TL;DR
PDO (polydioxanone) thread lifting has become one of the fastest-growing non-surgical treatments in UK aesthetics. However, not all threads are created equal — different thread types serve distinct purposes and...
Last updated: 5 March 2026
PDO (polydioxanone) thread lifting has become one of the fastest-growing non-surgical treatments in UK aesthetics. However, not all threads are created equal — different thread types serve distinct purposes and achieve different results. Understanding the three main categories — mono, cog, and screw threads — is essential for patients considering this treatment. This guide provides a thorough, evidence-based overview of each type, their applications, and what to expect.
Expert Insight
Thread lifting is both an art and a science. The choice of thread type, gauge (thickness), length, and insertion technique all influence the outcome. A skilled practitioner selects and combines thread types based on the patient’s unique anatomy, skin quality, degree of laxity, and aesthetic goals. There is no single “best” thread — the best result comes from the right combination applied with expertise.
What Are PDO Threads?
Polydioxanone is a synthetic absorbable suture material that has been used in surgery for over 30 years, particularly in cardiac and paediatric surgery. In aesthetic medicine, PDO threads are inserted beneath the skin using fine needles or cannulae to provide mechanical lifting, skin tightening, and collagen stimulation.
The threads dissolve naturally over 6–8 months through hydrolysis, but the collagen and elastin they stimulate during this period can maintain results for 12–24 months. PDO is chosen over other materials (such as PLLA or PCL) for its well-documented safety profile, predictable absorption timeline, and robust collagen-stimulating properties.
The Three Main PDO Thread Types
Mono Threads (Smooth Threads)
Mono threads are the simplest form — single, smooth filaments without barbs or texturing. They are typically the finest gauge (29G–30G) and are inserted in a grid or mesh pattern beneath the skin.
How they work: Mono threads create a scaffolding effect within the dermis. As the body’s wound-healing response activates around each thread, new collagen type I and III is deposited along the thread tract. Over time, this creates a network of collagen fibres that improves skin firmness, texture, and elasticity.
Best applications:
- Fine lines and crepey skin on the face and neck
- Skin tightening and texture improvement on the décolletage
- Under-eye area rejuvenation (with specialised technique)
- Forehead line smoothing
- Hand rejuvenation
- Foundation treatment to improve skin quality before cog thread lifting
What to expect: Mono thread treatment involves multiple thread insertions (typically 10–30 per area). The procedure takes 30–45 minutes with topical or local anaesthesia. Results develop gradually over 4–8 weeks as collagen builds, with minimal downtime (1–3 days of mild swelling).
Cog Threads (Barbed Threads)
Cog threads feature tiny barbs or “cogs” cut into the thread surface at regular intervals. These barbs anchor into the subcutaneous tissue, providing an immediate mechanical lift.
How they work: The barbs grip the tissue once inserted, allowing the practitioner to reposition sagging facial structures. The thread acts as a suspension device, physically lifting the tissue to a more youthful position. In addition to the immediate lift, the barbs create multiple micro-trauma points that stimulate an enhanced collagen response compared to mono threads.
Types of cog threads:
- Uni-directional cogs — barbs point in one direction; typically used in pairs for balanced lifting
- Bi-directional cogs — barbs point in two directions from a central point; provide anchorage from both ends
- 360-degree cogs (3D/4D threads) — barbs arranged in a helical pattern for multi-directional lifting
Best applications:
- Mid-face lifting (cheek ptosis)
- Jowl lifting and jawline definition
- Brow lifting
- Nasolabial fold reduction
- Neck lifting and recontouring
Screw Threads (Twisted Threads)
Screw threads consist of one or two mono threads wound helically around the insertion needle, creating a coil-like or “barber pole” configuration. They are sometimes called “tornado” or “twin” threads.
How they work: The helical winding creates greater surface area contact with surrounding tissue, producing enhanced volume effect and collagen stimulation compared to mono threads. The coiled structure also provides a degree of tissue gathering when the needle is withdrawn, creating a subtle volumising effect.
Best applications:
- Volume restoration in areas of hollowing (cheeks, temples)
- Nasolabial fold improvement
- Marionette line softening
- Forehead volume and smoothing
- Areas requiring both skin quality improvement and mild volume enhancement
Comparison of PDO Thread Types
| Feature | Mono Threads | Cog Threads | Screw Threads |
|---|---|---|---|
| Primary Effect | Skin tightening, texture | Mechanical lifting | Volume, skin quality |
| Immediate Lift | Minimal | Significant | Mild |
| Collagen Stimulation | Moderate | High | Moderate-High |
| Typical Gauge | 29G–30G | 19G–23G | 26G–29G |
| Threads per Session | 10–30+ | 2–8 | 4–15 |
| Procedure Time | 30–45 mins | 30–60 mins | 30–45 mins |
| Downtime | 1–3 days | 5–10 days | 2–5 days |
| Duration of Results | 8–12 months | 12–24 months | 8–15 months |
| UK Cost Range | £300–£800 | £800–£2,500 | £400–£1,200 |
| Pain Level | Mild | Moderate | Mild-Moderate |
Combining Thread Types for Optimal Results
Experienced practitioners frequently combine thread types within a single treatment session to address multiple concerns simultaneously. A common combination protocol involves mono threads for skin quality foundation, followed by cog threads for structural lifting, with screw threads used in areas where volume is also needed.
For example, a comprehensive lower face rejuvenation might involve 4 cog threads for jawline lifting, 10 mono threads for neck skin tightening, and 4 screw threads in the marionette line area for volume and skin quality. This combination approach typically delivers more comprehensive and natural-looking results than any single thread type alone.
Who Is a Good Candidate?
The ideal candidate for PDO thread treatment has mild to moderate skin laxity and good skin quality (not too thin or damaged). The best results are seen in patients aged 30–55, though both younger (preventative) and older patients can benefit. Contraindications include active skin infection, autoimmune conditions, pregnancy and breastfeeding, bleeding disorders or anticoagulant therapy, and previous adverse reactions to PDO or similar materials.
Safety and Regulation in the UK
PDO threads are classified as Class III medical devices under UK MDR regulations and must carry UKCA marking (or CE marking during the transition period). The procedure should only be performed by appropriately trained and qualified practitioners. In England, thread lifting falls under the licensing requirements of the Health and Care Act 2022 for non-surgical cosmetic procedures.
Potential risks include bruising, swelling, infection, thread migration, dimpling, asymmetry, nerve injury (rare), and palpable threads. These risks are minimised by choosing a practitioner with specific thread lifting training and experience, who uses quality-assured products, and who follows evidence-based protocols.
Frequently Asked Questions
Do PDO threads hurt?
Most patients describe the sensation as mild to moderate discomfort rather than true pain. Local anaesthetic is administered before the procedure, which significantly reduces sensation during thread insertion. Mono threads are the least uncomfortable, whilst cog threads involve slightly more sensation due to the larger gauge needles. After the procedure, patients typically experience a feeling of tightness or mild tenderness for 3–7 days, which is well-managed with over-the-counter pain relief such as paracetamol. Avoid NSAIDs (ibuprofen) for 24 hours as they can increase bruising.
How long do PDO thread results last?
The threads themselves dissolve over 6–8 months, but the collagen framework they create maintains results for longer. Mono thread results typically last 8–12 months, screw threads 8–15 months, and cog threads 12–24 months. Individual results depend on factors including age, skin quality, degree of laxity, lifestyle (particularly sun exposure and smoking), and the number and type of threads used. Many patients opt for maintenance treatments every 12–18 months to sustain and build upon results.
Can PDO threads be combined with dermal fillers or botulinum toxin?
Yes, PDO threads work well as part of a combination treatment plan. However, timing is important. Most practitioners recommend performing thread lifting first, then waiting 2–4 weeks before adding dermal fillers to fine-tune the result. Botulinum toxin can be administered either 2 weeks before or 2 weeks after thread placement. This sequential approach allows each treatment to settle and be assessed before the next is added, reducing the risk of complications and optimising overall outcomes.
What happens if I do not like the result?
Unlike dermal fillers, PDO threads cannot be “dissolved” — once placed, you need to wait for them to absorb naturally over 6–8 months. However, if there is significant asymmetry or an unsatisfactory result, a skilled practitioner can sometimes adjust the outcome by adding additional threads or, in rare cases, removing threads within the first 1–2 weeks. This is why choosing an experienced practitioner is essential. At your follow-up appointment (typically 2–4 weeks post-treatment), any minor refinements can be discussed and addressed.
Are there any thread types better than PDO?
PDO is the most widely used thread material in the UK, but alternatives include PLLA (poly-L-lactic acid) and PCL (polycaprolactone) threads. PLLA threads dissolve more slowly (12–18 months) and stimulate more prolonged collagen production, potentially offering longer-lasting results. PCL threads have the longest dissolution time (24–36 months). Each material has its own profile of benefits and risks. Your practitioner should discuss the specific products they use and why they have been selected for your treatment plan. The “best” material depends on your individual needs and the practitioner’s expertise and experience.
PDO thread lifting offers a versatile, minimally invasive approach to facial and body rejuvenation. Understanding the different thread types empowers patients to have informed discussions with their practitioner and set realistic expectations for their treatment outcomes.
Interested in thread lifting? Book a consultation to discuss which thread types are right for you. See also our guides to thread lifting for the neck and jawline and skin tightening technologies.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Thread lifting is a medical procedure that carries risks. Always consult a qualified, trained practitioner for personalised assessment and treatment. Individual results vary. All procedures should be discussed in detail during your consultation, including potential risks and side effects.
This content is provided for informational purposes only and does not constitute medical advice. Individual results may vary. Always consult with a qualified medical professional before undergoing any treatment. All treatments carry potential risks and side effects which will be fully discussed during your consultation.
Medical Disclaimer: This content is provided for informational purposes only and does not constitute medical advice. Individual results may vary. Always consult with a qualified medical professional before undergoing any treatment. All treatments carry potential risks and side effects which will be fully discussed during your consultation.