Clinical efficacy and patient satisfaction of poly-L-lactic acid and ε-caprolactone-hyaluronic acid threads for graded facial laxity treatment: A prospective interventional clinical study

Objectives: The objective of the study is to evaluate the clinical effectiveness and patient satisfaction associated with Aptos poly-L-lactic acid and ε-caprolactone (P[LA/CL]) hyaluronic acid (HA)-enriched lifting threads (Visage Excellence Method HA), used alone or in combination with additional thread methods, across varying degrees of facial laxity as classified by the facial laxity rating scale (FLRS). Materials and Methods: A prospective interventional study was conducted involving 60 patients stratified by FLRS into three treatment groups: Group 1 (FLRS 2–4) received Visage Excellence Method HA in the midface; Group 2 (FLRS 5–6) received additional jawline lifting using light lift thread method; and Group 3 (FLRS 7–9) received midface, jawline, and neck lifting using both light lift thread and light lift needle methods. Assessments were conducted at baseline and at 1, 3, and 6 months post-implantation using the FLRS (clinician-assessed), FACE-Q (satisfaction with skin and outcome modules), and the Global Aesthetic Improvement Scale (GAIS). Non-parametric statistical analyses were applied. Results: All groups demonstrated statistically significant reductions in FLRS scores at all follow-up points ( P < 0.001). A consistent 0.7–1.0 point mean decrease from baseline was sustained over 6 months, with the greatest changes observed within the first 3 months. FACE-Q satisfaction with outcome and satisfaction with skin scores increased significantly ( P < 0.001), with Group 2 reporting the highest levels of satisfaction at 6 months. GAIS scores indicated “very improved” results in 97% of patients at 1 month, slightly declining by 6 months, but still reflecting positive esthetic outcomes. No serious adverse events occurred. Minor side effects, such as swelling, tightness, and bruising, were transient and resolved spontaneously within one week. Conclusion: P(LA/CL) HA threads, either alone or in combination with additional thread techniques, demonstrated statistically significant clinical improvements in facial laxity and high levels of patient-reported satisfaction across all severity grades. Tailoring thread-lifting strategies based on FLRS grading yields effective and safe outcomes, with the most favorable balance of clinical and subjective results observed in moderate laxity cases. These findings support the use of P(LA/CL)-HA threads as a minimally invasive, patient-centered approach to facial rejuvenation.