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PDO Powder vs PLLA: Collagen Production Comparison




Polydioxanone (PDO) is a synthetic polymer primarily employed as an absorbable suture material, particularly in areas subjected to prolonged tension, with minimal associated side effects. Additionally, it has gained extensive use as an absorbable thread-lifting material, promoting collagen production. Since 2011, absorbable PDO threads have been introduced for skin lifting. PDO boasts a prolonged half-life and induces fewer tissue reactions compared to materials like catgut and polyglycolic acid (Dexon™).


On the other hand, Poly-L-lactic acid (PLLA) is a synthetic biodegradable polymer that is commonly used in the field of aesthetic medicine and dermatology. PLLA is derived from lactic acid, which is a naturally occurring organic acid. Lactic acid can be found in various sources, including milk and certain fruits, but the PLLA used in medical and cosmetic applications is synthetically produced. The lactic acid used for this purpose can be derived from renewable resources such as cornstarch or sugar.


Poly-L-lactic acid (PLLA) is known for its ability to stimulate collagen production in the skin, leading to improvements in skin texture, volume, and overall appearance. PLLA is often used in non-surgical facial rejuvenation treatments as it is considered safe and well-tolerated in medical and aesthetic applications. It has a low risk of causing allergic reactions or adverse effects when administered by trained healthcare professionals. Its biocompatibility is a result of its composition, as it closely resembles a substance naturally found in the body (lactic acid).


PDO and PLLA have their unique roles in collagen production and facial rejuvenation. PDO provides more immediate lifting effects with some collagen stimulation, while PLLA primarily focuses on substantial collagen production over time, leading to longer-lasting results. The choice between the two depends on the patient's goals, skin condition, and the specific area to be treated. In this blog, we will explain and compare further the difference and the efficacy of those two on collagen production.


Factors to Evaluate PDO & PLLA on Collagen Production

PDO (Polydioxanone) and PLLA (Poly-L-lactic acid) are both materials used in aesthetic and medical procedures to stimulate collagen production and promote skin tightening. They belong to the category of biostimulatory dermal fillers, which work by encouraging the body to produce its own collagen. However, they have some differences in terms of their mechanisms and longevity.


1. Mechanism of Action:


PDO: Polydioxanone is a synthetic absorbable suture material. When used in cosmetic procedures, such as PDO threads, it creates a support structure for the skin, and the body gradually absorbs it over time. This process stimulates collagen production as the body responds to the foreign material.


Here's how PDO works:

1. Introduction of PDO Threads: PDO threads are thin, absorbable threads made from PDO material. These threads come in various lengths, thicknesses, and designs, depending on the specific treatment goals and areas of the face or body being addressed.


2. Insertion into the Skin: During a PDO thread treatment, the threads are carefully inserted into the skin through tiny incisions or injections at strategic locations. The placement of the threads is determined by the desired outcome, which could be lifting sagging skin, improving facial contours, or reducing wrinkles.


3. Immediate Physical Support: PDO threads provide immediate mechanical support to the skin and underlying tissues. They act as a scaffold or framework, lifting and repositioning sagging or loose skin. This immediate physical support creates a visible tightening effect, often referred to as a "thread lift." Patients may notice an immediate improvement in the treated area's appearance due to this physical support.


4. Collagen Stimulation: Beyond their immediate lifting effect, PDO threads also stimulate collagen production through a secondary mechanism. As the body recognizes the presence of these foreign threads, it initiates a wound-healing response. Fibroblasts, which are collagen-producing cells, become activated in response to the perceived "injury."


5. Gradual Collagen Production: Over time, the activated fibroblasts start synthesizing new collagen fibers in the treated area. This collagen production occurs as part of the natural healing process, gradually improving skin texture, elasticity, and overall firmness. The collagen-stimulating effects are not immediate but develop over several weeks to months.


PLLA: Poly-L-lactic acid is also a synthetic material, but it works by stimulating the production of collagen through a different mechanism. It is typically injected into the skin and acts as a stimulant, causing the body to produce more collagen as it breaks down. The mechanism of action of Poly-L-lactic acid (PLLA) in aesthetic medicine involves its ability to stimulate collagen production in the skin, leading to improvements in skin texture, volume, and overall appearance.


Here's how PLLA works:


1. Introduction of PLLA: PLLA is a synthetic biodegradable polymer made from lactic acid monomers. It is typically administered in the form of a gel or microspheres suspended in a sterile solution. PLLA is injected into the skin using a fine needle or cannula.


2. Biostimulatory Properties: PLLA is classified as a biostimulatory filler because it does more than just add volume. Its primary mechanism of action is to stimulate the body's natural collagen production.


3. Injection into the Skin: When PLLA is injected into the skin, it is gradually absorbed into the body over time. It forms a matrix within the skin, creating a supportive structure that stimulates the production of collagen.


4. Collagen Production: Over a period of several weeks to months, PLLA initiates a biological response within the skin. The presence of PLLA microspheres prompts fibroblasts, which are collagen-producing cells, to synthesize new collagen fibers.


5. Gradual Results: The collagen-stimulating effects of PLLA are gradual and progressive. Patients typically begin to notice improvements in skin texture and volume as the newly produced collagen fibers integrate with the existing ones. One of the distinctive features of PLLA is its longevity. The results of PLLA treatments can last up to two years or more in some cases. This extended duration makes it a popular choice for individuals seeking long-lasting facial rejuvenation without the need for frequent touch-ups.


PLLA provides natural-looking results because the increase in collagen is gradual and resembles the body's own collagen production. This natural look is often favored by patients seeking subtle and refreshed facial enhancements.


2. Longevity

The longevity of results achieved with PDO (Polydioxanone) and PLLA (Poly-L-lactic acid) treatments can vary depending on several factors, including the specific product used, the treatment area, individual factors, and the number of sessions.


PDO treatments provide immediate and some long-term results through a combination of physical support and collagen stimulation. The duration of results with PDO is typically several months to a year. On the other hand, PLLA is renowned for its strong collagen-stimulating properties and offers longer-lasting results that can endure for up to two years or more. Here's the further comparison of the longevity of results between PDO and PLLA treatments:


PDO:

  • Immediate vs. Long-Term Results: PDO treatments provide both immediate and long-term results. The immediate results are due to the physical support and lifting provided by the PDO threads. However, these immediate effects may diminish over time.

  • Collagen Stimulation: The long-term results with PDO are primarily attributed to the collagen-stimulating effects of the treatment. PDO threads gradually stimulate collagen production in the skin, which contributes to improved skin texture, firmness, and elasticity.

  • Duration: The duration of results with PDO treatments can vary among individuals but generally lasts several months to a year. The collagen-stimulating effects can continue for an extended period, but they may not be as long-lasting as the effects achieved with PLLA.

  • Maintenance: To maintain the results of PDO treatments, patients may need periodic touch-up sessions. These can help sustain the collagen production and the overall rejuvenating effects.


PLLA:

  • Gradual Results: The results of PLLA treatments are gradual and progressive. Collagen production continues for several months after treatment. Unlike PDO, the effects of PLLA become more noticeable over time.

  • Collagen Stimulation: PLLA is well-known for its strong collagen-stimulating properties. It significantly increases collagen production in the treated areas, resulting in long-lasting improvements in skin quality and volume.

  • Duration: PLLA treatments offer longer-lasting results compared to PDO. The effects can last up to two years or more in some cases. Patients often appreciate the extended duration of results, which reduces the frequency of touch-up sessions.

  • Maintenance: While PLLA results are long-lasting, maintenance treatments may still be necessary. These maintenance sessions are typically scheduled at longer intervals compared to PDO treatments.


PDO & PLLA Safety


PDO has a well-established safety profile. It has been used for many years in surgical sutures and is known for its biocompatibility and low risk of causing adverse reactions. PDO is less likely to trigger allergic reactions or hypersensitivity responses in patients because it is a synthetic material with minimal immunogenicity. However, PDO thread treatments can have immediate side effects such as swelling, bruising, redness, and discomfort at the injection sites. These side effects are typically mild and temporary. Serious complications with PDO treatments are rare but can include infection, migration of threads, asymmetry, and tissue damage. These risks are generally minimized when procedures are performed by trained professionals.


PLLA also has a well-established safety profile when administered correctly by qualified professionals. It is considered biocompatible and biodegradable. PLLA is a synthetic material with low allergenic potential. Furthermore, allergic reactions to PLLA are rare. PLLA treatments offer gradual results, and patients may experience mild swelling, redness, or bruising at the injection sites. These side effects are generally temporary. Serious complications with PLLA are also rare but can include infection, lumps or nodules at the injection sites, and asymmetry. These risks are generally minimized with proper technique and patient selection.


In both cases, selecting a qualified and experienced healthcare provider is essential to ensure the safest and most effective outcomes. Patients should discuss their medical history, expectations, and potential risks with their provider before undergoing either PDO or PLLA treatments. Additionally, following post-treatment care instructions and attending any recommended follow-up appointments can help minimize the risk of complications and ensure optimal results.



Past Research on PDO vs. PLLA Comparison


The efficacy of powdered polydioxanone in terms of collagen production compared with poly‐L‐lactic acid in a murine model (2019)


The study involved various experimental procedures and histological examinations. This study used powdered PDO, conventional PLLA (Sculptra), and phosphate-buffered saline (PBS) for the experiments. Sprague Dawley rats were also used for the study. These rats were administered the test products in their dorsal skin. Tissue samples were collected at different time points after the procedures for histological examination and gene expression analysis.


The study examined the histopathological features of the granuloma reaction to both PDO and PLLA. Results showed that both PDO and PLLA induced granulomatous reactions in the rat tissues. PLLA-injected tissues exhibited typical sclerosing granulomas with more giant cells than PDO-injected tissues. The study also discussed the physical characteristics of the materials and their potential effects on tissue reactions. The study also performed real-time PCR to analyze the gene expression of collagen-related markers (COL1α1 and COL3α1) and growth factors (TGF-β1, TGF-β2, and TGF-β3) in the tissues. This study noted that collagen is a crucial component for maintaining skin elasticity and firmness.


This study discovered that both PDO and PLLA induced granulomatous reactions, but the characteristics of the reactions differed. The study suggested that PDO, even in powdered form, could potentially be used as a collagen-stimulating filler. Furthermore, continuous follow-up studies were deemed necessary to confirm the efficacy and safety of powdered PDO as a collagen-generating filler for human skin.


In summary, this research aimed to investigate the collagen-stimulating effects of powdered PDO and compare them to those of conventional PLLA in a rat model. The findings indicated that powdered PDO had a collagen-stimulating effect similar to PLLA, suggesting its potential as a collagen-stimulating filler for cosmetic and medical purposes. Further studies and clinical trials may be needed to validate these findings and assess the safety and efficacy of powdered PDO in human skin.



Reference:

The efficacy of powdered polydioxanone in terms of collagen production compared with poly‐L‐lactic acid in a murine model (2019)

Biostimulatory effects of polydioxanone, poly‐d, l lactic acid, and polycaprolactone fillers in mouse model (2019)

Long‐term results following polydioxanone sling fixation technique in unstable lateral clavicle fracture (2016)

Preterm premature rupture of membrane after polypectomy using an Endoloop polydioxanone suture II (2016)

Investigation on the cutaneous change induced by face‐lifting monodirectional barbed polydioxanone thread (2017)

 

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