When it comes to cosmetic enhancements, figuring out when to opt for non-surgical procedures and when to consider surgical nips and tucks can be ticky. If you are experiencing the volume loss and skin sagging that naturally arrives with age, injectable filler alone may not be enough and it may not yet be time for a facelift. For those who fall somewhere in between, wanting a natural-looking lift and an increase in collagen (the youth-preserving protein), a PDO thread lift may be the Goldilocks option.
Thread lifts have humble beginnings. They fell out of favor in the early 2000s due to their fragility, visibility under the skin, and lackluster results. Recently, however, the minimally invasive procedure has enjoyed a glow up. After a few enhancements of their own, threads are being utilized from head to toe to behind (specifically: the buttocks).
So, with their ability to address not just skin laxity concerns but also the internal production of collagen, could thread lifts lessen the need for facelifts, if not make them obsolete? The answer is not a simple yes or no, and we’ve gone to the experts to understand the pros and cons of the PDO thread lift.
What Is a PDO Thread Lift?
“A PDO, polydioxanone, thread lift is a procedure that uses dissolvable sutures to rejuvenate and lift sagging skin,” explains Julius Few, MD, a board certified plastic and reconstructive surgeon and founder of the Few Institute. It is one of three types of sutures commonly used in thread lift procedures — the other two types are made from poly-L-lactic acid (PLLA) and polycaprolactone (PCA).
When it comes to choosing PDO, PLLA, or PCA threads, Dr. Few says it really depends on the needs of the patient and their aesthetic goals. “PDO threads are better at repositioning and revitalizing tissue, while PLLA and PCA threads are better at lifting sagging parts of your skin,” he notes. These threads vary in length, diameter, size, and strength, says Cheryl Karcher, MD, a board certified dermatologist in New York City, which all impact the lifting process.
As she explains, “very fine threads would be used in smaller facial areas,” such as around the eyes or the lips. “Medium strength and length threads can lift the jawline, the marionette area, or the lines around the mouth and chin,” she says. Other use cases? Lifting the nasolabial folds and decreasing the wrinkles in the neck, she continues. Last but not least, “wider and stronger threads have been used to address laxity in areas such as breasts, sagging knees, and other body parts that may need a mild lift,” Dr. Karcher adds.
How PDO Threads Work
If you’ve seen videos of thread lifts on social media, the process of threading might look a little graphic. In reality, it is a relatively painless and quick procedure. “A small amount of local anesthesia is inserted into the area where the threads will be placed to lift,” Dr. Karcher says. “The threads are then inserted, gently tightened so that the tissue is gathered, and gently pulled with the excess thread cut.” The threads have little ridges that allow for the thread to act as an anchor and grasp the skin as it is pulled.
Externally, the use of these threads gives the skin the appearance of an immediate, albeit subtle, lift. Internally, the threads stimulate the body’s natural collagen production. They break down over the course of a few months (think: three to six), but the collagen remains. Depending on what the patient is hoping to accomplish, the thread lift may be paired with other facial rejuvenation treatments.
Dr. Few, for example, has developed his own approach for delivering more comprehensive and longer-lasting results. “The Inverso Suspension technique is a non-surgical treatment that I developed to incorporate non-surgical thread lifting with the restoration of lost volume in the jawline with micro Botox® or Xeomin® to the frown muscles of the mouth to create a graceful appearance that is not ‘done’ or unnatural in nature,” he explains. “The results of this approach may last two years or more.”
The Right Candidate for PDO Threads
While the benefits of thread lifts are promising, there are limits to what they can achieve. “The ideal thread lift candidate is usually in their late thirties to early fifties,” Dr. Few says. “Most patients over the age of about 55 will benefit more significantly from facelift surgery.” With that said, if you are of facelift age but not able to go under the knife, a thread lift can be an option. “Thread lifts can provide a facelift alternative for older patients who are unable to have surgery for medical reasons,” Dr. Few shares. Because they can be performed under local anesthesia, “many people who have age-related conditions that make them ineligible for surgery — like high blood pressure, type two diabetes, and cardiovascular disease — can safely have this treatment,” he adds.
PDO Thread Lift Recovery & Results
From procedure time through recovery, thread lifts are among the most expedited facial rejuvenation options. “One of the best things about this treatment is it only takes about 30 minutes,” Dr. Few says. “After that, you’re free to go back to work or whatever else you had scheduled for the rest of your day.” Post-procedure, patients may be advised to limit rigorous exercise and activity for about a week, but it’s usually possible to return to work immediately after. Swelling and bruising may also occur depending on the patient.
Now for the most important part: the results. As we mentioned, thread lifts have both short- and long-term effects that allow the visible results to keep on giving. “Another advantage is the results are seen immediately,” Dr. Karcher says. While the benefits of the collagen production take several months to show up, the lift from the threading is instant. The results can last up to two years, though you may seek a touch up before then...
Yes, You Can Get a PDO Thread Lift More Than Once
As we mentioned, the results of a PDO thread lift can last up to two years. Due to their nature, maintenance isn’t as routine as say, neurotoxin or filler, but Dr. Few notes that, at his practice, many patients come back for additional thread lifts after the initial sutures are absorbed by the body.
If you don't find the results satisfactory, surgical intervention may be the better solution — and it’s important to find a provider who will give it to you straight. “For patients who are clear surgical candidates, PDO is not the ideal tool, surgery is,” Dr. Few cautions. “If a patient feels, after three months, they want more lift than the PDO can deliver, I would advance them to either PLLA or surgery as an enhanced lifting, rejuvenating tool.”
Why PDO Threads Are Not the ‘New’ Faceliift
Now that we understand the powers and limitations of the procedure, it’s safe to say that, while they may offer a plumping lift, thread lifts are not a ‘forever’ option for all. “It’s a cheaper and faster alternative to facelift surgery, but the results don’t last as long and aren’t as dramatic,” Dr. Few says. Even so, the right cocktail of genetics and maintenance might make thread lifts enough for some. “Because the thread lift procedure is so low-risk, patients who like the results of their thread lift can usually opt to have a fresh set of temporary sutures placed once their old sutures are absorbed by the body,” he adds.
For those who can afford the upkeep, “this maintenance may help forestall or eliminate the need for a facelift down the road,” Dr. Few shares. Dr. Karcher echoes this sentiment. “The PDO thread lift will give the benefit of a more uplifted, tighter area without all the downsides of surgery,” she says. “This can greatly extend the time before someone gets surgery or it can eliminate the need for surgery.”
Few procedures work from the inside out to enhance and lift the way PDO threads do, which is what makes this modern version of the thread lift so popular. By addressing multiple causes and symptoms of skin again on a plethora of areas, it’s a great option for those who aren’t yet candidates for a facelift or are looking to avoid one altogether. There are, however, limits to what a PDO thread lift (or any thread lift) can accomplish, so it is important to consult with a board certified dermatologist or plastic surgeon to determine the best treatment protocol for your anatomy and aesthetic goals.
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