PDO Threads in Aesthetic Medicine: Biostimulatory Effects and Benefits
In the quest for minimally invasive facial rejuvenation, thread lifting with polydioxanone (PDO) has emerged as a groundbreaking technique. PDO threads are not only known for their immediate lifting and tightening effects but also for their long-term biostimulatory benefits. The ability to stimulate the body’s natural collagen production makes PDO threads a powerful tool for dermatologists and aesthetic practitioners looking to offer patients gradual yet lasting improvements in skin texture, elasticity, and overall appearance.
In this article, we examine the insights provided by Kwon et al. (2019) and Ko et al. (2016) on the biostimulatory effects of polydioxanone (PDO) threads in aesthetic treatments, with a focus on skin rejuvenation and collagen stimulation. Kwon et al. (2019) explore the biostimulatory effects of PDO fillers in a mouse model, demonstrating the material’s ability to stimulate neocollagenesis and improve skin texture. Meanwhile, Ko et al. (2016) investigate the application of a multi-PDO scaffold for forehead wrinkle correction, providing evidence of collagen production and long-term skin improvement in both animal models and human subjects. By integrating these perspectives, we delve into the unique capabilities of PDO threads in enhancing skin structure, offering a comprehensive overview of the biostimulatory mechanisms and their practical applications in aesthetic medicine.
Understanding the Biostimulatory Power of PDO Threads
PDO threads work by inducing a controlled tissue response that triggers the skin’s natural healing process. As the threads are inserted into the subdermal layer, they create a mechanical lifting effect that helps reposition sagging tissue. However, what makes PDO threads unique is their ability to stimulate neocollagenesis—promoting the production of new collagen, elastin, and other essential components of the extracellular matrix.
Collagen, a protein responsible for maintaining skin firmness and elasticity, naturally declines with age, leading to wrinkles, fine lines, and sagging skin. PDO threads counteract this decline by activating fibroblasts to synthesize new collagen over time. This continuous production results in enhanced skin support and structure long after the threads have dissolved.
The Science Behind Collagen Stimulation
Polydioxanone (PDO) is a biodegradable polymer with a well-documented history of use in absorbable sutures. PDO is broken down via hydrolysis, gradually releasing small byproducts that trigger a low-grade inflammatory response. This response activates fibroblasts, which are key players in collagen synthesis.
Research has shown that the biostimulatory effects of PDO threads lead to the production of two key types of collagen: Type I, the main structural component of skin, and Type III, which is essential for wound healing and tissue regeneration. This dual action of collagen synthesis enhances skin thickness, improves elasticity, and leads to a smoother, more youthful appearance over time.
Histological studies conducted in both animal and human models have demonstrated that PDO threads not only promote collagen production but also increase the density of collagen fibers around the insertion site. This dense collagen network acts as a natural scaffold, supporting the skin and providing long-lasting results that continue to improve over several months.
PDO Threads vs. Other Collagen-Stimulating Techniques
While several non-invasive techniques, such as fillers and lasers, aim to stimulate collagen production, PDO threads stand out due to their ability to provide both immediate and long-term benefits. Unlike dermal fillers, which focus on volumizing specific areas, PDO threads create a structural lift while also stimulating the skin’s regenerative processes. This makes PDO threads especially suitable for patients seeking gradual, natural-looking improvements.
Moreover, compared to other collagen stimulators like poly-l-lactic acid (PLLA) and polycaprolactone (PCL), PDO threads have a more predictable degradation process, reducing the risk of uneven results or complications such as nodule formation. The biostimulatory effects of PDO threads continue to evolve over time as the threads dissolve, leaving behind a scaffold of new collagen to support the skin.
Clinical Evidence of Biostimulation
Clinical studies have demonstrated the efficacy of PDO threads in stimulating collagen and improving skin quality. In a study involving PDO thread insertion in animal models, histological analysis showed significant increases in collagen synthesis at the thread insertion site. Human trials have confirmed similar results, with patients experiencing improved skin texture, reduced wrinkles, and enhanced skin elasticity for up to 12 months post-treatment.
Additionally, the gradual release of PDO thread byproducts ensures that the biostimulatory effects are sustained over time. This long-term improvement in skin quality makes PDO thread lifting an excellent option for patients who prefer gradual rejuvenation without the dramatic changes associated with other procedures.
Applications of PDO Thread Biostimulation
PDO thread lifting is highly versatile, allowing for tailored treatments across different facial and body areas. The biostimulatory effects of PDO threads are especially beneficial for areas prone to skin laxity, wrinkles, and sagging. Here’s how PDO thread lifting is applied in different regions:
Facial Rejuvenation The face is the primary area for PDO thread treatments, with key zones benefiting from both the immediate lift and long-term biostimulatory effects:
Jawline and Chin: PDO threads redefine the jawline and reduce the appearance of jowls by lifting sagging skin. Over time, collagen production further tightens the skin and improves contour.
Midface and Cheeks: In the midface, PDO threads help to lift sagging cheeks and improve the appearance of nasolabial folds. The threads also stimulate collagen formation, which plumps and firms the area over several months.
Eyebrow and Forehead Lifting: A common application is the non-surgical brow lift, where PDO threads are inserted to lift the brow and open up the eyes. The biostimulatory effects continue to improve the texture of the skin, reducing fine lines in the forehead region.
Neck and Décolletage: PDO threads are also used to treat the delicate skin of the neck, where sagging and wrinkles are prominent. By stimulating collagen, the skin tightens and appears smoother, improving the overall appearance of the neck and décolletage.
2. Body Contouring Although PDO threads are most commonly associated with facial rejuvenation, they are increasingly being used to treat areas of the body:
Abdomen: Skin laxity on the abdomen, especially after weight loss or pregnancy, can be treated with PDO threads. The biostimulatory effect tightens the skin over time, helping to improve the appearance of sagging.
Arms and Thighs: The upper arms and thighs are other areas where PDO thread lifts can be beneficial. The stimulation of collagen leads to firmer, tighter skin, reducing the appearance of sagging tissue and cellulite.
Knees: PDO threads can even be applied to tighten the skin around the knees, improving crepey skin and sagging, which are common concerns as patients age.
Techniques to Maximize Collagen Stimulation
The success of PDO thread lifting largely depends on the technique used to maximize both the mechanical lift and the biostimulatory effects. Achieving optimal collagen stimulation requires proper thread selection, placement, and insertion technique. Below are the key strategies for enhancing biostimulation:
Choosing the Right Thread Type PDO threads come in various types, each designed for different effects. Selecting the correct thread is essential for maximizing biostimulation:
Smooth Threads: These threads are primarily used to stimulate collagen and improve skin texture. They are often placed in a mesh pattern to cover larger areas, stimulating collagen production for subtle tightening and wrinkle reduction.
Barbed Threads (Cog Threads): These are designed for mechanical lifting, as the barbs anchor the threads in place, repositioning sagging tissue. The additional collagen stimulation from the barbed threads provides long-lasting improvement in skin firmness.
Screw Threads: Used for both lifting and volumization, screw threads are coiled to provide added support and create a volumizing effect in areas like the cheeks or jawline.
Inserting Threads with Precision The way threads are inserted plays a crucial role in enhancing collagen production:
Linear Insertion: A commonly used technique, linear insertion involves placing threads in straight lines, following the natural contours of the face. This method is often used in the jawline and neck to create a lifting effect while stimulating collagen in the subdermal layers.
Mesh or Cross-Hatching Technique: In areas where greater collagen production is desired, such as the cheeks or neck, threads can be placed in a mesh or cross-hatching pattern. This technique increases the surface area treated, encouraging more widespread collagen stimulation. It is especially useful for tightening skin and reducing the appearance of fine lines and wrinkles.
Fanning Technique: Fanning is a technique used to cover larger areas with minimal insertion points. Multiple threads are placed from a single entry point, fanning out to cover a wider treatment area, which helps to maximize collagen stimulation and skin tightening.
Depth of Thread Placement Correct placement of PDO threads is critical to stimulating fibroblasts and encouraging collagen production. Threads should be inserted into the dermal-subcutaneous junction, where collagen synthesis is most active. Placement that is too superficial may lead to visible threads or suboptimal collagen stimulation, while threads placed too deeply may not deliver the desired effects.
Combination with Other Treatments To enhance the biostimulatory effects, PDO threads can be combined with other aesthetic treatments such as dermal fillers, botulinum toxin injections, or energy-based devices like radiofrequency (RF) or ultrasound. Combining these treatments can enhance collagen production, improve skin texture, and provide a more comprehensive anti-aging solution. For example, while PDO threads lift and stimulate collagen, RF treatments can tighten the skin further, maximizing the rejuvenating effects.
Factors That Influence Successful Collagen Stimulation
Several factors contribute to the success of PDO thread lifting and its ability to stimulate collagen production:
Patient Selection: The biostimulatory effects of PDO threads are most effective in patients with mild to moderate skin laxity. Those with severe sagging may require more invasive treatments for optimal results.
Customizing Treatment: Tailoring the thread type and technique to the patient’s specific needs is essential. Analyzing the patient's skin type, texture, and level of laxity helps determine the best approach to maximize biostimulation.
Post-Treatment Care: Proper aftercare, such as avoiding strenuous activities and excessive facial movements, helps maintain the effects of the PDO threads and supports ongoing collagen production.
The biostimulatory effects of PDO threads offer a powerful solution for skin rejuvenation by stimulating collagen production and enhancing skin texture and elasticity over time. From facial lifting to body contouring, PDO thread lifting provides a versatile, non-surgical option for patients seeking long-term improvement in skin quality. By using the correct techniques and selecting the appropriate threads, practitioners can maximize the biostimulatory benefits of PDO threads, providing patients with gradual, natural-looking rejuvenation that continues to improve for months after treatment.
Safety and Long-Term Outcomes
One of the key advantages of PDO thread lifting is its excellent safety profile. Since PDO threads are fully absorbable, they carry minimal risk of long-term complications. The biostimulatory effects are gradual, reducing the likelihood of overcorrection or unnatural results.
Moreover, PDO threads have been shown to produce less inflammatory response compared to other materials, further contributing to their safety and efficacy in aesthetic treatments. The gradual biodegradation of PDO ensures that the threads are safely absorbed by the body, leaving behind only the benefits of new collagen.
Conclusion
PDO threads represent a cutting-edge approach to facial and body rejuvenation, offering both immediate lifting and long-term biostimulatory effects. For dermatologists and medical aesthetic doctors, PDO threads provide a versatile tool for stimulating collagen, improving skin texture, and delivering natural, gradual results that continue to improve over time.
By harnessing the body’s natural collagen production, PDO thread lifting not only addresses the visible signs of aging but also helps regenerate the skin from within, making it an invaluable addition to any aesthetic practice. As research continues to support the efficacy of PDO threads in collagen stimulation, their use is poised to expand even further in the field of aesthetic medicine.
Reference:
Kwon TR, Han SW, Yeo IK, Kim JH, Kim JM, Hong JY, Lee BC, Lee SE, Moon HS, Kwon HJ, Kim BJ. Biostimulatory effects of polydioxanone, poly-d, l lactic acid, and polycaprolactone fillers in mouse model. J Cosmet Dermatol. 2019 Aug;18(4):1002-1008. doi: 10.1111/jocd.12950. Epub 2019 Apr 15. PMID: 30985064.
Ko HJ, Choi JY, Moon HJ, Lee JW, Jang SI, Bae IH, Choi JK, Kim H, Park WS, Oh WJ, Choi SY, Kim BJ. Multi-polydioxanone (PDO) scaffold for forehead wrinkle correction: A pilot study. J Cosmet Laser Ther. 2016 Nov;18(7):405-408. doi: 10.1080/14764172.2016.1191643. Epub 2016 Aug 5. PMID: 27223252.
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