BACKGROUNDThread lifting is a minimally invasive technique for facial rejuvenation. Various devices for thread lifting using polydioxanone (PDO) are popular in aesthetic clinics in Korea, but there have been a few studies regarding its use.OBJECTIVETo describe PDO thread and techniques adopted to co

Outcomes of polydioxanone knotless thread lifting for facial rejuvenation.

Minimally invasive cosmetic procedures are in increasing demand worldwide. Patients are constantly searching for office-based techniques that can help improve the signs of aging but without the morbidity of a surgical procedure. 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. The threads are absorbable and come in different shapes and lengths. The rate of complications and the downtime of the procedure are low, which are something patients are looking for. Ideally, these procedures should be performed by trained specialists who have complete knowledge of the facial anatomy, thus enhancing and improving results. Thread lifting with PDO absorbable threads has become an excellent option for minimally invasive facial rejuvenation procedures with a high satisfaction among patients and very few complications. It is a new tool that can be introduced in the armamentarium of specialists who work in the field of facial plastic surgery and who can offer this option to their patients with improved outcomes.

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Use of Polydioxanone Threads as an Alternative in Nonsurgical Procedures in Facial Rejuvenation.

Background One of the most common nonsurgical options for facial rejuvenation is lifting using threads. Application of polydioxanone (PDO) threads is generally secure and effective procedure, but complications on the involved regions can occur. Objective In this study, we shared our experiences of efficacy and safety of PDO thread lifting for facial rejuvenation and presented our technique to prevent the migration of threads. Materials and methods Thirty-eight patients who underwent PDO cog treatment for facial rejuvenation were evaluated. Via 23 G/90 mm sharp needle, bidirectional barbed PDO cog thread was inserted into subcutaneous tissue. The outcomes of procedure were assessed by Global Aesthetic Improvement Scale (GAIS) and patient satisfaction. Results Thirty-eight patients were included in this study. Mean age of participants was 39.6 ± 7.5 years. The GAIS score showed satisfactory results (very much improved: 78.9%; much improved: 18.4%; improved: 2.6%). According to patient satisfaction, all patients were satisfied with the clinical outcomes of procedure (excellent: 76.3%; very good: 21.0%; good: 2.6%). No patient reported 'fair' or 'poor' result. Conclusions Our results revealed barbed PDO cog thread is highly effective in facial rejuvenation. Also, tying the PDO threads in same entry point to each other seems to be an effective technique to prevent thread migration.

Experiences of barbed polydioxanone (PDO) cog thread for facial rejuvenation and our technique to prevent thread migration.

Background:In 2006, Villa et al. published a review article concerning the use of thread-lift sutures and concluded that the technique was still in its infancy but had great potential to become a useful and effective procedure for nonsurgical lifting of sagged facial tissues. As 11 years have passed

Thread-Lift Sutures: Still in the Lift? A Systematic Review of the Literature.

BACKGROUND Owing to its potentially greater mechanical force on the implanted tissue, barbed thread is frequently used in face-lifting procedures. However, the long-term durability thereof remains controversial. Moreover, reports on underlying histologic and molecular changes resulting from face-lifting procedures are scarce. OBJECTIVE To evaluate histologic and molecular changes induced by absorbable, barbed face-lifting thread in an animal model. MATERIALS AND METHODS Fragments of monofilament, monodirectionally barbed polydioxanone thread were implanted in dorsal skin from 12 guinea pigs. Tissue samples were harvested at 1, 3, and 7 months thereafter. Histopathologic analysis and quantification of Type 1 collagen and transforming growth factor beta 1 (TGF-β1) levels were performed. RESULTS Implantation of a single fragment induced fibrous capsule around the thread. Tissue reactions were strongest at 1 month after implantation, showing marked infiltration of inflammatory cells and fibroblasts, which gradually decreased. On molecular analysis, Type 1 collagen and TGF-β1 levels were significantly increased, compared to normal skin, throughout the 7-month study period. CONCLUSION Our results suggest that implantation of barbed thread induces strong anchorage to skin tissue. Quantitative analysis of collagen and its downstream signaling molecule TGF-β supports the long-term durability of the thread. Therefore, the authors expect potential beneficial effect for rejuvenation on its clinical application.

Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread.

Background. The aging face loses the tensile strength of structural integrity. Cog threads have been used recently to tighten lax skin and soft tissue.

Objective. A comparative study of the effects of cog, monofilament, and multifilament threads under rat skin.

Methods. Each cog, monofilament, and multifilament thread was inserted under the facial skin of a cadaver and the panniculus carnosus of rat dorsal skin. The maximum holding strength (MHS) of the thread and the tearing strength of the skin around the thread were measured with a tensiometer. The thickness of the capsule around the thread and the myofibroblasts was observed histologically.

Results. In the cadaver, the MHS of the cog thread was 190.7 ± 65.6 g. It was greater than that of the monofilament (22.4 ± 7.7 g) or multifilament (40.4 ± 19.7 g) thread. In the rat, the MHS of the cog thread was 95.1 ± 18.8 g. It was greater than that of the monofilament (4.3 ± 1.3 g) or multifilament (10.9 ± 2.1 g) thread in the second week. The thickness of the capsule around the cog thread was 93.0 ± 3.2 μm. It was thicker than the monofilament thread's capsule, 39.2 ± 12.1 μm, in the fourth week. The number of myofibroblasts presented significantly more in the cog (96.0 ± 72.4) than in the monofilament thread (4.3 ± 4.4). The rumpled in-between skin suspended by each of the three different threads returned to its original state in 2 weeks.

Conclusion. The cog thread placed under the rat skin immediately pulled the skin and subcutaneous tissue. The myofibroblasts around the thread played a role in fibrous tissue contracture 4 weeks postinsertion of the thread. These findings could be the basis for clinical application.

THIS STUDY WAS SUPPORTED BY A GRANT FROM THE KOREA HEALTH 21 R&D PROJECT, MINISTRY OF HEALTH AND WELFARE, REPUBLIC OF KOREA.

Effect of Cog Threads under Rat Skin

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Outcomes of polydioxanone knotless thread lifting for facial rejuvenation.

Effect of Cog Threads under Rat Skin