Synergistic facial rejuvenation with PDO threads and Botulinum Toxin A for aging skin

Evaluation of Efficacy and Safety of Botox in the Management of Facial Wrinkles

BackgroundTraditional facial aging surgeries have risks and extended recovery times, leading to a demand for minimally invasive alternatives. PDO (polydioxanone) threads, which are absorbable sutures that stimulate collagen production and tissue contraction, offer improved aesthetic outcomes. This paper evaluates the combined use of PDO thread mid-cheek lift and lower blepharoplasty for facial rejuvenation.MethodsThis retrospective study compared outcomes in patients undergoing lower blepharoplasty combined with a mid-face lift using PDO threads versus those undergoing only lower blepharoplasty. Focused on individuals with baggy lower eyelids and pronounced nasolabial folds, outcome measures included the Modified Fitzpatrick wrinkle scale, Allergan® midface volume deficit scale, Width of inter zygomatic distance, Patient and Observer Scar Assessment Scale, and patient satisfaction questionnaires, assessed at baseline, 3 months, and 1 year postoperatively.ResultsThe combined procedure demonstrated superior aesthetic outcomes and higher patient satisfaction compared to lower blepharoplasty alone. Improvements were more significant in wrinkle reduction, midface volume, and inter-zygomatic distance in the combined procedure group. Although the combined procedure had a longer mean operation time, scar assessment scores were similar between both groups, with no complications reported.ConclusionThe combination of lower blepharoplasty and mid-face lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly enhances wrinkle reduction, mid-face lifting, and patient satisfaction. Ultrasound-guided thread lifting, a method of assessing and performing mid-face lifting, proves to be safe and efficient. This approach holds promise as a future option in cosmetic anti-aging surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266.

Introduction: The fascination with beauty attracts optimizations of surgical techniques through the use of PDO (polydioxanone) threads. In recent years, the use of barbed tensor threads has gained popularity as a means of rejuvenating the face. Objective: This study presented the main clinical and aesthetic approaches to optimizing techniques using PDO threads for facial rejuvenation. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 101 articles were found. A total of 17 articles were evaluated and 14 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 38 studies with a high risk of bias and 35 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=65.7%>50%. It was concluded that the combination of lower blepharoplasty and midface lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly improves wrinkle reduction, midface lift, and patient satisfaction. Ultrasound-guided thread lift, a method of evaluating and performing midface lift, proves to be safe and efficient. This approach holds promise as a future option in anti-aging cosmetic surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime. The Cartesian Technique™ with Smart PDOs™ is an effective protocol for skin resurfacing that enhances cellular biostimulation through the release of bioactive drugs. Using PDO threads for midface lifting is simpler, faster, and less invasive than conventional surgical methods, and this method simultaneously achieves satisfactory results. The combination of hyaluronic acid fillers and PDO threads was effective in achieving and maintaining long-term improvements in facial volume and contour. Thread lifting with short, wedge-shaped PDO sutures is safe and effective for facial rejuvenation. The vertical lifting technique has shown advantages over current approaches. Wedgeshaped PDO sutures in a folded configuration are a promising treatment option for deep static wrinkles in the upper face. The “Half Moon Base” incision and use of 4.0 PDO threads have shown significant aesthetic results in the eyebrow.

Thread lifting is one of the most common minimally invasive options in facial rejuvenation procedures. The application of polydioxanone (PDO) showed good results and fewer complications. PDO threads effectively strengthen the contour of the face, reduce roundness, and lift sagging skin due to collagen-stimulating properties. The purpose of this study was an evaluation of the efficacy of the PDO threads: the combination of the cog type and press cog type threads (Ncog and Nfix) and cog type thread (Ncog) alone. And this study was conducted to define complications related to thread inserting during the follow-up period. Thirty patients who underwent PDO thread treatment for facial rejuvenation and tightening sagging skin tissues were evaluated. The follow-up period was seven months. Photographic objective and subjective evaluations were performed during this period. Thirty patients were included in this study. The mean age of participants was 51.8years (range 65 to 34). There was a statistically significant difference between pre and 1-month post-operative results in both groups with a mean score of 1.94±0.43 (p<0.05). Furthermore, the combination of Ncog and N fix showed slightly better results than Ncog alone. According to patient satisfaction, all patients were satisfied with the clinical outcomes. Our results revealed PDO threads are effective in aged skin rejuvenation, soft tissue retraction, and support, showing fewer complications. In addition, it could be assumed that treatment with thicker thread could be a more efficacious procedure. However, this statement requires further researches.

We propose a new facial lifting protocol using polydioxanone (PDO) threads embedded in acetyl hexapeptide-8 (Argireline [Arg]). We assume that Arg reinforces the effects of PDO threads, as it is a mimetic of botulinum toxin. Because the PDO suture is hydrolyzable, this assumption is analyzed by instrumental analysis. To demonstrate the capacity of the PDO suture as a system for the controlled release of acetyl hexapeptide-8 to apply in deep wrinkles of the upper third. Three segments of 1-cm long 21G PDO threads immersed in 1 mL of Arg. PDO threads were observed under an optical, electron microscope at 24, 48, and 72 h later. They were also weighed before and after being soaked in Arg, and employing ultraviolet (UV)-visible spectroscopy, the release rate of Arg from the PDO suture was measured. Finally, was insert the thread PDO-Arg following a protocol designed especially for deep static wrinkles in the upper third. The electronic weighing revealed that the PDO thread enjoys capillarity by the peptide, doubling its weight every 24 h. UV spectra revealed that PDO thread is a well-controlled release system for Arg, allowing its sustained release for 1 h. Optical and electronic photomicrographs confirm the swelling of the PDO thread by absorbing Arg by its capillarity, but this hydrophilicity does not lead to its premature physical degradation. The PDO thread system with Arg is an intelligent bioactive system useful in facial harmonization. It recommend conduct clinical trial to verify his superior lifting effect.

The thread lift is becoming an increasingly popular treatment within the field of aesthetic medicine. The procedure can be performed using polydioxanone (PDO) threads to lift, tighten and rejuvenate areas of sagging skin, and minimise fatty tissue. This allows for the non-surgical redefinition of facial contours and enhancement of skin integrity. Thread lifting with PDO can also provide certain aspects of the much sought after surgical facelift in a clinic setting. PDO threads aim to promote targeted lipolysis of fatty areas and neocollagenesis in sagging skin, as well as lift the treated areas. However, it is important to note that the extent of these enhancements varies between individuals, and can carry unwanted side effects. The author draws on his experience to discuss the importance of managing patient expectations pre and post PDO thread lifting, describe the treatment's mechanisms of action, and highlight important considerations for aesthetic practitioners who wish to pursue these treatments.

ABSTRACTIntroductionThe combination of hyaluronic acid (HA) fillers and polydioxanone (PDO) thread lifting is gaining popularity for mid‐face rejuvenation, especially among the Asian population. Despite the common use of these techniques, there is a paucity of long‐term studies assessing their combined efficacy and safety. This study aims to evaluate the efficacy and safety of combined HA filler and PDO thread treatment for mid‐face rejuvenation over a 24‐month period in a Korean population.Materials and MethodsThis prospective, blinded, single‐center, open‐label trial included 11 Korean subjects, aged 29–70 years, with mid‐face volume loss graded 1–4 on the antero‐medial cheek fullness scale. Participants were treated with crosslinked HA dermal fillers and PDO threads. Assessments were conducted using the Global Aesthetic Improvement Scale (GAIS), investigator‐led clinical evaluations, and volumetric measurements using the Morpheus 3D system at baseline, 6, 12, and 24 months post‐treatment.ResultsQuantitative analysis revealed a significant reduction in mid‐face width from an average baseline of 149.27–145.00 mm at 24 months (p < 0.00001). Similarly, lower‐face width decreased from 130.36 to 117.27 mm at 24 months (p < 0.00001). The GAIS scores demonstrated high levels of subject satisfaction, with 9 out of 11 patients reporting consistent satisfaction or improvement over 24 months. Minimal adverse events were reported, and no serious complications occurred.DiscussionThe combination of HA fillers and PDO threads was effective in achieving and maintaining long‐term improvements in facial volume and contour. The Morpheus 3D system provided objective volumetric data, which supported the subjective improvements observed by patients and investigators. The study results highlight the benefits of ongoing neocollagenesis and tissue remodeling beyond the dissolution period of the materials.ConclusionThe combination of HA filler injections and PDO thread lifting offers a promising and minimally invasive option for long‐term mid‐face rejuvenation with high patient satisfaction and a favorable safety profile. Further studies are warranted to confirm these findings across diverse populations and compare this approach with other aesthetic treatments.

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.

Introduction: The popularity of cosmetic treatments is increasing, including treatments using polydioxanone (PDO) threads. Among the various complications that PDO threads can cause are swelling, skin dimpling, paresthesia, thread visibility/palpability, infection, and thread extrusion. On the other hand, it is an alternative to surgical facelift. Purpose of work: To collect information on the complications after PDO threads for facial lifting. Summary: In the literature review, there were reported complications after PDO threads for facial lifting as edema, allergy, inflammation, infection, skin dimpling, contour irregularity, visible threads, hematoma, thread extrusion, and incomplete facial paralysis. Knowledge of complications after face lifting with PDO threads allows us to prepare for these side effects and act appropriately in the event of their occurrence, thus avoiding the long-term effects of the cosmetic procedure.

Tear trough deformity, hyperpigmentation, and skin laxity of the lower eyelid make individuals appear fatigued and elderly. Many patients prefer less invasive, cosmetic correction of the aged lower eyelid. Polydioxanone (PDO)-barbed threads introduced braided fine threads design, which works as a template for attraction of the regenerative factors and for cells' migration and proliferation. The purpose of this study was to estimate the outcomes of simultaneous additional application of braided type PDO threads (N-scaffold) for aged lower eyelids' rejuvenation in patients, who underwent the midface PDO thread lifting. A total of 30 patients with mildly loose skin in the facial area, who underwent the thread lifting using PDO threads, were included in this study. Patients were divided into two groups, 15 patients per group. The first group underwent the midface thread lifting using PDO threads ("non-SCA" group). The second group underwent midface thread lifting in combination with braided PDO threads for tear trough deformity improvement ("N-scaffold" group). The results were evaluated subjectively, based on the patients' satisfaction rates, and objectively, by evaluating photographs. According to Barton's grading system, 7 months after the treatment, there was a statistically significant difference between the two groups: 1.733 ± 0.74 in the non-SCA group and 0.733 ± 0.83 in the N-scaffold group (p < 0.05). Based on patients' self-assessment, there was a significant difference at 7months after the treatment: 2.86 ± 0.84 in "non-SCA" group and 3.76 ± 0.90 in "N-scaffold" group, p < 0.05. Complications such as persistent swelling, hematoma, skin irregularity, and infection were not observed during follow-up assessments. The application of braided type PDO threads (N-scaffold) as part of the midface thread lifting, for aged lower eyelids rejuvenation appears to be effective and safe within a period. This study suggests that PDO threads insertion may be a useful, additional, and non-invasive tool for the aged lower eyelids rejuvenation.

Polydioxanone (PDO) is absorbable thread which is usually used for wound closure and face lifting. These days, PDO thread is used increasingly for aesthetic purposes such as correction of facial wrinkles, laxity and even rhinoplasty in many oriental traditional medicine clinics. As rhinoplasty with PDO thread increases, complications also increase. In this study, we will report on the clinical features of patients who got rhinoplasty using PDO thread. From August 2018 to July 2019, seven patients (three males and four females) visited our clinic for complications after rhinoplasty with PDO thread. We checked ultrasonography and laboratory findings including wound cultures. We used conservative treatment using antibiotics and performed surgery on three patients. Three patients experienced severe complications with open wounds, abscesses and skin necrosis. Four patients experienced mild complications including redness and thread exposure without open wounds. The location of infection included the nasal tip and inner lining. Six patients had a history of rhinoplasty before. On ultrasonography, abscess formation was seen around the implant inserted before. During the operation, PDO thread cannot be seen except in one patient. PDO thread cannot be seen in radiologic findings and can cause severe infections like abscess formation with open wounds. In severe infections, massive debridement with the removal of the implant would be required. PDO thread is absorbed usually after sixmonths; mild infection can be controlled by the conservative treatment. The best is not undergoing rhinoplasty with PDO thread for patients who had implants because of potential side effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Objective To observe the safety and efficiency of face-lift combined with fat grafting in facial rejuvenation. Methods We performed a retrospective study, which included 23 patients. SMAS suspension and multi-site suspension were combined to correct the nasolabial fold, mid-cheek aging and malar mounds. Structural fat grafting was performed to treat the volume loss in mid-face. Results All patients demonstrated a significant improvement in midfacial appearance. No infection or nerve injury were found in this study. Only three patients did not get primary healing in temple region, which led to temporal hair loss from secondary healing. Conclusions This study demonstrates that fat grafting and multiple layers face-lift are efficient method for facial rejuvenation. These approaches appear to be very promising for facial anti-aging techniques. Key words: Face lifting; Fat grafting; Aging face

Background/Objectives: Aging affects the face and eyebrow areas, with various resultant procedures for lifting the eyebrows. Recently, thread lifting using absorbable threads has become increasingly popular, with the advantages of a faster recovery and no visible scars, when compared with conventional facial rhytidectomy. Furthermore, polydioxanone (PDO) thread lifting is a favorable surgical method that has been used for eyebrow lifting. However, simply raising the eyebrows overall does not always result in high patient satisfaction. Therefore, in this study, we successfully applied a surgical method to lift the eyebrows, achieving a softer impression of the changing eyebrow shape that is associated with aging. We report on the favorable results yielded by the application of this surgical method. Methods: Between January 2023 and January 2024, a retrospective chart review was conducted for 29 patients who had undergone eyebrow lifting using only PDO threads. Photographs were taken pre- and 3 months post-operatively, in a photo studio with indirect lighting. Patient satisfaction and adverse effects were evaluated immediately and 3 months post-operatively. Results: The overall change in the eyebrow height was minimal at approximately 1.2–1.3 cm; nonetheless, the changes in the angles of the inner eyebrows at 4.00° and 4.44° resulted in a more favorable appearance. In total, 26 out of 29 patients expressed being “satisfied” or “very satisfied” with the outcomes. Serious complications were not observed. Conclusions: An effective, noninvasive eyebrow correction, considering the shape of the inner eyebrow, was performed. A thread-lifting method was used, which lifted the overall eyebrows and corrected the eyebrow shape.

Objective To explore the application of Lux1540 nm non-stripping array laser in facial rejuvenation. Methods A total of 100 patients were collected for Lux1540 nm non stripped lattice laser treatment in patients with facial skin aging, once a month, totally four times treatment; 1 month after the treatment, the skin of patients was analyzed by skin image analyzer VISIA for quantitative evaluation. Results After 4 treatments, the skin wrinkles, texture, pores, skin roughness, brown spots, erythrocyte and purple spots were all improved, with statistically significant differences (P 0.05). After treatment, 80 patients were satisfied, 17 were comparatively satisfied, and 3 were dissatisfied, with a satisfactory rate of 97%. All patients had needle-like pain during the treatment, which could be tolerated without local anesthesia ointment. Ice compress was given after treatment, which significantly alleviated the discomfort after treatment. Only 3 cases had mild pigmentation. During the treatment and follow-up, no adverse events such as skin redness and swelling, pigmentation and pruritus were found. Conclusions Lux1540 nm non-ablative dot array laser has positive efficacy, high safety and few side effects in facial rejuvenation, and it is an effective method to treat facial skin aging. Key words: Laser therapy; Skin aging; Treatment outcome; Lux 1540 nm non-ablative fractional laser; Facial rejuvenation

Background:Polydioxanone (PDO) thread lift is a widely used technique for minimally invasive facial rejuvenation. Although the technical outcomes and complications are well-documented, postoperative dissatisfaction remains underexplored, particularly among large multicenter cohorts. This study aimed to identify the predictors of dissatisfaction after PDO thread lift.Methods:We performed a multicenter retrospective analysis of 1500 patients who underwent PDO thread lifts at cosmetic surgery clinics in Japan. Postoperative dissatisfaction was defined as a return visit due to insufficient results. Univariate and multivariate logistic regression analyses evaluated the associations between age, thread count, sex, and dissatisfaction. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values using the Youden index.Results:Postoperative dissatisfaction was reported in 51 (3.4%) patients, with age (odds ratio = 1.06; 95% confidence interval = 1.03–1.08; P < 0.001) and thread count (odds ratio = 1.09; 95% confidence interval = 1.03–1.16; P = 0.001) as significant predictors. Receiver operating characteristic analysis identified an optimal cutoff of 43 years (area under the curve [AUC] = 0.701; sensitivity = 0.725; specificity = 0.615) and 10 threads (AUC = 0.674; sensitivity = 0.784; specificity = 0.566). The AUC of the combined multivariate model was 0.754.Conclusions:Increased age and higher thread count were independent predictors of dissatisfaction after PDO thread lifts. These findings underscore the need for individualized risk stratification, age- and volume-adapted thread strategies, and preoperative counseling to align expectations with realistic procedural outcomes.