The Plastic Surgery Guide to PDO Threads

PDO threads are used by many modern plastic surgeons to achieve impressive anti-aging results on male and female patients of all ages. But surprisingly, many people have never heard of the procedure. When patients want to turn back the clock without going under the knife, they often first think of facial paralytics like Botox, or dermal fillers like Juvederm. These treatments are safe and effective, and yield beautiful results when applied properly. But a PDO threadlift can often be used alongside of — or in lieu of — injectables to combat facial sagging, minimize lines and wrinkles, and tighten up the skin. If you have only mild to moderate skin laxity, or just want to avoid the higher stakes and price tag of a full facelift, PDO threadlifts are definitely a nonsurgical option worth exploring.

What are Polydioxanone or PDO threads?

Polydioxanone or PDO threads are a special medical-grade thread that are much like sutures and are made in varying diameters and thicknesses.  When larger PDO threads are used, the threads can be used for lifting various parts of the face and body. When smaller diameter threads are used, these threads are used for volumization, much in the same way that in injectable filler is used to create facial volume. 

In my practice, I use both lifting threads and volumizing threads. The term thread lift is used when the thread is inserted to create lifting of soft tissues. The interesting thing about these threads, is that there are microbarbs welded to the thread, so that these small barbs can keep the tissue from falling. I explain this to my patients as though the barbs on threads are like those metal parking lot devices that prevent drivers from re-entering a parking lot after exiting.  

Let me explain, imagine you’re leaving a parking lot, and you’re driving over the angled metal teeth that prevent you from re-entering the parking lot. What we do with these barbs is to place these underneath the skin, then we pull the skin up and over the barb, and the skin “stick” to this. Preventing it from descending. The only difference is that instead of large pieces of metal, the microbarbs hold the tissue up.

With a PDO “threadlift,” lidocaine or another numbing agent is first injected at the threading site so that the patient feels little to no pain during the procedure. Then, the PDO threads are not stitched into the patient’s skin, they are inserted under the patient’s skin, subcutaneous fat, or underlying facial muscles, depending on the target area and the type of threads used. When done by an expert, the PDO threads will not be visible, and will dissolve naturally over time. 

The PDO threads act as a sort of mini facelift. They can help correct sagging skin, relax the muscles that cause wrinkles, and stimulate the body’s natural production of collagen, elastin, and hyaluronic acid. The benefits of PDO threadlifts are thus two-fold in many cases. The stitching itself gives a slight, natural-looking lift to the facial features. Meanwhile, the substances in the threads, and the micro-trauma from the procedure, prompt the body to create more of its own age-defying resources at the threading site. The result is firmer, younger-looking skin with reduced sagging and wrinkling. 

Different types of PDO threads are used for different purposes. Barbed threads are used to lift the skin, whereas twist threads are used to add volume to sagging areas, depressions, or deep creases. Smooth threads can help fix more superficial lines in thinning or crepey skin. An expert PDO thread practitioner can use a combination of threads on different areas of the face and neck to achieve the patient’s desired results. 

What’s better, PDO threads or fillers?

PDO threads may be used alone or in combination with dermal fillers and Botox. A combination of different treatments are often used together to achieve maximum nonsurgical facial rejuvenation, so PDO threads versus fillers is not necessarily an either/or proposition. 

That said, fillers are best for areas that require added volume. Products like Juvederm and Resytlane are popularly used to augment the lips, cheeks, and chin. Results are immediate and there is no recovery time. Fillers will usually need to be reinjected every 9 months or so, though some newer formulations are longer-lasting. 

PDO threadlifts, by comparison, are used more for lift than for volume. While PDO threads can plump and firm up the skin by stimulating increased collagen production, they generally do not add actual volume to the treatment site. If you want to create the appearance of fuller cheeks or lips, filler is your best option. If you’re going for overall facial rejuvenation rather than feature modification, a PDO threadlift may be a better bet. 

Are PDO threads dangerous?

PDO threads are FDA-approved, and have been used safely and successfully in a wide variety of surgeries for over a decade. PDO threadlifts pose very few serious risks, and the fact that no incisions or general anesthesia are required makes it a safer alternative to invasive surgery, though results will be less dramatic and long-lasting. You may not be a good candidate for a PDO threadlift if you have active acne, broken skin, or are prone to cold sores. And always tell your practitioner if you are pregnant, diabetic, have an infection, or an autoimmune disease. 

To cut down on any bruising and bleeding from a PDO threadlift, blood thinning medications should be avoided prior to treatment if possible. You’ll also want to avoid alcohol, extreme temperatures, and rubbing or touching the affected area for a week or so after your procedure. As always, follow your doctor’s pre- and post-care instructions closely. The main risks of PDO threadlifts have to do more with poor technique or non-sterile conditions. Complications like visible sutures, migration, asymmetry, puckering, or infection are possible. But you can reduce these risks by going to the most experienced plastic surgeon in your area. Generally speaking, PDO threadlifts are quite safe and well-tolerated. 

Do PDO threads dissolve?

Yes, PDO threads are made of biodegradable material that dissolves on its own within 12 weeks, so the absorbable sutures will not need to be removed once they’ve been placed. You will see some noticeable difference immediately after the procedure, but it will take about 10-14 days for initial results to truly show up. This is when the process of natural protein synthesis starts to occur at the threading site. The additional collagen, elastin, and hyaluronic acid produced by your own body starts to revitalize sagging skin, giving it extra firmness and structure. The appearance of fine lines and wrinkles start to diminish. Results will continue to gradually improve after a PDO threadlift, usually peaking at about 6 months, and lasting for up to 2 years. So in terms of nonsurgical anti-aging treatments, PDO threads offer patients long-lasting results with no anesthesia risks and no lengthy recovery time. 

Where can PDO threads be used?

The uses for these threads are up to the imagination and resourcefulness of the practitioner. They can be placed in the forehead to elevate the brow, placed in the cheek to elevate the cheek soft tissues, or placed along the jawline to further define the neck. The smaller threads can be used for volumization. 

While PDO threadlifts are especially popular for periorbital rejuvenation (the area around the eyes and eyelids), they are used for a wide variety of applications on the face, neck, and body. PDO threadlifts are often used to correct:

  • Drooping cheeks
  • A sagging jawline
  • Wrinkles and folds around the chin and on the neck 
  • Sagging eyebrows
  • Hooded upper eyelids, or depressions under the lower eyelids
  • Vertical and horizontal forehead wrinkles 
  • Nasolabial folds
  • Marionette lines 
  • Crow’s feet 
  • Fine lines around the lips 

Are PDO threads as effective as surgery?

PDO threads do not work as well as traditional surgery, because the tissue planes are not as fully separated as they are in standard surgeries. However the advantages of these include lower cost, less downtime, and virtually no scarring. The patient only needs to know that the PDO thread is not going to work as well, nor as long, as traditional surgery results. The lasting time is related to when the thread dissolves. Most PDO threads dissolve completely within 12-18 months.

Have questions about PDO threads?
Email Dr. Sykes at hello@sykesplasticsurgery.com

About Dr. Jonathan Sykes

Dr. Jonathan Sykes is a world-famous expert plastic surgeon who performs all cosmetic and functional plastic surgery procedures on the face and neck. He is a past president of The American Academy of Facial Plastic and Reconstructive Surgery, and served on their Board of Directors for over 10 years. He is also a Professor Emeritus in Facial Plastic Surgery from UC Davis Medical Center, and the former Director of Facial Plastic Surgery at that institution.

He is known as the expert’s expert, and is often called to consult and advise other plastic surgeons in both Northern California and Beverly Hills. He has a special interest in eyelid and browlift surgery, facial rejuvenation surgery including facelifts, and rhinoplasty. He also has a particular interest in facial feminization surgery. Have questions? Email Dr.Sykes at: hello@sykesplasticsurgery.com.