Polydioxanone (PDO) Thread Lift for Face: A Novel Anatomical Approach

Barbed thread facelift has grown in popularity, however, optimal strategies for thread placement remain inconclusive. Currently, most practitioners use cannula-driven method for thread facelifts. However, the lifts are generally performed without firm anchors, and many cephalad barbs remain unused. These methods could result in differing degrees of clinical effectiveness. This paper proposes a novel technique using molded polydioxanone (PDO) threads for facial rejuvenation. For midface lift, PDO threads attach to the zygomatico-cutaneous ligaments (ZCL) and anchor to the superficial layer of the deep temporal fascia (SDTF) using a bi-directional threading technique. For buccal fat ptosis and lower face lift, we use threads to engage the buccal fat complex and hitch it at the sideburn region. Additional improvement of jowling is also attained by utilizing the platysma auricular ligament. We have performed this procedure in 83 patients with minimal complications. The engagement of ZCL and buccal fat, along with solid thread anchoring and utilization of all barbs, allows for effective mid and lower face elevation with favorable aesthetic outcomes. The results appear natural, and patient's satisfaction is high. This method applies long-standing plastic surgery concepts to achieve enhanced thread lifting effects. Even though PDO thread facelifts only produce temporary effects, they provide an option for patients who are hesitant about surgical facelifts.