The evolution of aesthetic advancement: A review of PDO threads in medical aesthetics

In recent years, the demand for non-invasive and minimally-invasive aesthetic procedures has experienced a remarkable surge. Patients are seeking alternatives to surgical interventions that offer effective and natural-looking results with minimal downtime. Among the various options available, Polydioxanone (PDO) threads have emerged as a promising solution.

THE SCIENCE OF PDO THREADS

PDO threads are biodegradable sutures made from polydioxanone, a synthetic, absorbable polymer. They have a proven safety profile in various medical applications e.g. resorbable sutures used in surgical procedures, but also in facial aesthetics, for strengthening and supporting the skin as well as repositioning it to achieve lifting. The threads are inserted subcutaneously to lift and tighten sagging skin, stimulate collagen production, and improve overall skin texture. The biocompatible nature of PDO makes it an ideal material for such procedures.

ALTERNATIVE THREAD MATERIALS

In addition to PDO, various alternative materials are used in thread procedures. These materials include Poly-L-Lactic Acid (PLLA), Polycaprolactone (PCL), barbed threads, and threads with hyaluronic acid (HA) coating. Each material possesses unique properties, offering practitioners a range of options for non-surgical facial rejuvenation.

MECHANISM OF ACTION

The mechanism of action of PDO threads involves two main processes: mechanical lifting and collagen stimulation.1 The threads provide an immediate lifting effect by physically supporting sagging tissues. Additionally, they stimulate the body’s natural collagen by subclinical inflammation by macrophages, followed by microparticle encapsulation and collagen production by fibroblasts, contributing to long-term improvements in skin elasticity and firmness.2

APPLICATIONS IN NON-SURGICAL FACIAL REJUVENATION

PDO threads have shown remarkable efficacy in addressing various aesthetic concerns, including facial sagging, fine lines, and wrinkles. Common applications include:

• Mid-facial rejuvenation: PDO threads can lift and tighten the mid-face, reducing the appearance of nasolabial folds and marionette lines.

• Neck and jawline contouring: The threads are used to redefine the jawline and improve the contour of the neck, providing a more youthful appearance.

• Eyebrow and eyelid lift: PDO threads offer a non-surgical alternative to lift and rejuvenate the eyebrows and eyelids, reducing hooding and restoring a refreshed look.

• Collagen boosting: Beyond immediate lifting effects, PDO threads stimulate collagen synthesis, promoting natural rejuvenation over time.

PERSONAL PREFERENCE: PDO THREADS WITH MICRO-PUNCHED RECESSES3

My personal preference leans towards PDO threads featuring micro-punched recesses. Clinical experience with PDO material has been extensive, and its excellent safety record speaks volumes.4 The micro-punched recesses create a secure grip, stronger than cog projections, ensuring a robust connection with surrounding tissues. This enhanced attachment proves valuable for achieving pleasing initial improvement and longlasting results in non-surgical facial rejuvenation. An additional advantage of the recessed PDO thread is that, with no cog projections, a thicker thread can be mounted in any given size of a cannula. The more PDO material inserted, the greater the collagen response, due to more PDO material inducing inflammatory rection and longer time for full resorption, enhancing efficacy and resulting longevity.

PATIENT SELECTION AND SAFETY CONSIDERATIONS

While PDO threads offer a minimally-invasive alternative to surgical procedures, careful patient selection and thorough assessment are crucial. It is absolutely critical that patients are comprehensively informed about possible outcomes and maintain realistic expectations regarding the results they can expect. This also includes risks, like nerve damage, extrusion of a thread, infection, pain which can persist, swelling and bruising, but also unfavourable results.5

ENSURING EXPERTISE AND QUALITY ASSURANCE

For clinicians venturing into thread procedures, seeking comprehensive training from recognised experts in the field is imperative. The intricate nature of these techniques demands a deep understanding of facial anatomy, patient selection, and the nuances of each thread material. Specialised training enhances proficiency and contributes to the overall safety and efficacy of aesthetic procedures.

Furthermore, the choice of clinic plays a pivotal role in ensuring patient well-being and regulatory compliance. Practitioners are encouraged to operate from clinics approved by regulatory bodies such as the Care Quality Commission (CQC). This endorsement signifies adherence to rigorous standards of care, hygiene, and patient safety, instilling confidence in patients and reflecting a commitment to maintaining the highest ethical and professional standards within the field of medical aesthetics.

FUTURE DIRECTIONS AND EVOLVING TECHNIQUES

As technology advances, so do the techniques and applications of PDO threads. Emerging research explores novel thread configurations, combination therapies, and enhanced thread materials to further improve outcomes and expand the scope of non-surgical medical and aesthetic interventions.6

CONCLUSION

PDO threads and a variety of alternative materials represent a paradigm shift in medical aesthetics, providing safe, minimally invasive solutions for facial rejuvenation. The versatility and effectiveness of these materials make them valuable tools for practitioners meeting the growing demand for non-surgical aesthetic procedures. As science and technology continue to advance, threads with different materials are likely to play increasingly prominent roles in shaping the future of aesthetic medicine.

DR ANTONIOS PETROU-AMERIKANOS

Dr Antonios Petrou-Amerikanos DipDS (1985), PgDip Cosmetic Medicine (2021) Dental surgeon with 35 years’ experience, 18 years in cosmetic medicine. Trainer and KOL for N-Finders PDO Threads distributed by Eden Aesthetics Distribution Ltd, expert trainer for Cosmetic Courses and faculty member for Dermafocus.