Polydioxanone threads: rejuvenation of face and body

Irina Lopadina, dermatovenerologist, cosmetologist (Cyprus)

Modern medicine has the potential to prevent disease and aging; thanks to this, in recent decades the aging process has slowed down and a person at 55–60 years old can look and feel 10 years younger.

Skin aging is a complex biochemical process characterized by metabolic, structural and functional changes in the cells of all its layers and surrounding tissues, which occurs due to the depletion of the body's bioresources. The aging process affects all layers of the skin, as well as muscles, fascia and bones. The arsenal of aesthetic medicine doctors today is very wide. Most often, injection methods of introducing hyaluronic acid, vitamins, amino acids, peptides, micro- and macroelements, homeopathic medicines, as well as peelings, lasers, ultrasound, etc. are used for rejuvenation. The rejuvenation effect of these technologies is insignificant and lasts no more than a few months over a period of time. by activating blood circulation, stimulating metabolism and skin regeneration, especially when doctors use multicomponent drugs and combined techniques. The synthetic activity of keratinocytes, fibroblasts and other skin cells increases, resulting in renewal of the epidermis and restructuring of the dermis, where no more than 1.5% of new collagen is synthesized. This amount of the main reinforcing component is not enough for obvious skin rejuvenation, but this is quite suitable for doctors for the prevention of aging and correction of early age-related changes.

Polydioxanone threads

For visible rejuvenation results, it is necessary to include pathological stimulation of collagen synthesis, which will ultimately more significantly renew the skin structure through neocollagenesis.

One such skin rejuvenation method is polydioxanone (PDO) threads. This is a new approach that harmoniously complements existing methods in aesthetic medicine. The effectiveness of this procedure has been confirmed by my many years of experience, and I am ready to share it with readers.

Polydioxanone is a linear polymer formed during the catalytic polymerization of the heterocyclic compound p-dioxanone: O = CH -CH2- O-CH2- CH = O (C4H6O3).

The breakdown of PDO occurs through hydrolysis of the polymer and forms two monomers of 2-hydroxyethoxyacetic acid (C4H8O4), which then breaks down into water and carbon dioxide and is absorbed by the skin.

A synthetic fiber is created from this material, consisting of one monofilament thread, which dissolves in tissues after 4–6 months, depending on the thickness, triggering reparative processes in the skin and stimulating pathological neocollagenesis. The uniqueness of the technology lies in the fact that a polydioxanone thread is inserted into the injection needle or cannula, which acts as a conductor, the free end of which comes out of the needle and is attached to it with a sponge. The injection needle is made of special steel and laser sharpened, is flexible and does not break in tissues. This allows you to control changes in direction (up-down and left-right) and ensures high quality reconstruction of skin contours and volumes. After inserting a needle or cannula with thread, they are easily removed, and the thread remains inside the tissue.

Effects of PDO

Over the past three years, manufacturers of PDO threads have introduced a large number of different types of threads. They are twisted, woven into braids or collected into bundles, laser notches are made on them, welded to anchor threads, wound on or attached to a needle, and thick threads are inserted into atraumatic cannulas.

Depending on the modification of PDO threads, they cause three main effects in tissues.

The revitalizing effect is achieved through the reconstruction of the epidermal matrix due to injury and the effects of biodegradation of polydioxanone through hydrolysis, which leads to improved trophism and regeneration of the skin, increased tone, and improved structure. The tissue response is an increase in the pool of dividing cells in the basal layer of the epidermis, improvement in the condition of the basal membrane of the epidermis due to the focal appearance of perpendicular elastic fibers, restoration of type IV collagen around the vessels, and the appearance in the area of ​​the dermoepidermal junction of the expression of dermal papillae and epithelial ridges.

The lifting effect is achieved due to the formation of soft fibrosis around the implanted thread. Macrophages, fibroblasts and single leukocytes form a cellular infiltrate around the thread with mild cellular reactions. In the outer part of the infiltrate, due to individual activated fibroblasts, a primary connective tissue sheath is formed from thin collagen fibers, which gradually thicken and mature. This process continues until the thread is completely absorbed. Thus, at first, the thread is gradually replaced by loose connective tissue, which gradually turns into fibrous tissue, thickening the skin due to the ordered synthesis of collagen and elastin fibers in the dermis. This is what causes the delayed lifting effect.

The effect of true (mechanical) lifting is a rapid process of anti-gravity fixation of tissues due to their reposition using thread fixing elements, notches or anchors. Subsequently, the process of neocollagenesis also starts in the epidermal structures of the skin, which causes long-term lifting.

Indications and contraindications

Indications for the introduction of direct PDO threads on the face, neck, décolleté:

• horizontal and vertical forehead wrinkles (sleep wrinkles);
• increased mobility and laxity of the soft tissues of the forehead;
• wrinkles of the bridge of the nose and nose;
• drooping of the eyebrows or the outer edge of the eyebrow;
• flabby and sagging tissues of the upper eyelid (sleep wrinkles);
• flabby temple tissue (sleep wrinkles);
• wrinkles at the corners of the eyes (crow's feet);
• painting bags;
• smile wrinkles around the eyes;
• early cheek ptosis;
• smile wrinkles on the cheeks;
• nasolabial folds;
• folds of the corners of the lips (“marionette lines”);
• lip contour modeling;
• perioral wrinkles;
• preauricular wrinkles;
• wrinkles and porosity of the chin;
• minor changes in the contour of the lower jaw;
• increased mobility and laxity of the soft tissues of the lower jaw contour;
• wrinkles and sagging neck skin;
• wrinkles and sagging skin of the décolleté.

Indications for direct PDO threads on the body:

• rejuvenation of the skin of the mammary glands, abdomen, arms, legs and buttocks;
• stretch marks on the chest, abdomen, arms, legs and buttocks;
• skin unevenness after liposuction;
• cellulite;
• local fat deposits on the arms, chest, abdomen, legs.

Indications for PDO threads with notches and anchors:

• gravitational ptosis of the forehead, eyebrows, cheeks, submental area;
• severe nasolabial and labiomental “marionette folds”;
• violations of the oval line of the face with the formation of “jowls”;
• sagging and sagging skin of the neck, chest, arms, abdomen, back, buttocks, inner thighs;
• to give a new shape and additional volume to certain areas of the face (for example, cheekbones or cheeks) and body.

Contraindications for insertion of PDO threads:

• very pronounced hypodermis;
• severe excess skin;
• autoimmune diseases;
• feverish conditions;
• various acute infectious diseases (ARVI, etc.);
• inflammation of the skin in the area of ​​the procedure;
• non-absorbable implant (silicone) in the area where the threads are inserted;
• oncology and severe somatic diseases;
• tendency to form hypertrophic and keloid scars;
• hemophilia, bleeding tendency and some blood diseases;
• pregnancy and lactation;
• neurotic and psychological disorders.

Administration techniques

The principles of working with PDO threads are constantly being improved, which expands the possibilities of their application.

Fan technique

PDO threads are introduced subcutaneously parallel to the surface of the dermis from one point in different directions in the form of a fan. The fan technique is most often used for threads with notches and anchors.

Sandwich technique

PDO threads are introduced subcutaneously, sometimes intramuscularly, parallel to the surface of the dermis from one point in the same direction, but to different depths of the hypodermis or muscle, that is, the threads are inserted one under the other, which resembles a sandwich.

Linear vector technique

PDO threads are injected subcutaneously and intramuscularly parallel to the surface of the dermis in the selected direction. Distance between thread injections: minimum 0.2 mm, maximum 1 cm. This technique is used for all threads, including filler threads and barbed threads. This technique is also used in acupuncture. Needles with PDO threads are inserted perpendicular to the skin into acupuncture points and leave the needle in the skin for 15–20 minutes, periodically twisting the needle holder. Then the needle is removed, and the thread, remaining at the acupuncture point, stimulates it for a long time.

Reinforcement technique, or mesh

PDO threads are introduced subcutaneously, parallel to the surface of the dermis from different points, forming vertical and horizontal vectors, that is, the threads intersect, forming a strong mesh. Distance between threads: minimum 0.2 mm, maximum 1 cm. This technique restores and enhances the elasticity of the entire skin area and supports the surrounding tissue, gently and evenly distributing loads throughout the mesh.

Suture technique

PDO threads are inserted at an angle to the surface of the skin, then the needle is lowered to the deep layers of the hypodermis and even muscles and again raised to the upper layers of the hypodermis, forming a zigzag or wave, that is, from top to bottom and back, capturing different layers of the hypodermis and pulling them together. A zigzag can be done horizontally inside the fat compartment, repeating the movements of a crawling snake, stitching it in different directions. This technique helps tighten and lift sagging skin tissue. The end of the thread should always remain deep in the fabric. This technique is used for long and thick threads, including threads with notches and anchors.

Combined technique

PDO threads of different configurations are administered subcutaneously and intramuscularly in different directions, combining techniques.

Principles of introducing PDO threads

For the correct exposure of the threads, it is necessary to remember the thickness of the skin in different areas of the face, described by Mario Gonzalez-Ollua in 1957.

When working in different areas, it is necessary to solve the tasks assigned to the doctor:

• change skin quality;
• tighten the hypodermis and associated muscles;
• reduce the activity of facial muscles;
• limit the mobility of the skin-muscle layer.

Each task has its own solutions and its own types of thread insertion.

Read the full version of the article in the magazine "Les Nouvelles Esthétiques Ukraine" No. 1 (113) 2019