What Causes Natural Aging?
Natural aging is inevitable but premature aging is caused by many factors. These
include lifestyle choice, nutrition, environmental factors, sun exposure and a
variety of diseases. Both natural and premature aging consist of a reduction in
skin thickness and elasticity, loss of connective tissue ground substance and a
reduction in circulation. In addition, there is loss of underlying facial bony
structure, redistribution and loss of deeper fat pockets and gravitational
changes. If we look specifically at the skin, the synthesis of collagen and elastin
proteins are reduced in the dermis and the combination of all these different
factors lead to changes in skin colour and tone, wrinkling, tissue ptosis and
How Facelift Surgery Can Help?
Facelift surgery removes excess skin, tighten the underlying layer (SMAS) and
rejuvenate the appearance. However, not all patients are ready for surgical
intervention and in addition, a facelift is not the right option to improve the skin
Aesthetic medicine has increased its repertoire in dealing with the aging
appearance through the use of Botulinum toxin, skin peels, PRP, Hyaluronic acid
injections and laser treatment. Some of these treatments aim to improve the
overall skin quality and some will reduce wrinkle lines. Others will induce skin
tightening and with others aiming to replenish the facial volume loss.
Alongside those mentioned above, the use of Polydioxanone (PDO) threading is
an effective treatment option that plays an important role in aesthetic medicine.
PDO threading has gained popularity in Asia and in particular Korea, where non-
surgical anti-aging treatment is very advanced.
PDO threads are absorbable threads that can be introduced in the subcutaneous
plane with a needle. They are strong synthetic monofilament fibres of variable
thickness. They work by stimulating tissue growth and tighten the skin. Some of
these threads have additional barbs (Cog) on the fibre with anchoring effects
which help with tissue lifting and help to reposition the tissue.
The technique of PDO threading involves the use of an injection needle or
cannula containing the thread with one free end of the thread attached to a
sponge. The insertion of the needle will deposit the thread inside the dermis or
the underlying tissue.
After the initial stimulation from the microtrauma of the injection, the presence
of the PDO threads in the subcutaneous tissue will continue to induce local
inflammation, which will lead to an increase in circulation and the production of
collagen in the area. The rate of collagen production varies between patients and
can be affected by medication, smoking and age. The quality of the skin
continues to improve over the next 4-6 months with wrinkle reduction and skin
tightening. The threads will eventually dissolve in the tissue within this time
period, depending on the thickness of the thread.
By using finer threads into the glabellar, peri-orbital and per-oral regions, they
can help to reduce the wrinkle lines by stimulating the underlying collagen
production and reduction in muscle activity. The final result is usually
preserved for 12-18 months. In older patients with tissue ptosis, jowling, the use
of PDO threads with Cog is more effective as these threads provide addition lift.
The bi-directional cogs anchor the tissues and provide an upward and lateral
traction depending on the placement.
The improvement will not be as significant as face-lift surgery but it is an
effective treatment for those that are not ready for surgical intervention. With
good adjunct and maintenance therapy, PDO thread lifting will help to improve
facial appearance with minimal recovery time.
Another benefit of PDO threads is facial remodelling. Tightening around the
jawline with threading produces a slimmer facial appearance and this is
sometime known as the “V” lift. The slimming appearance with skin tightening
has gained popularity over the years particular in Asia. Threading can also be
combined with dermal filler augmentation to the cheekbone, chin or other areas
to improve facial definition.
With time, utilization of PDO threads has expanded beyond the facial region.
Practitioners are now using threads to perform skin tightening to heavier tissues
such as the abdomen, breast, buttock and upper arms. Similar to facial
treatment, results will be dependent on the amount of simulation by the threads
and collagen production by individual patients. It is a replacement for surgery
but threading may also be a consideration for those interested in some minor
improvements and for those who are reluctant to have surgical treatment.
The overall complications from PDO threading is relative low with issues such as
swelling, infection, bruising, haematoma and transient irregularity. In patients
who have had a large number of threads inserted, transient pain, itchiness and
tenderness can occur but these are usually resolved within a couple of weeks.
Your surgeon will guide you through the different treatment options and address
your concerns during the consultation.