PDO vs. PLLA Threads in 2025: Indications, Longevity & Risks

By Dr. Cosentino

Published: Sun, Oct 26/2025

Diagram showing safe PDO thread vectors along the jawline for early jowling.

Introduction

Minimally invasive facial shaping remains a top 2025 request, but “threads” are not one-size-fits-all. This guide clarifies where polydioxanone (PDO) and poly-L-lactic acid (PLLA) threads excel—and where they don’t—so you can select patients by indication, set realistic longevity expectations, pair with skin-tightening judiciously, and reduce complication risk. If you’re building skills or standardizing protocols, you can translate these insights directly into your training roadmap via Empire On-Demand.

Threads 2.0 at a Glance (Executive Summary)

Bottom line:

PDO offers short-term lift and collagen support; think early jowling, jawline definition, midface soft lift in mild laxity; absorption ≈ 4–6 months, with any remodeling effects extending beyond that but typically not durable at 12 months without adjuncts or retreatment.
PLLA cone threads (e.g., Silhouette-type systems) are better for mild–moderate descent where longer-lived scaffolding is desired; published experience suggests more durable effect than PDO, though comparative head-to-head, high-quality trials remain limited.
Don’t use threads as a substitute for significant skin laxity, heavy platysmal bands, or major volume loss—these require surgery and/or volumization/energy-based tightening first. Evidence syntheses consistently warn that outcomes diminish by ~6–12 months in many PDO series and that overall study quality is variable.
Complications are usually minor (bruising, dimpling, asymmetry), but extrusion, infection, and foreign-body reaction occur and are material/design dependent; reported complication rates vary across thread types and study designs.

Indication-Based Selection: PDO vs. PLLA

Snapshot: Match material and design to tissue problem. PDO for fine repositioning and collagenic “edge sharpening” in mild laxity; PLLA cones for vector-based lift with modest longevity in mild–moderate descent. Evidence quality is mixed, so anchor decisions in anatomy, laxity grade, and vector feasibility.

PDO Threads: Where They Fit

Best for:

Early jowling / jawline softening where subtle mandibular contour improvement is needed.
Cheek support in mild midface descent when fillers alone would look heavy.
Refinement after neuromodulators/fillers to crisp borders (marionette, prejowl sulcus).

Why: PDO is biocompatible and fully absorbed in ~4–6 months; mechanical lift is modest and short-lived, but collagen remodeling can give a “held” look for a time afterward. This underpins indications that require light lift + skin quality signaling rather than robust suspension.

Where they don’t:

Moderate–severe laxity (heavy jowls/neck).
Highly mobile zones opposing vectors (perioral descent against muscular pull), where cheese-wiring risk and early relapse are higher.

PLLA Cone Threads: Where They Fit

Best for:

Midface and lower-face descent in mild– moderate laxity when patients want more sustained effect and visible vectoring.
Brow repositioning for subtle lateral tail elevation in right candidates.

Why: PLLA cones provide bidirectional anchoring with biostimulatory collagen for potentially longer persistence than PDO, though magnitudes differ by device and patient factors; robust, comparative RCT data remain limited.

Where they don’t:

Significant dermatochalasis and neck laxity where energy-based tightening or surgery is primary.
Patients unwilling to accept palpable cones during early healing or granuloma risk associated with certain biodegradation kinetics.

Longevity: What Patients Can Actually Expect

TL;DR: Immediate lift often softens by 6 months with PDO and may be absent at 12 months in many cohorts; PLLA may outlast PDO but still trails surgical lifting by a wide margin.

A frequently cited 160-patient PDO study reported visible benefit early, notable decline by 6 months, and absence by 1 year; early postoperative complication rate ~34% (varied events). Manage expectations accordingly.
Reviews warn that evidence quality is limited and heterogeneous, making broad claims risky; this is especially relevant when counseling on durability.
Absorption vs. effect: PDO hydrolyzes by ~4–6 months, but neocollagenesis may briefly “hold” contour past that point; the clinical magnitude is modest and patient-dependent.
PLLA cones show longer-lived scaffold-plus-biostimulation effects in retrospective series and expert chapters, including brow lifting cohorts; still, confirm vector feasibility and skin quality first.

Clinical script:

“Threads buy time in mild laxity. PDOs are great for ‘polishing the edges’ for several months; PLLA cones can hold a bit longer. If you want multi-year change, we’ll pair with tightening or consider surgical options.”

Thread Lift Risks and How to Avoid Them

Key risks: bruising, swelling, puckering/dimpling, asymmetry, suture visibility or extrusion, infection, foreign-body reaction/granuloma (risk varies by polymer/design) and nerve/vascular injury if technique and vectors are poor. Large safety reviews across PDO and PLLA/PCL categories emphasize generally minor events but non-trivial rates overall—underscoring training and patient selection.

Complication-avoidance checklist (Threads 2.0):

Select for skin quality + laxity grade: Favor mild laxity; stage energy-based tightening or volumization first when skin is thin or laxity is moderate+.
Plan vectors that don’t fight muscle pull (avoid perioral lifts that oppose powerful elevators/depressors).
Depth discipline: Stay in the correct plane to limit visibility/extrusion; avoid superficial passes in atrophic skin.
Minimize bioburden & friction: Strict asepsis, atraumatic cannula work, tensioning after tissue settling.
Inform on re-intervention: Set expectations for touch-ups by 6–12 months (PDO) or staged combination plans (PLLA).

Pairing Threads with Skin Tightening: What Helps—and What Doesn’t

Short answer: combination plans are common in practice, but high-level evidence is limited. Base pairing on pathology: threads for descent; energy devices for lax collagen/dermal quality; fillers for volume; neuromodulators for muscle pull.

RF microneedling / needling improves texture, pores, and mild laxity; it does not replicate surgical lift and should complement (not replace) vector suspension.
Reviews on modern thread lifting stress multimodal sequencing to extend perceived benefit—e.g., neuromodulator for DAO/masseter pull, subtle volumization of deflation zones, and device-based tightening before or after as indicated. Evidence grade is low-to-moderate, so frame as adjunctive.

A practical pairing pathway:

Assess triad: descent (vectors), dermal quality (tightening), and deflation (volume).
If descent > dermal laxity: consider PLLA cones; add RF microneedling 8–12 weeks later for quality.
If dermal laxity > descent: prioritize energy-based tightening first; add PDO for fine contouring if needed.
If muscle pull dominates (DAO, platysma bands): sequence neuromodulator first, then threads if vectors remain feasible.

Building a Safe, Scalable Thread Program in 2025

Training > product: Outcomes track to anatomy-first planning, vector discipline, and complication playbooks more than brand labels. If you’re formalizing team capabilities:

Start with fundamentals and live demonstrations in a Level I curriculum, then progress to advanced vectoring and salvage strategies. The PDO Thread Lift Training Level I course is a solid entry point for standardizing basics, landmarks, and patient selection across your team (see PDO Thread Lift Training Level I for structured modules and demos).
As cases get more complex—combo plans, cone threads, revision of ripples/puckers—step into advanced pearls and cadaver-level anatomy. The Advanced PDO Thread Lift Training (Level III) pathway focuses on high-stakes zones, vector optimization, and complication management (explore Advanced PDO Thread Lift Training Level III).

Clinical Scenarios (Apply-It-Now)

1) 38-year-old with early jowls, good skin quality

Goal: Sharpen jawline, soften marionette transition.
Plan: PDO barbed vectors from lateral to prejowl; microcannula filler micro-bolus in prejowl sulcus; neuromodulator to DAO. Set durability at ~6–12 months for visible lift; offer maintenance or staged RF microneedling.

2) 49-year-old with midface descent, mild platysmal bands

Goal: Re-suspend malar fat pad, improve nasolabial shadow.
Plan: PLLA cone threads along malar vectors; low-dose neuromodulator to platysma; consider device-based tightening at 12 weeks for skin quality. Counsel on longer hold vs PDO but not surgical-level durability.

3) 58-year-old with moderate lax neck + heavy jowls

Goal: Wants “no downtime facelift.”
Plan: Do not promise thread success; recommend surgical consultation or staged tightening/volumization first. Threads alone likely insufficient and at higher risk of extrusion/relapse.

Quick Reference: Where Threads Don’t Fit

Significant skin redundancy / severe laxity → Surgical facelift/necklift consult first.
Platysmal banding as primary complaint → neuromodulators, energy, or surgery; threads add little.
Perioral vertical lift against strong muscle vectors → high relapse risk (“cheese-wiring”).
Thin, photodamaged skin with poor dermal grip → tighten/restore first or avoid threads.

Call to Action

Ready to operationalize a threads-plus strategy with reproducible safety? Build from fundamentals, then master advanced vectoring and complication rescue with Empire’s stepwise curriculum and case-based coaching on Empire On-Demand. Your future before-and-after gallery—and your complication log—will thank you.

FAQs

1) What’s the real-world longevity of PDO threads?

Most patients see early improvement that softens by ~6 months and can be gone by 12 months without adjuncts; collagen remodeling may briefly extend perceived benefit.

2) Do PLLA cone threads last longer than PDO?

Often yes in clinical series and expert consensus, but high-quality comparative trials are limited. Set expectations for months, not years, and plan maintenance.

3) Are complication rates high?

Most are minor and self-limited (bruising, dimpling). Still, extrusion, infection, asymmetry, and foreign-body reactions occur—lower your risk with patient selection, depth control, and asepsis.

4) Can threads replace a facelift?

No. Threads are best for mild laxity and contour refinement; surgery remains the standard for moderate–severe laxity.

5) How do I pair threads with devices?

Use threads for descent and RF microneedling/other energy for dermal quality, staged several weeks apart. Evidence is supportive but not robust; present as adjunctive.

6) Which zones are highest risk?

7) What aftercare reduces problems?

Limit extreme expressions and heavy massages initially; review alarm signs (increasing pain, erythema, visible suture). Evidence varies by protocol, but asepsis and vector protection matter most.

8) Do threads stimulate collagen?

Yes—both PDO and PLLA can stimulate neocollagenesis; PDO fully absorbs ~4–6 months, with remodeling effects that may outlast the suture but are modest.

9) Are “marionette-line lifts” reliable with threads?

Often unreliable because vectors oppose muscle pull; consider neuromodulators and volume or surgery.

10) Will training really change outcomes?

Yes—complications correlate with vector planning, plane control, and case selection. Structured curricula and repetition improve safety and consistency.

References

Aesthetic Surgery Journal Open Forum. (2025). Is more always better? A randomized comparative … https://doi.org/10.1093/asjof/ojaf002 OUP Academic
Bertossi, D., et al. (2019). Effectiveness, longevity, and complications of facelift by barbed suture insertion. Aesthetic Surgery Journal, 39(3), 241–247. https://academic.oup.com/asj/article-abstract/39/3/241/4883474 OUP Academic
de Benito, J., et al. (2021). The safety profile of thread lifts on the face and neck: An updated review. Journal of the American Academy of Dermatology. https://www.jaad.org/article/S0190-9622(21)01548-6 JAAD
Guyuron, B., & contemporaries. (2019). Commentary on: Effectiveness, longevity, and complications… Aesthetic Surgery Journal, 39(3), 248–253. https://academic.oup.com/asj/article/39/3/248/5320203 OUP Academic
Lee, C., et al. (2020). Update on thread-lifting. Advances in Cosmetic Surgery, 3(1), 95–108. https://www.advancesincosmeticsurgery.com/article/S2542-4327(20)30006-0/fulltext Advances in Cosmetic Surgery
Li, E., et al. (2019). Thread-lift sutures: Anatomy, technique, and review of current literature. Journal of Oral and Maxillofacial Surgery, 77(10), 2065.e1–2065.e11. https://www.sciencedirect.com/science/article/pii/S0278239119313382 JOMS
Zhang, Y., et al. (2021). Complications following facial thread lifting: A retrospective review. Journal of Stomatology Oral and Maxillofacial Surgery, 122(6), 636–642. https://www.sciencedirect.com/science/article/pii/S209669112100039X ScienceDirect

Note: Combination-therapy evidence is evolving; where high-level data are limited, we have stated so explicitly and relied on reviews/consensus.

By Stephen Cosentino

Mar 04, 2025

What is a non-surgical facelift?

Most of us have experienced that slightly sinking sensation when we look in the mirror and spot the signs of aging. Whether it's the appearance of new or deepening wrinkles, loose skin, or the loss of your jawline, aging is a natural process (even if its effects aren't always welcome!)

Dealing With the Signs of Aging

At Empire Medical Training, we believe it's important to celebrate your natural beauty and be confident in yourself. Aging is a gift in so many ways, but we also understand that not everyone feels their best when their appearance changes.

And, if you've not always applied your SPF, eaten well, slept deeply, or generally invested in your self-care, you may find that the signs of aging are hitting a little faster than you'd like!

The Challenge of Modern Life and Aging

We all live busy and stressful lives, and it shows in our faces, especially when this stress is combined with other environmental factors such as pollution, UV (not just from the sun, but also from digital devices), and second-hand smoke, even if we don't smoke ourselves.

Embracing Aging... Your Way

The good news is, that there are so many ways to tackle the signs of aging, whether you're interested in lip augmentation, a cheek lift, or jawline contouring. Search for 'fillers near me' and you'll find so many options.

But it's vital that you choose a highly skilled and accredited aesthetics practitioner who knows how to integrate surgical and non-surgical practices to deliver the best, tailored results for your unique needs, preferences, and situation.

We'll cover this more shortly, but for now, let's take a look at the fascinating topic of nonsurgical facelifts. Firstly, what is a nonsurgical facelift, and how is it different from a traditional plastic surgery facelift?

Why plastic surgery facelifts are less popular

A lot of people reach an age where they feel that the signs of aging are coming thick and fast, and what they see in the mirror doesn't reflect how they feel inside!

But at the same time, the risks of traditional plastic surgery - correctly called a rhytidectomy - can be significant, and this type of aesthetic work can also be very expensive.

Let's be honest too, most of us have seen people who have received a traditional plastic surgery facelift and the results are very obvious, especially if they have had more than one facelift.

Traditional plastic surgery facelifts are permanent but they tend to need renewing every few years as the effects of age continue. They are medical procedures with clear risks and if they are carried out poorly, they can leave side effects such as physical scarring (or worse.)

The rise of non surgical facelifts

Because many people were concerned about the dangers of traditional plastic surgery facelifts, and the many risks associated with a 'facelift gone wrong' (from unnaturally taut results that change the individual's appearance to medical complications), aesthetics industries have developed an alternative, which is generally known as the non surgical facelift.

If you love the thought of minimally-invasive aesthetics procedures, tailored for jawline contouring, cheek lifting, or lip augmentation, the non surgical facelift might be the aesthetics treatment for you!

What is a non surgical facelift in aesthetics?

A nonsurgical facelift is an aesthetic procedure that is only very minimally invasive. However, it delivers excellent results that are comparable to traditional plastic surgery, and it can be tailored or combined with other services, such as fillers, to deliver clear and desired effects (lip augmentation, a cheek lift, or jawline contouring, for example.)

Nonsurgical facelifts are also less expensive than plastic surgery facelifts, they have shorter recovery times and they also have fewer side effects overall. However, because this kind of aesthetic treatment is non-surgical, it is temporary.

How long does a nonsurgical facelift last?

A non surgical facelift will usually last from around 3-4 months to perhaps two years, depending on the treatment, the patient, and the individual factors involved.

For most people though, especially anyone already searching for 'fillers near me' the prospect of a nonsurgical facelift is highly appealing. Let's take a closer look at what you need to know.

How effective are nonsurgical facelifts?

Non surgical facelifts are an aesthetic treatment that can be used to achieve specific results for problem areas. For example, your aesthetic practitioner might combine a thread lift, or cheek lift, use Botox for lip augmentation and jawline contouring, and inject dermal fillers to add volume back into areas of your face for a youthful, plump finish.

Can nonsurgical facelifts be used for all aesthetic goals?

No, these 'light touch' procedures are less effective for more serious aesthetic complaints, or situations where the client wants a permanent change to his or her face.

If you are concerned about widespread sagging skin (perhaps for example if you have lost a lot of weight, or have sun damage), or if you have very deep facial creases (perhaps from stress, genetics, smoking, or other underlying factors), traditional plastic surgery may be the best route.

In all instances, the first point is to discuss your concerns and the possibilities for aesthetic treatment with a skilled aesthetics professional with the right qualifications, training, experience, and certification.

Why you must use highly skilled aesthetics practitioners

The skill of the aesthetics practitioner will very much determine the results of a nonsurgical facelift, as this combination treatment requires expertise, professional judgment, experience, and deep knowledge of the various aesthetics procedures that can be applied for the best possible results.

For this reason, at Empire Medical Training, we never recommend simply searching for 'fillers near me', or 'Botox near me', to find your nearest beautician without establishing their professional credentials, certifications, and insurance.

As a leading national provider of CME for the aesthetics industry, we can provide you with information on highly skilled and certified aesthetics professionals in your area.

Please contact us for more information or find out more about the courses we offer to see the quality of our offer and the credentials of our faculty. After all, when you're dealing with your face, you can't leave anything to chance!

Why Are Nonsurgical Facelifts Less Risky than Traditional Plastic Surgery Facelifts?

Traditional plastic surgery facelifts require a general anesthetic. This is inherently risky but it is required because the surgery involves deep incisions. These incisions are also riskier because, as surgical sites, they will require full healing and there is always a risk of infection.

Why Are Non Surgical Facelifts Less Expensive than Traditional Plastic Surgery Facelifts?

Nonsurgical facelifts are cheaper than surgical facelifts for a number of reasons:

Plastic surgery facelifts must be performed by a board-certified plastic surgeon. Nonsurgical facelifts can be performed by aesthetics professionals.
Nonsurgical facelifts don't require an operating suite or an overnight stay. They can be performed in your aesthetic practitioner's offices, and you can go home immediately afterward.
Nonsurgical facelifts do not require a team of support staff to aid the procedure or recovery
Nonsurgical facelifts have a shorter recovery team and require less of a follow-up than a traditional plastic surgery facelift.

Is There One Type of Nonsurgical Facelift?

No, and this is the beauty of this aesthetic procedure! When you work with a skilled practitioner, you can combine treatments to achieve the effect of a full facelif, but with different minimally or non-invasive procedures to achieve your desired looks.

For example, you might have hyaluronic acid to achieve a cheek lift, and Botox for lip augmentation and jawline contouring, with a chemical peel for a completely refreshed and rejuvenated appearance across your entire face.

You also can (and most likely will) have different procedures done at different times, so that the effects are gradually layered for the best results. This also creates a more subtle finish that doesn't surprise people with a sudden severe change in your appearance!

What Are the Most Popular Types of Nonsurgical Facelift?

From botox to fat injections, a good aesthetics practitioner will have various tools and techniques on offer to deliver that look you hope for.

At Empire Medical Training we constantly invest in the latest training for all current and emerging aesthetics protocols and technologies, so our graduates are at the cutting edge of this exciting industry.

The three types of nonsurgical facelifts are typically the most popular:

Thread Lifts for a Cheek Lift and Jawline Contouring

If you have loose skin in your cheeks, eyes, forehead, or chin, a thread lift (also known as a barbed thread lift or PDO thread lift depending on the medical thread used), can be highly effective. This procedure will stimulate elastic and collagen production whilst simultaneously tightening the treated area.

The production of new collagen and elastin will work over the course of a few months to restore lost volume naturally and gradually, and the overall effects of the thread lift will typically last for 1-2 years.

Because of the gradual improvement, clients who have aesthetics thread lifts usually say that friends, colleagues, and loved ones ask them what their secret is because the results are effective but subtle and gradual.

Botox Injections (Neuromodulator Injection)

Search for 'Botox near me' and you will find endless local listings because Botox is so incredibly popular! Botox and other branded neuromodulation drugs relax overactive muscles to smooth out fine lines.

This is a quick and simple in-clinic procedure with low risks, so long as it is performed by a skilled and certified aesthetics professional.

The results don't last as long as with a thread lift, but it's very easy to get targeted Botox touch-ups when you need them, with minimal downtime (many people nip in to get a Botox session on their lunch break!)

Botox is also affordable and skilled practitioners can even use it to change the contours of a person's face, for example, to straighten a nose, or for jawline contouring, as well as to soften laughter lines and frown lines.

Dermal Filler Injections

Dermal fillers are also called soft tissue fillers, and these highly popular aesthetic procedures restore volume to hollow or sagging areas of the face. For example, they can be used for lip augmentation or to create fuller cheeks. Hyaluronic acid is the most common type of dermal filler, but other types include PMMA and calcium hydroxylapatite and PMMA.

When delivered by a skilled dermal filler practitioner, the results can be superb, and depending on the filler chosen, can last for six months to several years.

Again, as with thread lifts and Botox, dermal fillers have low risks and side effects. However, because they involve injections, it's important to choose a certified provider who has completed an accredited dermal filler training course, and who continues to invest in their CME.

At Empire Medical Training, our aesthetic graduates are committed to becoming the finest practitioners in their chosen fields. Fully certified, highly skilled, and trained by incredibly respected faculty, our students undertake comprehensive training to offer their clients the best possible results. Why not browse our course list to find out more?

Speak to the Aesthetic Training Experts

Our friendly team is always here to answer any questions you might have about aesthetic training, aesthetic procedures, and the industry in general. Whether you're looking for a trusted practitioner or considering an aesthetic career yourself, talk to us for advice you can trust.