Although surgical techniques are highly effective for correction of sagging tissues of the mid- and lower-third face, the continuous growth in demand for non-surgical or “minimally invasive” modalities have recently been met with the implementation of the polydioxanone (PDO) thread lift as a new, minimally invasive, office-based treatment for lifting.
Thread lifting procedures have been around for decades, however it was not popularized in the United States until 2015 when NovaThreads first introduced dissolvable lifting threads composed of PDO. PDO is a safe and reliable suture that has been used worldwide for several decades, and currently holds FDA indication for soft tissue approximation of the soft tissues of the face and body.
Identifying appropriate candidates
It is essential for patients to have reasonable expectations for the results that can be achieved from this procedure. Patients with severe laxity and jowls are not good candidates for this procedure, however it is the best non-surgical intervention available for skin laxity. Candidates for a thread lift procedure include:
● Patients in their 30s to 50s with mild-to-moderate sagging
● Patients who are seeing the first signs of aging on their face and want to take immediate action
● Patients looking to achieve lifting of the cheeks and minimize smile lines
● Patients looking to achieve lifting of the jowls and jawline
● Patients looking to achieve tightening and lifting of the neck
● Patients looking to decrease the appearance of fine lines and wrinkles
● Patients who want to improve overall skin texture and quality
Once photographs and consent have been documented, the patient is then positioned in the chair either sitting upright with their head leaning back onto the head rest or they can be lying down on their back for comfort.
Prior to any numbing, I plan the insertion points and map the thread tract directions by drawing vectors onto the patient for mid-face and lower third lifting. The insertion points of the thread are injected with 1% lidocaine with 1:100,000 epinephrine and ten minutes are allowed to elapse. The patient is numbed by mixing 2.5 mL of 1% plain lidocaine with 0.5 mL of 8.4% sodium bicarbonate and injecting 0.3 to 0.5 mL of this mixture along each planned thread tract with a long, two and three-quarters inch blunt microcannula. Utilizing a microcannula along the tract allows me to effectively pre-tunnel the tissue in the correct plane, which will assist in guiding the cannula threads along the planned vectors for optimal and accurate placement.
The thread is pre-loaded in the cannula which is then inserted in the superficial subcutaneous plane along the vector path. It is important to stay in a consistent plane that is not too superficial to avoid irregularity and puckering. The thread remains deployed under the skin as I carefully withdraw the cannula. The bi-directional and circumferentially spaced barbed threads are utilized to create a lift by approaching the area of sagging from distal to proximal and withdrawing the cannula. As the cannula is removed, gentle massage in the direction of the desired lift is performed to achieve the result. There is no fixation of the sutures to deeper tissue or exiting of the skin distally as is the case with other thread lifting systems.
After placement of threads in multiple favorable vectors, there is a net resultant effect by the re-draping of the tissues over the threads. The excess thread is then trimmed at the insertion point.
Longevity of lifting procedures will naturally depend on multiple factors including the age and weight of the patient, the patient’s overall health and metabolism, the correct technique and vector placement of the threads and the number of threads placed. We advise that results generally last from 6 months to 18 months, with average result duration of 12 months.
With proper patient selection and technique, PDO threads are excellent for aesthetic enhancement, particularly when combined with current modalities such as neurotoxin and injectable fillers. We typically combine thread placement (performed first) with injectable fillers simultaneously to address the volume loss component of facial aging.
PDO thread lifting procedures should only be performed by experienced providers who understand and are very familiar with the anatomy of the face.
Patient satisfaction has been overall positive in our experience thus far in over 1,000 patients. Puckering and irregularity are the most common complications and happen in about 10% of the procedures performed, and typically self-resolve in one to two weeks.
Learn about Dr. Karimi’s nonsurgical lifting and rejuvenation techniques in person during the Advanced Injectable Applications and Techniques Special Focus Course: Emerging Concepts in Facial Injectables at The Aesthetic Show 2019. Click here to learn more.
About the author
Kian Karimi, M.D., F.A.C.S.
Dr. Karimi is a double-board certified facial plastic surgeon / head and neck surgeon. Originally from Ind., Dr. Karimi received his medical degree at Indiana University School of Medicine and graduated at the top of his class, earning him membership into the Alpha Omega Alpha honor society. Dr. Karimi completed his residency at the University of Florida and fellowship in facial plastic surgery at the University of Toronto. He maintains an active practice in facial plastic surgery, head and neck surgery and endoscopic endonasal skull base surgery in Los Angeles, Calif. Dr. Karimi is serving his fourth year as one of the team plastic surgeons for the Los Angeles Kings Hockey organization. He is a volunteer lecturer and clinical instructor for the UCLA-Santa Monica Department of Family Medicine.