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Outcomes of PDO Knotless Thread Lifting for Facial Rejuvenation

The process of aging affects the contour, texture, and colour of the face. Facial shape is mostly transformed by uneven descent and laxity of skin and soft tissues. Texture is primarily dependent on fine wrinkles and pores of the skin.

As of late, there has been an increase in demand from patients who are looking for minimally invasive aesthetic procedures with minimal downtime and risk.

In this article, we will be reviewing a recent study on the results of PDO knotless thread lift for facial rejuvenation, and it proves that facial rejuvenation, using PDO thread is a safe and effective procedure associated with only minor complications when performed on patients with modest face sagging, fine wrinkles, and marked facial pores.

In the study, a retrospective chart review was conducted over a 24 month period. A total of 31 thread lifting procedures were performed. On each side, 5 bidirectional cog threads were used in the procedure for the flabby skin of the nasolabial folds. And, the procedure was performed on the marionette line using 2 twin threads.

Please see below the details of the study:

Polydioxanone PDO threads

Figure 1: Schematic figure of knotless PDO thread device.

A schematic figure of the knotless PDO thread device is presented in Figure 1. PDO threads for facial rejuvenation can be classified into 3 different types.

1) Mono PDO thread is monofilament, non-barbed, and thin (0.07–0.15 mm). 2) A spring or twin thread, made by a twined single monofilament or 2 monofilaments together, is more extendable than mono PDO thread.

3) Cog PDO thread includes barbs, which cling to tissues for lifting effects when added.

Based on the direction of these spikes, cog PDO thread is categorized as unidirectional, bidirectional, or multidirectional. (Figure 2)

Figure 2: Various knotless PDO thread devices. (A) Mono thread, (B) Spring thread, (C) Twin thread, (D) Uni-direction cogged thread, (E) Bi-direction cogged thread, and (F) Multi-direction cogged thread.

The thread, when inserted to a needle, will form a V-shape with an inner half inserted in the caliber of the needle and the other half outside. After inserting the needle or cannula, the thread will then remain intact with the tissue upon the removal of the needle or cannula. (Figure 3)

Needle thicknesses of 18 to 31 gauge and threads with varying length and thickness are available. Appropriate thread span was selected depending on the epidermis length of the insertion area. Blend of cog and twin threads was used for rejuvenating and lifting purposes in all patients.

Figure 3: A diagrammatic representation of the actual passage of the threads through the skin. After insertion of the needle, removal of the needle alone results in the thread remaining intact in the tissue.

Procedure

Numbing cream was used an hour before the procedure, followed by Betadin. Local anaesthetic nerve block was performed with 2% lidocaine with epinephrine (1:100,000) (Yuhan, Seoul, Korea).

The selected area was chosen to follow the thread insertion line depending on the condition of the patient’s wrinkle. The patient’s skin, facial framework, and age were accounted for in designing the procedure, which was generally against the vector of sagging skin. The patient’s skin, facial framework, and age play a role in designing the procedure, which was generally against the vector of sagging skin.

At first, 5 points were made according to the nasolabial fold, and then 2 points were made along the hair line. A straight line was drawn from the edge of the lips to below the ear lobule (Figure 4). Then, they inserted 3.0 bidirectional cog threads on the nasolabial folds in accordance with the straight line. On both cheeks, five threads were inserted subcutaneously, with the vector direction against the sagging nasolabial folds. On each side, additional 2 twin threads were inserted lateral to the marionette line, parallel to the mandibular border.

To minimize edema and swelling, ice packs were applied onto the affected area. Oral cephalosporin was given up to 5 days following procedure. Within the first 3 weeks after the procedure, abrupt actions and big movements of the perioral muscles such as yawning and laughing were prohibited, as well as facial massage. Patients were encouraged to sleep in a supine position.

Figure 4: Basic guidelines for knotless PDO thread technique. First, 5 points were made according to the nasolabial fold, and then 2 points were made along the hair line. A straight line was drawn from the edge of the lips to below the ear lobule (A). Then, they inserted bidirectional cog threads on the nasolabial folds according to the straight line. Additional 2 twin threads were inserted lateral to the marionette line, parallel to the mandibular border (B).

Results

Presented in Table 1 are patient clinical characteristics and outcomes. A total of 31 patients underwent PDO knotless thread lifting over a 2-year period. Four of which were men and the remainder were women, with an average age of 44.13 +- 11.02 years. The follow-up period was 24 weeks. In 27 (87%) self-evaluated results, 19 patients (61%) deemed the procedure as excellent and 8 (21%) felt that the turnout results were good.

Texture improvement was classified as exceptional for 13 (41.9%), good for 9 (29.0%), fair for 8 (25.8%), and poor for 1 (3.2%) patient(s). Lifting was evaluated as excellent for 11 (35.5%), good for 6 (19.4%), fair for 5 (16.1%), and poor for 9 (29.0%) patients. According to the research, PDO thread lifting was better for skin texture improvement than for lifting, although there was no statistically significant difference (p = .139). (Figure 5)

The most frequent complication was bruising, which happened in 29 patients (93.5%). Mild post-procedure swelling was observed in 28 patients (90.3%). Mild asymmetry was observed in 2 patients (6.5%). These side effects lasted for a maximum of 2 weeks and did not warrant any treatment.

Figure 5: Preoperative and postoperative clinical photograph of a 53-year-old male patient: (A) initial; (B) 6-month follow-up.

Reference: https://www.ncbi.nlm.nih.gov/pubmed/25993611

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