Lifting the Lower Face With an Absorbable Polydioxanone (PDO) Thread

September 2017 | Volume 16 | Issue 9 | Case Reports | 932 | Copyright © September 2017

Kian Karimi MD FACS and Alexandra Reivitis BA

Rejuva Medical Aesthetics Los Angeles, CA

used to supplement the results achieved by the thread lift; often, when tissue has been lifted, volume deficits are revealed, which can be corrected with a variety of dermal fillers.All threads were injected subcutaneously using 1% lidocaine local anesthetic with epinephrine injected into the insertion points with a 30-gauge hypodermic needle on the bilateral jawline. Three ml of 1% plain lidocaine was injected for intraoral nerve blocks using a 27-gauge needle. The treatment areas were marked and the skin was cleansed with chlorohexidine. A pilot hole was made with a 20-gauge hypodermic needle and three 3.5-inch Barbed NovaThreads were inserted into the pilot hole. Once the threads were inserted and engaged with surrounding tissue, the end of the thread was trimmed and antibiotic ointment applied to the insertion points.The procedure was performed in less than 30 minutes and was well tolerated. Mild swelling at the insertion points and general treatment area resolved completely within 7 days without intervention. Bruising was not observed.Figure 1 shows the patient before treatment and 7 months after treatment.


PDO threads, including NovaThreads, are FDA approved for soft tissue approximation of the skin of the face or body, although, the use described herein is considered "off-label" and should be indicated as such. Advantages of PDO thread-lifts include minimal invasiveness, short downtime, and nearly invisible scarring. NovaThreads require no deep fixations or knots. Instead, they “lift” tissue with bi-directional “barbs” along the length of each thread. NovaThreads are available in different lengths and sizes, depending on the target area of the face or body. The NovaThreads are loaded into a needle or cannula. Once inserted, the thread is placed into position and the cannula or needle removed.Novathreads are indicated for patients who want to achieve improvement of jowls with mild to moderate sagging without surgery. Since NovaThreads address volume descent and ptosis, the patient requires less filler when he or she has a thread-lift as well. This is because injectable fillers alone cannot “lift” tissues; they address only volume loss. Novathreads are useful for lifting up the cheeks when they are “over-volumized” as a result of injected fillers. If proper thread-lift technique is not used, minor complications such as bruising, hematoma, irregularity, migration of threads, extrusion of threads, infection, and injury to deeper structures may occur.PDO threads last 6 months20,22 and there is an increase in collagen and elastin concentration in the skin during this time.19 This Reivitismay allow for the effects to last longer (i.e., 7 months in the case study) than the actual duration of the threads. In the author’s experience, clinical results have been noted out to 12 months after injection. After 6 months it is safe to re-inject as the threads will have been dissolved.Shimizu and Terase19 recently showed that monafilament PDO threads (Lead Fine Lift, Grand Aespio, Korea) successfully lifted sagging facial skin of several patients in Japan. Hypodermal bleeding was the most common side effect and loose threads on the skin surface were noted in 2 patients. Histopathological studies showed fibrosis around PDO along with clustering of lymphocytes, histiocytes, and aerotropism. Rejuvenation results persisted for 6 months in most patients. The authors cautioned that these results were preliminary, and that long-term studies were needed.Suh and colleagues20 conducted a retrospective chart review of 31 knotless PDO thread-lifting procedures over a 24-month period in Korea. Patient satisfaction was high in 27 of the 31 patients (87%). Texture improvement was fair, good, or excellent in all but 1 patient (3.2%), while lifting was fair, good, or excellent in all but 9 patients (29%). Complications were limited to bruising (90%) and mild asymmetry (6.5%), both resolving within two weeks without treatment.Proper patient selection for PDO thread-lift is important to ensure positive outcomes.20 Shimizu and Terase19 stated that good candidates for PDO thread-lifting are those who want to restore volume, improve hollowness, and have a smaller, younger-looking face without invasive surgeries. Paul14 suggested that patients should also have a low body mass index, minimal softFigure1