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What’s Better? Thread Lift or Mini Facelift?

One of the first areas of concern people have with aging is the drooping of the corners of your mouth. This sagging makes you look sad, tired and old. You may find yourself pulling on your cheeks to improve this deformity. While traditionally a surgical lift is the ideal technique to rejuvenate this area, majority of people want non-surgical options. Minimally invasive, and non-surgical options are the most popular treatments sought today.

PDO Thread Lift

You may have heard about the thread lift, or the PDO thread lift. I’m sure you’ve seen advertisements claiming the ability to correct that jowling that you’re not happy with. I can see the attraction of this technique. It’s an in office procedure. The idea of using a barbed suture to simply pull back the sagging tissue sounds attractive. So is this thread lift better than a mini-facelift?

What is the PDO thread lift? Essentially, it’s a technique where the doctor passes a barbed wire or suture under your skin. It’s directed to the sagging tissue and then used to “pull” back that area. PDO stands for polydioxanone, the material used in surgical sutures that are absorbable over time. The suture is designed with tiny barbs with intent to “grab” tissue.

The procedure is performed with topical or local anesthesia and is performed basically like an injection. The injector will aim the suture to areas of sagging tissue, using desired vector to improve the sagging tissue. One or multiple sutures may be used per side, depending on the effects desired.

Benefits of a PDO Thread Lift

While both options have the same goal of re-suspending your sagging jowls, the only benefits that PDO thread lift offer are avoidance of cutting your skin and perhaps less expensive. Because there’s no cutting, the recovery might be quicker than a mini facelift. But there will still be some swelling after this procedure. Another relative benefit is possibly more choices of physicians. Since this is non-surgical procedure, you will find other doctors offering thread lifts, not just facial plastic and plastic surgeons.

Limitations of a Thread Lift

More choices may be an important consideration for some patients. While these are valid advantages, there are potential limitations of the PDO thread lift. One important limitation is the degree of sagging. Only mild aging signs can be effectively treated with this technique. The thread has limited pull strength. In addition, you can’t anchor it deep since the needle is passed just beneath the skin. Facelift surgeons know that the key structure to suspend is the Superficial Musculoaponeurotic system (SMAS) that is deeper than the needle depth.

It’s a key structure that is best adjusted with dissection and exposure. Another potential problem is potential visibility of the barbed wires, skin dimpling, or unwanted pull. Once the wire thread is inserted, pulled and engaged, it’s very difficult to remove it. So the injector really has one shot to get the treatment right. Unlike hyaluronidase fillers, there is no medicine that can dissolve the thread if you don’t like the results. You just have to wait for it to absorb.

Mini-Facelift the Better Option

In my hands, a mini facelift is still the better option, and I do not offer the PDO thread lift. As a facial plastic surgeon who understands the detailed anatomy of the face, the SMAS is the key structure that needs to be suspended. I just don’t see how I can reliably engage that without seeing it. I don’t like the fact I can’t re-adjust or remove the suture if I’m unhappy with the effect. With surgery, I can see the SMAS. I can pull the SMAS in the correct vector I want and suspend accurately with sutures.

If I don’t like the results, I can cut the sutures and then readjust my vector. The ability to confidently and accurately suspend sagging tissue is a major advantage. In my hands, I can get better results than a PDO thread lift. Though mini facelift is surgical, it’s less extensive than a formal facelift.

A mini facelift can be performed in our clinic operating room, with just oral sedation. The incisions are from temple to bottom of your ears, and the scar is well hidden. Because the surgery is limited, the post-op swelling is not as bad as a formal facelift. I would argue the swelling is just a little bit more than from thread lift, but not significantly more.

A PDO thread lift can be effective, but I believe only in the right hands. As with all techniques and devices in the cosmetic industry, there is never “one best” treatment. I really believe each surgeon has his particular techniques that work best for him or her. I’m sure there are doctors who do a lot of thread lifts that can achieve good results. You just have to do proper research and then visit them. Personally, I have seen some patients come in for facelift consults who had a thread lift elsewhere.

Most were not super happy with the results. In our practice, we will offer dermal fillers and lasers as non-surgical options. Voluma can be used in a specific way to pull the jowls—the effect is limited and lasts only about nine months. But I think its effect approaches that of PDO threads, without the disadvantages I mentioned. Ultimately, when a prospective patient consults for early sagging jowls, I will recommend a mini facelift because that is how I can deliver the best results.

Contact a San Antonio Facial Plastic Surgeon

For more information about facelifts in San Antonio, schedule a consultation with Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery or contact our Concierge Patient Coordinator at (210) 876-6868.