Is More Always Better? A Randomized Comparative Clinical Trial About the Impact of Polydioxanone Threads Quantity for Facial Lifting

Abstract Background Minimally invasive aesthetic procedures, such as the use of polydioxanone (PDO) threads, are increasingly popular for facial rejuvenation. Objectives This study investigates the impact of the number of PDO threads on tissue displacement, volume changes, and patient satisfaction. Methods This randomized controlled trial involved 22 patients seeking facial lifting using PDO threads. Participants were divided into 2 groups: G1 with 3 threads per hemiface and G2 with 6 threads per hemiface. Three-dimensional stereophotogrammetry was used to evaluate volumetric changes and tissue displacement at baseline, 20 days, and 60 days posttreatment. Patient satisfaction was assessed using the Global Aesthetic Improvement Scale (GAIS). Results Significant volumetric changes were observed over time in both midface and lower face regions (P < .05), but no significant intergroup differences were found (P > .6). Tissue displacement showed statistical significance over time (P = .039) but not between groups (P = .821). GAIS scores did not differ significantly between groups or between patients and specialists. Adverse events were minor and transient, primarily involving pain. Conclusions The number of PDO threads used did not significantly influence sustained lifting outcomes or patient satisfaction. Initial improvements in volume and tissue displacement diminished by 60 days, suggesting that additional threads do not enhance long-term efficacy. Further studies with longer follow-up are needed to better understand collagen stimulation’s potential role in lasting effects. Level of Evidence: 2 (Therapeutic)