Polydioxanone (PDO) threads are a cornerstone of modern non-surgical facial rejuvenation, offering minimally invasive lifting and collagen stimulation with a strong safety profile. Recent clinical trials and histological studies (2024–2025) have expanded our understanding of PDO threads’ efficacy, optimal use, and comparative performance. All PDO thread procedures at Cosmetic Injectables Center Medspa are performed by certified expert injectors under the direct supervision of Dr. Sherly Soleiman, MD, a board-certified physician and nationally recognized leader in medical aesthetics.
What Are PDO Threads?
PDO threads are absorbable sutures made from polydioxanone, a biocompatible polymer used in surgery for decades. When inserted into the skin, they provide immediate lifting and, over time, stimulate fibroblasts to increase collagen production, improving skin texture and firmness. PDO threads are fully absorbed by the body within 6–8 months, but their collagen-stimulating effects can last longer, depending on thread type and patient factors (PMC, Healthline).
Types of PDO Threads and Their Clinical Uses
PDO threads come in several designs, each tailored for specific aesthetic goals. At Cosmetic Injectables Center Medspa, we offer a full spectrum of PDO thread procedures, including both smooth (mono) threads and barbed (lifting) threads.
Mono (Smooth) PDO Threads
- Description: Single, smooth filaments.
- Primary Use: Skin tightening, fine line reduction, and subtle rejuvenation.
- Mechanism: Induce collagen synthesis without significant lifting.
- Best For: Early signs of aging, crepey skin, and areas needing texture improvement.
Barbed PDO Threads
- Description: Threads with tiny barbs or cogs that anchor into tissue.
- Primary Use: Lifting sagging skin and repositioning facial contours.
- Mechanism: Provide mechanical lift and stimulate collagen.
- Best For: Jawline, cheeks, jowls, neck, and brow lifting.
Screw PDO Threads
- Description: Threads wound around a needle, sometimes double or triple.
- Primary Use: Volume restoration and localized lifting.
- Mechanism: Create more tissue volume and stimulate collagen in targeted areas.
- Best For: Nasolabial folds, marionette lines, and areas needing subtle volumization.
Press Cog and Combined Threads
- Description: Advanced barbed threads (e.g., press cog type) for enhanced anchoring.
- Primary Use: Stronger lifting in moderate-to-severe laxity.
- Clinical Evidence: Combined press cog and cog threads show improved facial contour and skin tightening (Meta).
Comparison Table: PDO Thread Types
| Thread Type | Structure | Primary Use | Lifting Power | Collagen Stimulation | Longevity* | Best For |
|---|---|---|---|---|---|---|
| Mono (Smooth) | Single, smooth | Skin tightening | Low | High | 6–8 months | Fine lines, crepey skin |
| Barbed (Cog) | Barbed/cogged | Lifting, contouring | High | High | 6–12 months | Jawline, cheeks, jowls, neck |
| Screw | Twisted/spiral | Volume, lift | Moderate | High | 6–8 months | Nasolabial folds, marionettes |
| Press Cog | Enhanced barbs | Strong lift | Highest | High | 6–12 months | Moderate-severe laxity |
*Longevity refers to thread absorption; collagen effects may persist longer. Individual results vary.
Clinical Evidence: Efficacy, Safety, and Mechanisms
Recent Clinical Trials (2024–2025)
- Optimal Thread Quantity: A 2025 randomized trial investigates whether more threads yield better lifting outcomes, addressing dose-response and optimal protocols (J Cosmet Dermatol, PMID: 39692727).
- Combination Therapies: Prospective, blinded studies show that combining barbed PDO threads with hyaluronic acid fillers enhances mid-face contouring, with sustained results at 1–2 years (PubMed).
- Safety and Effectiveness: Ongoing US clinical trials are evaluating barbed PDO sutures for mid-face wrinkle reduction. No PDO threads are currently FDA-approved for this specific indication, highlighting the importance of ongoing research (Dr. Kian Threadlift Study).
Histological and Comparative Studies
- Collagen Stimulation: Animal studies confirm PDO threads increase dermal collagen density and improve skin quality, with effects comparable to more slowly absorbed threads like PLLA and PCL (Iran J Basic Med Sci, 2025).
- Absorption and Longevity: PDO threads are absorbed in 6–8 months, while PLLA and PCL threads last 12–18 months (Hanging by a Thread, 2017).
- Biostimulatory Effects: A 2024 pig model study found PDO threads are safe, effective, and suitable for clinical application, with long-term collagen stimulation (Wiley Online Library).
Comparative Table: PDO vs. PLLA vs. PCL Threads
| Feature | PDO Threads | PLLA Threads | PCL Threads |
|---|---|---|---|
| Absorption Time | 6–8 months | ~12 months | 12–18 months |
| Collagen Stimulation | High | High | Highest (per studies) |
| Lifting Power | High (barbed) | High | Highest |
| FDA Approval (Aesthetic) | Not for mid-face | Not for mid-face | Not for mid-face |
| Clinical Use | Lifting, tightening | Lifting, tightening | Lifting, tightening |
| Safety Profile | Well-established | Well-established | Well-established |
| Research Status | Extensive, ongoing | Moderate | Increasing |
Safety, Side Effects, and Patient Selection
PDO threads are generally well-tolerated, with a low risk of serious complications when performed by certified expert injectors. Common side effects include mild swelling, bruising, and temporary discomfort. Rare risks include thread migration, infection, or asymmetry. At Cosmetic Injectables Center Medspa, every patient receives a comprehensive Good Faith Exam and full informed consent, ensuring the highest standards of safety and transparency.
Eligibility: Not all patients are candidates for PDO threads. Exclusion criteria in recent clinical trials include active skin conditions, bleeding disorders, autoimmune diseases, recent facial procedures, and certain medications (Dr. Kian Threadlift Study). A thorough consultation is essential to determine suitability.
Longevity and Maintenance
While PDO threads are absorbed in 6–8 months, the collagen they stimulate can maintain results for 12–24 months or longer, depending on age, skin quality, and lifestyle. Combination treatments (e.g., with hyaluronic acid fillers) may further enhance and prolong outcomes. Individual results vary, and periodic maintenance may be recommended.
Regulatory Status and Research Gaps
As of 2024, no PDO threads are FDA-approved specifically for mid-face wrinkle reduction, though they are cleared for soft tissue approximation. Ongoing clinical trials are expected to inform future regulatory decisions. Systematic reviews highlight a need for large-scale, long-term randomized controlled trials and meta-analyses to refine best practices and standardize techniques (PubMed).
Why Choose Cosmetic Injectables Center Medspa for PDO Threads?
- Physician-Led Expertise: All procedures are overseen by Dr. Sherly Soleiman, MD, a board-certified physician, national trainer, and clinical trial investigator (NPI Registry).
- Certified Expert Injectors: Every provider is certified, experienced, and receives ongoing advanced training.
- Safety and Natural Results: A conservative, “less is more” philosophy ensures subtle, proportional outcomes.
- Comprehensive Care: Full spectrum of PDO thread options, including smooth (mono) threads and barbed (lifting) threads, tailored to individual needs.
- Patient-First Approach: Every patient receives a comprehensive assessment, informed consent, and follow-up care.
“My favorite procedure is doing what makes the face look natural… Injectables are a wonderful tool to enhance a person’s confidence, but the result has the opposite effect if they look awkward and out of proportion.” – Dr. Soleiman, Beverly Hills Magazine
Frequently Asked Questions
What are PDO threads made of?
PDO threads are made from polydioxanone, a biocompatible, absorbable polymer used in surgical sutures for decades.
How long do PDO thread results last?
Threads dissolve in 6–8 months, but collagen stimulation can maintain results for 12–24 months or longer. Individual results vary.
Are PDO threads FDA-approved for facial lifting?
As of 2024, PDO threads are not FDA-approved specifically for mid-face wrinkle reduction, but are cleared for soft tissue approximation.
What is the difference between smooth and barbed PDO threads?
Smooth (mono) threads tighten skin and improve texture, while barbed threads provide mechanical lift and reposition sagging tissue.
Can PDO threads be combined with other treatments?
Yes, combination with hyaluronic acid fillers or other modalities can enhance and prolong results, as supported by recent clinical studies.
What are the risks of PDO thread procedures?
Risks are low when performed by certified experts but may include swelling, bruising, infection, or thread migration. Proper technique and patient selection minimize complications.
How do PDO threads stimulate collagen?
Thread insertion triggers a localized healing response, activating fibroblasts to produce new collagen and improve skin quality.
Who is not a candidate for PDO threads?
Patients with active skin infections, autoimmune disorders, bleeding disorders, or recent facial procedures may not be eligible.
How do PDO threads compare to PLLA or PCL threads?
PDO threads absorb faster (6–8 months) but provide strong collagen stimulation. PLLA and PCL threads last longer but may not be suitable for all patients.
Is there downtime after a PDO thread procedure?
Most patients experience mild swelling or bruising for a few days. Normal activities can usually be resumed within 24–48 hours.
For more information or to schedule a consultation with our certified expert injectors, visit Cosmetic Injectables Center Medspa or explore our PDO thread procedures. All treatments are performed under the direct supervision of Dr. Sherly Soleiman, MD, ensuring the highest standards of safety and natural results.