Understanding PDO Threads: Types, Uses, and Results

Last updated: 9 August 2026

What are PDO threads?

Polydioxanone (PDO) thread lifting is a minimally invasive treatment that uses absorbable sutures inserted beneath the skin to provide mechanical lifting, tissue repositioning, and collagen stimulation. Originally developed from materials used in surgical suturing (PDO has been used in cardiovascular and orthopaedic surgery for decades), thread lifting has evolved into a sophisticated aesthetic technique with an expanding evidence base.

Clinics offer PDO thread treatments as part of our comprehensive approach to facial rejuvenation. Practitioners are trained in advanced thread placement techniques and understand both the capabilities and limitations of this treatment modality. This article provides an evidence-based overview to help patients understand whether thread lifting may be appropriate for their concerns.

The science of PDO threads

Material Properties

Polydioxanone is a synthetic, absorbable polymer with several properties that make it suitable for aesthetic use. It is fully biocompatible and has been used in medicine since the 1980s. PDO is absorbed by the body through hydrolysis over approximately 6–8 months. It triggers a controlled foreign body response that stimulates neocollagenesis (new collagen formation) around the thread. Also, PDO has intrinsic anti-inflammatory properties that support tissue healing.

The collagen stimulation mechanism

When PDO threads are inserted into the subcutaneous tissue, the body recognises them as foreign material and initiates a controlled inflammatory response. This response progresses through well-characterised stages, as described in research published in the Journal of Cosmetic Dermatology (2023):

1. Inflammatory phase (weeks 1–4): Macrophages and fibroblasts migrate to the thread site.
2. Proliferative phase (weeks 4–12): Fibroblasts lay down new type III collagen around the threads, forming a collagen sheath.
3. Remodelling phase (months 3–12): Type III collagen matures and converts to stronger type I collagen, creating a permanent structural framework even after the threads have dissolved.

This collagen-stimulating effect persists long after the threads themselves have absorbed, the biological improvement continues for 12–18 months following insertion.

Types of PDO Threads

PDO threads are categorised by their design, each serving different purposes:

Mono threads (smooth threads)

Simple, smooth threads without barbs or cogs. They are inserted in a mesh-like pattern beneath the skin to stimulate diffuse collagen production. Mono threads do not provide significant lifting but are excellent for improving skin quality, texture, and fine lines. They are commonly used for:

• Neck skin tightening and horizontal line improvement
• Perioral (around the mouth) rejuvenation
• Under-eye skin quality improvement
• Overall facial skin quality enhancement

Cog threads (barbed threads)

Threads with bidirectional barbs (cogs) that anchor into tissue. This provides mechanical lifting and repositioning. Cog threads are the primary lifting threads in aesthetic practice, used for:

• Mid-face lifting (addressing jowling and nasolabial folds)
• Jawline definition
• Brow lifting
• Neck lifting (addressing platysmal laxity)

The barbs engage with subcutaneous tissue, gathering and repositioning it in the desired vector (direction of lift). Modern cog threads have improved barb geometry based on engineering analysis, helical, bidirectional designs provide stronger anchoring than early unidirectional versions.

Screw Threads

One or two mono threads wound around an insertion needle in a spiral pattern. They create volume and are used in areas where localised plumping is desired, such as the nasolabial region, marionette areas, and glabellar lines.

Mesh/Molding threads

Newer thread designs featuring a mesh-like structure that provides both scaffolding and collagen stimulation across a broader area. These are particularly useful for skin quality improvement over larger zones.

Clinical Evidence

The evidence base for PDO threads has grown substantially in recent years:

Lifting Efficacy

A systematic review published in Aesthetic Surgery Journal (2023), analysing 28 studies with 2,340 participants, reported that cog thread lifts produced clinically significant improvement in facial laxity (measured by Global Aesthetic Improvement Scale) in 78% of patients. Patient satisfaction rates ranged from 75–90% at 6-month follow-up and 60–75% at 12-month follow-up. The degree of visible lifting was modest compared to surgical facelift, typically 3–5mm of tissue repositioning versus 10–15mm with surgery.

Collagen Stimulation

Histological studies confirm significant collagen deposition around PDO threads.

Skin quality improvement

Mono thread treatments have been shown to improve skin elasticity by 20–30%, reduce fine wrinkle depth by 15–25%, and improve skin hydration and luminosity. These effects are more consistently achieved than lifting effects and represent a significant benefit of the treatment.

The treatment process

Consultation and Assessment

A thorough consultation includes assessment of skin laxity and tissue quality, facial analysis identifying optimal lift vectors, evaluation of patient expectations (critical for satisfaction, threads produce subtle, not dramatic, lifting), medical history review including blood-thinning medications and previous facial procedures, and discussion of alternatives (filler, energy-based devices, surgery) to ensure threads are the optimal choice.

The Procedure

Thread lifting is performed under local anaesthesia. The number and placement of threads depend on the indication. A typical mid-face lift involves 4–8 cog threads per side, inserted through small entry points in the temporal hairline and directed along predetermined vectors towards the mid-face. Mono thread treatments may use 20–40 smooth threads in a cross-hatching pattern. The procedure takes 30–60 minutes.

Recovery

Post-treatment, patients can expect mild swelling and bruising for 3–7 days, mild discomfort (managed with paracetamol, avoid NSAIDs which affect healing), and a slightly “tight” or “pulled” sensation for 1–2 weeks. Restrictions during the first 2 weeks include avoiding wide mouth opening, sleeping on the back, no strenuous exercise, and no facial massage or energy-based treatments.

Results are visible immediately but continue to improve over 2–3 months as collagen formation enhances the lifting effect and improves skin quality.

Who is a suitable candidate?

Ideal Candidates

• Mild to moderate skin laxity (the “not quite ready for surgery” patient)
• Age typically 35–55 (though this varies with individual ageing patterns)
• Good skin quality with some remaining elasticity
• Realistic expectations, understanding that threads provide subtle, not dramatic, improvement
• Patients seeking collagen stimulation and skin quality improvement alongside gentle lifting

Less suitable candidates

• Significant skin laxity (these patients would benefit more from surgical options)
• Very thin skin with minimal subcutaneous tissue (insufficient tissue for barb engagement)
• Active skin infection or inflammation in the treatment area
• Autoimmune conditions affecting wound healing
• Unrealistic expectations of surgical-level results

Risks and Complications

Common complications (5–15%) include bruising and swelling, mild asymmetry (often resolving as swelling settles), temporary dimpling at entry points, and discomfort or tenderness for 1–2 weeks. Less common complications (1–5%) include thread palpability or visibility (particularly in thin-skinned patients), thread migration, infection (rare, typically responding to antibiotics), and nerve injury (very rare with proper anatomical knowledge).

Combining threads with other treatments

PDO threads are often most effective as part of a multi-modal treatment plan. Common evidence-based combinations include threads plus botulinum toxin (treating dynamic lines alongside mechanical lifting), threads plus dermal filler (addressing both laxity and volume loss), and threads followed by skin boosters or energy-based treatments (at appropriate intervals) for comprehensive rejuvenation.

Key Takeaways

• PDO threads provide both mechanical lifting and long-term collagen stimulation
• Different thread types (mono, cog, screw) serve different purposes, lifting, skin quality, or volume
• Results are subtle and best suited to mild-moderate laxity in patients with realistic expectations
• The collagen-stimulating effect persists beyond thread absorption, with improvements lasting 12–18 months
• Threads work best as part of a comprehensive treatment plan rather than as a standalone solution