Understanding Thread Types — PDO, PLLA, and PCL

Last updated: 5 March 2026

Thread Lifts: A Guide to PDO, PLLA, and PCL Threads

Thread lifting has evolved significantly since its introduction, becoming a popular minimally invasive alternative to surgical facelifts for patients with mild to moderate skin laxity. Central to understanding thread lifts is knowledge of the three main thread materials — PDO, PLLA, and PCL — each with distinct properties, advantages, and clinical applications. This guide provides an evidence-based comparison to help patients and practitioners make informed choices.

At Axiom Aesthetics, our practitioners are trained in advanced thread lift techniques using clinically proven thread materials, selecting the optimal thread type for each patient’s anatomy, concerns, and desired outcomes.

What Are Aesthetic Threads?

Aesthetic threads are absorbable sutures inserted beneath the skin to provide mechanical lifting, tissue repositioning, and collagen stimulation. They work through two mechanisms:

1. Immediate mechanical effect — barbed or cogged threads physically grip and reposition sagging tissue
2. Delayed biological effect — the foreign body response to the thread material stimulates collagen production (neocollagenesis) around the thread pathway, providing continued improvement even after the thread absorbs

PDO Threads (Polydioxanone)

Material Properties

PDO is a synthetic, absorbable monofilament suture that has been used in surgery for decades (notably in cardiovascular surgery). It is the most widely used and extensively studied thread material in aesthetic medicine.

Key Characteristics

• Absorption time: 6–8 months (fully absorbed by the body)
• Collagen stimulation duration: Effects last approximately 12–18 months
• Tensile strength retention: Loses 50% of strength at approximately 4 weeks
• Collagen type stimulated: Primarily type I collagen
• Inflammatory response: Relatively mild

Available Configurations

• Smooth (mono) threads — fine threads for collagen stimulation and skin tightening without mechanical lifting
• Barbed (cog) threads — directional barbs grip tissue for mechanical lifting and repositioning
• Screw threads — spiral-shaped for volumisation effect
• Mesh threads — interwoven for broader surface area stimulation

Clinical Evidence

PDO threads have the most extensive evidence base. A systematic review in Aesthetic Surgery Journal (2022) evaluating 38 studies found statistically significant improvement in facial laxity with a favourable safety profile. Patient satisfaction rates ranged from 70–90% at 6 months.

PLLA Threads (Poly-L-Lactic Acid)

Material Properties

PLLA is the same biocompatible polymer used in Sculptra dermal filler and absorbable surgical sutures. Its key differentiator is a stronger and more prolonged collagen-stimulating effect.

Key Characteristics

• Absorption time: 12–18 months (significantly longer than PDO)
• Collagen stimulation duration: Effects may last 18–24 months or longer
• Tensile strength retention: Maintains strength longer than PDO
• Collagen type stimulated: Types I and III collagen
• Inflammatory response: More pronounced than PDO, which drives greater collagen production

Advantages Over PDO

• Longer-lasting results due to extended absorption time and greater collagen stimulation
• Sustained lifting effect as the material maintains tensile strength for longer
• Progressive improvement over months as collagen builds around the thread

Clinical Evidence

While evidence is less extensive than for PDO, published studies demonstrate superior longevity. A comparative study in Dermatologic Surgery (2023) found PLLA threads maintained statistically significant improvement at 18 months, whereas PDO thread results had diminished by 12 months.

PCL Threads (Polycaprolactone)

Material Properties

PCL is a semi-crystalline biodegradable polymer with the longest absorption time of the three materials. It is the same material used in some long-lasting dermal fillers (Ellanse).

Key Characteristics

• Absorption time: 24–36 months (the longest of all thread types)
• Collagen stimulation duration: Potentially 2–3 years
• Tensile strength retention: Maintains integrity longer than both PDO and PLLA
• Collagen type stimulated: Types I and III with prolonged neocollagenesis
• Inflammatory response: Moderate; well-tolerated

Advantages

• Longest duration of effect among absorbable threads
• Sustained mechanical support throughout the extended absorption period
• Continued collagen stimulation for up to 2–3 years

Limitations

• Less clinical data than PDO (newer to the aesthetic market)
• Higher cost per thread
• Longer-lasting also means longer to fully resolve if complications arise
• Fewer product options and configurations currently available

Choosing the Right Thread Material

The optimal thread selection depends on multiple factors:

• Treatment goals: Skin tightening (PDO mono threads may suffice) vs significant lifting (barbed PLLA or PCL preferred)
• Desired longevity: PDO (12–18 months) vs PLLA (18–24 months) vs PCL (24–36 months)
• Treatment area: Some areas respond better to specific configurations
• Patient age and skin quality: Younger patients with milder laxity may do well with PDO; more advanced laxity may benefit from PLLA or PCL
• Budget: PDO is generally most cost-effective; PCL is most expensive
• Practitioner experience: Familiarity with specific thread systems influences outcomes

Common Treatment Areas

• Midface and cheek lifting
• Jawline definition and jowl reduction
• Brow lifting
• Neck tightening
• Nasolabial fold reduction
• Marionette line improvement

Safety Considerations

Thread lift complications, while uncommon, can include:

• Bruising, swelling, and discomfort (expected and temporary)
• Thread palpability or visibility (usually resolves as swelling settles)
• Asymmetry (can be corrected with additional threads)
• Infection (rare with proper aseptic technique)
• Thread migration or extrusion (uncommon with correct placement)
• Dimpling (usually temporary)

Frequently Asked Questions

How long does a thread lift procedure take?

A typical thread lift takes 30–60 minutes, depending on the number of threads and areas treated. Local anaesthesia is used, and most patients can return to normal activities within 24–48 hours, with some restrictions on facial movements for 1–2 weeks.

Can thread lifts replace a surgical facelift?

Thread lifts are best suited for mild to moderate laxity. They cannot replicate the dramatic lifting of a surgical facelift and are not appropriate for severe skin excess. However, they offer a valuable minimally invasive alternative for the right candidates.

Do threads dissolve completely?

Yes, all three materials (PDO, PLLA, PCL) are fully biocompatible and absorbed by the body over time. The collagen produced around the threads persists after the thread material has dissolved.

Can I have fillers and threads at the same time?

Yes, combination approaches are common and often produce superior results to either treatment alone. Threads provide lifting and collagen stimulation, while fillers restore volume. Your practitioner will advise on the optimal sequencing and combination for your specific needs.

This article is for informational purposes only and does not constitute medical advice. Thread lifts should only be performed by qualified, trained practitioners. Always consult a professional for personalised assessment. Individual results may vary.