Professor Syed Haq, Chairman of The Association of PDO Threads UK, discusses the popularity of thread-based technology to bring about skin rejuvenation, skin tightening and lifting of the face, as well as treating other body parts. Improved understanding of the use of Polydioxanone (PDO) threads as the principal underlying device in aesthetic/cosmetic non-surgical interventions, alongside correct patient selection and the increased experience of clinicians in the United Kingdom, has created a significant upsurge in their use in the past five years. Invariably this has led to improved patient outcome in general, though the application of this powerful technology has to be taken in the correct context.
Currently, various knotless thread lifting devices using PDO are popular in aesthetic clinics. The thread forms a V-shape with portions residing outside the needle/cannula and the other half inside the caliber. After inserting the needle or cannula, one simply removes the needle or cannula resulting in the thread ﬁxation inside the skin without anchorage or knots.
An example of the use of multiple monofilament PDO threads provides an alternative approach to facial augmentation by not using cog PDO thread technology. This type of approach is most commonly used in S. Korea.
The advantage of using mono-filaments facilitates a quick and simple procedure. Mono-filament PDO threads are also being used for wound suturing that requires prolonged tensile strength. In general Polydioxanone threads remain in situ, taking about six months to be fully absorbed, which is longer than both Vicryl and Dexon, providing an added advantage in aesthetic augmentation. The use of cog threads should be one of caution. Both uni- and bi-directional cogs have inherent issues with slippage and dimpling. This is less common than with multi-directional cogs. In my experience the most stable lifting cog is based on the three-dimensional projection. This for the uninformed should not be confused with the spiral thread. 3D cog threads provide excellent lift of the face or neck provided the anchor point is well chosen and the threads are placed at the level of the superficial muscular aponeurosis . Whether mono/screw or cog, if the PDO threads are placed correctly with respect to tissue depth and vector orientation, a patient should experience improved clinical changes over the first four months.
The most important limitation of this procedure is that it is only indicated for a modest degree of facial soft tissue laxity. Careful patient selection through experience in midface lifting using absorbable 3D cog sutures is more effective than using barbed bi- or multi-directional sutures. The reason for this is due to better techniques in fixation, combination thread use and better quality cogs being made available. The most favourable anatomic characteristics for absorbable thread lifting are low body mass index, minimal fullness to the soft tissues, strong underlying bony projections to support the elevated tissue, and good skin quality.
Many changes have taken place in PDO thread technology over the past three years. The clinical indications for use seem to be ever expanding. At present PDO thread lifting appears to be providing a viable solution for those patients who either choose not to undergo surgical intervention to resolve their clinical issues, or for those patients who are caught between the standard non-surgical and surgical approaches. I believe that this transition group of patients will continue to expand – provided that further studies are conducted using PDO thread therapy that explore and deliver long- term clinical results without compromising safety. To that end it is a fundamental requirement that standardisation in the method, techniques, training and product quality are at the heart of the PDO thread therapy movement. Strict regulatory control and the establishment of non-profit organisations like the Association of PDO Thread Therapy UK will be paramount to ensure that the highest levels of outcome with patient safety are adhered to.
Register for the latest non-invasive anti-ageing procedure at upcoming IFAAS's Private Hands-on Korean Thread Lifting Master Courses and learn from the master of the technique itself from South Korea.