Polydioxanone (PDO) sutures have been widely used to tighten and lift the face, but also to improve skin texture with brightened complexion and skin elasticity. In this paper, authors trying to determine what significant changes occur in the tissue over time when a PDO suture is inserted.
4 White Yucatan variety pygmy pigs with skin that most closely resembles the structure of human skin is chosen for the experiment. 9cm 4-0 PDO thread in a 25G needle were inserted into the subcutaneous fat layer parallel to the skin at 1cm intervals. Tissue samples were obtained at 4, 12, 24 and 24 weeks. And H&E staining, Masson trichrome staining, and anti-smooth muscle actin immunohistochemical staining techniques were used.
The findings are described below:
1. The changes in the PDO thread after injection into the body can be observed over time. The thread retains its shape for 12 weeks, becomes fragmented by 24 weeks, and is fully disolved by 48 weeks. If the maintenance of thread shape is important, the effect will last for 12-24 weeks. However, if the thread itself is important regardless of fragmentation, the effect will last for 24-48 months.
2. A collagen producing effect will last for more than 48 weeks. If the procedure is performed for the purpose of collagen production, the effect will last for more than 48 weeks.
3. Granulation tissue will last for more than 48 weeks. In some cases, we can observe a foreign body reaction. Even absorbable thread injection can cause unwanted nodules due to foreign body reactions.
4. Inflammation from PDO thread injection will last 4-12 weeks.
5. Fibrous connective tissues increase via PDO thread insertion and join the pre-existing fibrous connective tissue. The fibrous tissue in the subcutaneous fat layer does not exist in isolation. This tissue is joined by part of the facial fibrous connective tissue. Therefore, we can infer that PDO thread injection can strengthen the subcutaneous fat layer. As the effect of fibrous tissue generation lasts for more than 48 weeks, the strengthening effect will last for more than 1 year.
6. Myofibroblasts appear between 0 and 12 weeks after PDO thread injection. They appear in the wound healing process and are particularly associated with wound contraction. The effect of tissue contraction by PDO thread injection occurs between 0 and 12 weeks.
7. The proliferation of fibroblasts occurs between 0 and 24 weeks. The effect is associated with findings 2 and 5. Collagen proliferation occurs within 6 months.
8. Capilary size increases. We can expect an improved vascular supply.
9. The thickness of the fat layer is reduced by fat celi denaturation. The duration of this effect is longer than 48 weeks.
The tissue change results provide not only additional information that has not been reported in previously published studies but also a theoretical rationale for the PDO thread lifting procedure.
Reference: Yoon JH, Kim SS, Oh SM, Kimm BC, Jing W. Tissue changes over time after polydioxanone thread insertion: J Cosmet Dermatol. https://www.ncbi.nlm.nih.gov/pubmed/30058213
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