factors:

• Pain and risk tolerance. Remember that the more threads you’ll want, especially if they’re the barbed threads, will mean more discomfort during the procedure. Not everybody’s pain tolerance will be the same, so what can but uncomfortable for one patient, may be unbearable for another.
• Patient’s face type and the actual skin’s aging process. Even if the patient can be considered as a candidate, every patient’s case will be different. With patients with “heavy” faces, they may need to have multiple sessions and will need more threads than a patient with a more hallow face.
• Patient’s expectations. Some patients may expect to have the exact same results as an actual facelift or have a particular idea of what they’ll look like after the Thread Lift procedure. It’s important that the proper expectations are set, with a realistic goal of what the area they want lifted/filled will look like after the procedure.
• If there are any other treatments to be done. Patient’s should remember that Thread Lifts are not the only procedure they can use for the face lift. There are other minorly invasive procedures (like fillers) that can help frame the face to still achieve the face lift.

Q. What is PDO thread lift cost?

The cost of a PDO Thread Lift procedure can range from USD$1500 to USD$4,000, depending on the experience of the cosmetic surgeon, how many areas are getting treated, the quality and how many threads will be used, etc.

Q. How long does it take to recover from a PDO Thread Lift?

Since the recovery time is really fast, some patients can opt to go straight to work right after the procedure. Recovery time for any possible bruising or swelling can last up to a week.Always follow everything that your doctor prescribed in the post-op care instructions, which can include also some or any of the following:

• Painkillers
• Prophylactic antibiotics (to prevent any risk of infection)
• Ice packs to minimise swelling
• Advise to avoid wearing make up and avoid strenuous actions on the skin and strenuous activities (see answers to question 22 on the necessary things to avoid after a Thread Lift procedure)