Topicals have a ceiling. Retinoids can brighten and smooth, peptides can condition, and sunscreen protects the collagen you already have. None of those move lax tissue back to where it used to sit. When laxity shows up as jowls softening your jawline, crepey skin in the midface, or a slack neck under certain lighting, people start asking about a middle path between skincare and surgery. That is the lane where PDO threads live.
I have placed thousands of threads over the last decade, across faces that ranged from their late 20s to their 70s. When they are planned well and placed correctly, PDO thread treatment can refresh contours, trigger collagen, and tighten skin that no cream can grab. When used on the wrong candidate, with the wrong expectations, they frustrate. The difference sits in assessment, technique, and aftercare.
The material behind the lift
PDO stands for polydioxanone, a biocompatible polymer used in medical sutures for more than 30 years. Your body knows how to break it down over several months into water and carbon dioxide. In aesthetics, PDO threads come as smooth filaments for collagen stimulation, twisted or “screw” types to add gentle volume, and barbed or cogs, which can engage the tissue and provide an immediate mechanical lift. That last group is what most people imagine when they think of a PDO thread lift.
The threads do two jobs. First, the barbs catch in the fibroseptal network under the skin and allow the provider to reposition tissue a few millimeters. Second, as the PDO dissolves over roughly 6 to 9 months, it incites a Click here to find out more controlled wound healing response, laying down new collagen types I and III around the thread path. The collagen persists beyond the life of the thread, which is why results outlast the material itself.
Where PDO threads make the biggest difference
Treatment planning is regional. A PDO thread facelift is not a literal facelift, but it can soften the signs of descent that make someone look tired or “melted” by late afternoon.
- Jawline and jowls: Threads for the jawline can refine the mandibular angle, pull the pre-jowl sulcus flatter, and improve facial definition. I often see a 2 to 4 millimeter upward shift here, which translates into a crisper edge in photos. Midface and cheeks: A modest cheek elevation restores light to the malar region. PDO threads for cheeks can make nasolabial folds look shallower by moving the cheek pad north rather than filling the fold itself. Marionette lines and smile lines: Threads placed along the lateral lower face can ease the weight that drags into the marionette zone, supporting the oral commissure without overfilling. Neck and under chin: PDO threads for the neck target horizontal necklace lines and mild laxity. Under the chin, they can tidy the submental area, especially when paired with fat reduction if bulk is part of the problem. Brows and under eye: A small lateral brow lift can open the eye. Under-eye skin responds better to smooth threads for collagen stimulation than to traction, given the thinness here.
The best candidates for a PDO thread cosmetic procedure have mild to moderate facial sagging, decent skin thickness, and realistic expectations. If you can pinch and lift the skin into a position you like with two fingers, threads often can approximate that look. If you have heavy tissue, significant sun damage, or advanced aging skin with pronounced platysmal banding, you will likely do better with energy devices first or a surgical lift.
What PDO threads can and cannot achieve
Clarity upfront avoids regret. A PDO thread lifting treatment offers an immediate but subtle change after placement, followed by gradual improvement as collagen builds. When you compare PDO threads before and after, the early result shows repositioning, while the 8 to 12 week pictures reveal tighter texture and better snap. On average, the visible benefit lasts 12 to 18 months in the midface and jawline, a bit shorter in the neck where motion and thinner skin accelerate breakdown. Repeat treatments are common, often with fewer threads than the initial placement.
Threads cannot replace volume lost with age. If your cheeks have deflated or your temples are hollow, a PDO thread therapy plan often includes filler or biostimulators to restore structure. Threads also do not remove fat. Under a double chin that owes more to adipose than lax skin, thread therapy follows fat reduction, not the other way around. And threads are not a permanent solution. Think of them as a reset that buys time before surgical correction, or as periodic maintenance for those who prefer non surgical treatment routes.
The appointment, step by step
A PDO thread appointment starts with mapping. I watch you animate: smile, frown, chew. I look at where light lands on your face and how your tissues behave in profile. Then I mark entry points and vectors. For a jawline contour, for instance, I might plan two or three barbed threads per side, starting just anterior to the ear and advancing along the mandibular border toward the jowl. For midface elevation, vectors often run from the zygomatic arch toward the nasolabial region.
After photography, we cleanse thoroughly, apply antiseptic, and numb. I prefer a combination of topical anesthetic and small blebs of lidocaine at entry points. Cannulas used for the PDO threads are flexible and blunt, which lowers the risk of vascular injury and bruising. The thread sits inside the cannula, which I advance through the subdermal plane until it reaches the planned endpoint. I then withdraw the cannula while holding the thread in place so the barbs engage. The tiny protruding end gets trimmed and buried.
Two practical details matter. First, depth. Too superficial and you can see or feel threads, too deep and they lose grip. Second, vector balance. Pulling only vertically can make the face look odd when you smile. I prefer a gentle lateral and superior orientation that respects natural ligament lines. After placement, I seat the tissue with light molding, apply small steri-strips to support tension points if needed, and go over aftercare.
The PDO thread procedure steps take 30 to 60 minutes for the lower face, slightly longer if we include the neck or brow. You can drive yourself home, though I do not recommend major social plans that night.
Recovery time and what it feels like
Most people describe the aftermath as tightness and soreness, like a pulled muscle when you laugh or chew. Expect swelling for 2 to 5 days, with the peak in the first 48 hours. Bruising is possible, especially along entry points or in patients who take fish oil, aspirin, or other blood thinners. I ask patients to avoid big mouth movements, dental visits, high-heat exercise, and heavy pressure on the face for 7 to 10 days. Sleep on your back with your head elevated for the first few nights. Makeup is fine the next day if entry points are closed.
If you feel a small ripple or a palpable thread end in the first week, do not panic. Many of those smooth out as swelling settles. Dimpling at an entry site often resolves within 7 to 14 days, especially with gentle massage guided by your provider. Pain beyond day three that worsens, skin blanching, or a fever deserves a call to the clinic immediately.
Side effects, safety, and how we prevent problems
Every cosmetic procedure has a risk profile. PDO threads count as a safe treatment when performed by trained clinicians who understand facial anatomy, but they are not risk free. The most common issues are bruising, swelling, transient asymmetry as tissues settle, palpable threads, and mild puckering. Less common events include infection, thread migration, visible threads under thin skin, and prolonged tenderness. Rare complications include vascular events if an entry needle pierces a vessel or if tension compromises blood flow, and nerve irritation if the plane or vector is wrong.
I mitigate these risks by using sterile technique, mapping around known danger zones, choosing appropriate thread types and lengths for the tissue, and staying within safe planes. For example, I avoid aggressive traction in very thin skin under the eye and favor smooth threads there for skin rejuvenation. I space barbed threads to distribute load rather than stacking too many in one vector. If a thread needs to be removed, most can be backed out through the original entry with a small hook, particularly in the first few weeks. After collagen has formed, removal rarely makes sense unless there is infection.
The art of combination therapy
PDO thread therapy for face works best as part of a plan. If laxity is your main issue, threads do heavy lifting. If texture and pores bother you, microneedling radiofrequency a month or two after threads can tighten the dermis further without disrupting the new collagen. For stubborn creases like etched smile lines or marionette lines that persist even after lift, a whisper of filler or diluted collagen stimulators can soften the groove. For a double chin that has both fat and lax skin, I often debulk with deoxycholic acid or micro-liposuction first, then add PDO threads under the chin six to twelve weeks later. If vertical platysmal bands dominate your neck, neuromodulators to relax the band combined with PDO threads for skin firming gives a more comprehensive result.
This is why a PDO thread consultation should feel like a strategy session, not a sales pitch. The right answer might be threads now, lasers later, and skincare always.
How much it costs, and why prices vary
You will see wide ranges for PDO threads treatment cost, and it is not smoke and mirrors. Pricing reflects thread type and count, brand, provider experience, and your market. In large US cities, a lower face and jawline PDO threads facial lift treatment often falls between 1,200 and 3,000 dollars. Adding the neck may add 800 to 1,500. A brow lift can range from 600 to 1,200. Smooth threads for collagen boosting are usually priced per area or per thread bundle and are less costly per unit, but you often need more of them. Clinics that advertise dramatically lower prices may be using fewer threads, shorter lengths, or spending less time on mapping and follow up. Ask what is included: number and type of threads, touch-up policies, and whether follow up visits are standard.
Insurance does not cover aesthetic procedures, so plan the investment. If you are cross-shopping a PDO threads non surgical facelift with devices like ultrasound tightening or radiofrequency microneedling, ask to see the provider’s own before and after images for your age group and concern. Different tools excel in different tissues.
What results look like across time
Right after a PDO thread lifting procedure, you will see a lift. It can look slightly exaggerated for a day or two because of swelling and tension. By week two, the lift reads more natural. Around weeks six to twelve, the collagen stimulation shows up as smoother texture, better snap, and a softening of fine lines at rest. PDO threads for fine lines do not erase etched wrinkles the way a resurfacing laser might, but they make the skin look denser and more responsive to light.
Patients who maintain their results typically schedule a review around nine to twelve months. Sometimes we add a couple of reinforcing vectors, or we switch to maintenance with smooth threads for skin rejuvenation if the lift is still holding. The cadence depends on your biology, lifestyle, and what your mirror demands. Sun protection, retinoids, protein intake, and not smoking all preserve collagen gains.
Choosing thread types with intention
A single face can benefit from multiple thread styles. For facial lifting, I use barbed or cogs along vectors that anchor into sturdier fascia near the temples or preauricular area. For the skin over the cheeks or smile lines where creepiness shows, smooth or twisted threads add bulk and stimulate collagen without pulling. Under the chin, a lattice of smooth threads can tighten the hammock, and one or two barbed threads can help define the central valley if laxity is mild. On the nasolabial folds, I prefer to redirect the cheek mass above rather than chase the fold with traction, then consider a small filler top-off only if needed.
Brand matters less than the integrity of the barbs, the consistency of the cannula, and the provider’s hands. I value threads that hold their form and have reliable engagement without shredding. If your skin is very thin, I choose smaller gauge and shorter lengths to avoid visibility.
When threads are not the right choice
The hardest part of an ethical practice is saying no. A patient with heavy sebaceous skin, thick subcutaneous fat, and severe laxity will not get a satisfying result from PDO threads for facial sagging alone. They need debulking and, often, surgical vectoring that only a facelift can deliver. If you have a history of keloids, are on anticoagulants that cannot be paused, or have active skin infection, we delay. If you are seeking a brow position that changes your bone-to-soft-tissue proportion dramatically, threads will disappoint. And if your life includes contact sports, deep tissue facials, or a toddler who head-butts your cheek every night, timing matters. Threads need a few weeks without significant shear forces.
A patient story that illustrates the trade-offs
A 44-year-old photo editor came in bothered by soft jowls and a blurred jawline that showed up in side lighting, plus a faint double chin that she noticed on video calls. Good skin quality, mild laxity, and a stable weight made her a strong candidate for a PDO thread face tightening approach. We mapped two barbed threads per side along the jawline, one midface vector per side to lift cheek tissue, and a fan of eight smooth threads under the chin to tighten the hammock. No filler at this visit.
Day two, she sent a message about feeling “too tight” when laughing. That is normal while barbs settle. At two weeks, the jawline read clean, and the marionette shadows were lighter even without adding volume. At ten weeks, she looked less tired in profile and said that blush sat better on her cheek, a subtle but telling marker of lifted tissue. Eighteen months later, she returned for a smaller refresh with one barbed thread per side, because collagen from the first treatment had stayed with her.
Another patient, age 61 with pronounced neck laxity and strong platysmal bands, wanted the same. I advised that a PDO thread cosmetic lift would not address the bands and bulk, and she would likely feel underwhelmed. We staged it instead: neuromodulator for the bands, a radiofrequency microneedling series for dermal thickness, then selective threads to the jawline. She later chose a surgical lower facelift for a definitive change. The point is not to sell a thread, it is to solve the problem.
What to ask at your consultation
A few questions protect your investment and your face.
- How often do you perform PDO threads, and can I see your own before and after photos for cases like mine? Which thread types and lengths do you plan to use, and why those vectors? What temporary changes should I expect in the first two weeks, and how do you manage issues like dimpling or tenderness? What is the aftercare, and what restrictions do you recommend? If I am not an ideal candidate, what sequence of treatments would you recommend to reach my goal?
Clear, confident answers tell you a lot. So does a provider who points out limits and suggests alternatives. A thoughtful PDO thread consultation establishes whether you are aiming for lift, skin support, or both, and whether threads now or later make sense.
Practical aftercare that speeds recovery
Your provider will tailor guidance, but a few habits help. Keep entry sites clean and dry the first day. Use cool compresses for the first 24 hours. Sleep face up with two pillows for three nights. Avoid exaggerated expressions and big bites for a week. Hold off on saunas, hot yoga, and strenuous workouts for seven to ten days, because heat and blood pressure can increase swelling and bruising. Skip facial massages and professional treatments for at least three weeks. If you feel a small catch when you yawn, that is the barbs doing their job. If pain intensifies or you see blanching, call.
I also suggest leaning into protein and hydration in the first month. Collagen synthesis needs building blocks. Sunscreen matters more than ever because you have invested in new collagen you want to protect.
Comparing threads to other non surgical options
Energy devices like ultrasound and radiofrequency microneedling excel at global skin tightening and texture improvement. They heat collagen, causing immediate contraction and delayed remodeling. Results usually arrive slowly over 3 to 6 months. PDO threads provide a visible lift right away, with remodeling layered on, and they selectively reposition tissue. Fillers restore lost volume and can smooth transitions, but they do not move skin up the face. Neuromodulators relax motion lines and neck bands. No single tool does everything. A smart plan assigns each tool where it shines.
If you are deciding between a PDO threads aesthetic procedure and a surgical facelift, weigh downtime and magnitude. Threads have minimal downtime, cost less, and deliver a lighter, reversible change. A surgical facelift carries more recovery and expense, but the magnitude and longevity of the lift are in a different category. Many patients use PDO threads to defer surgery for several years or to maintain surgical results later without constant filler.
The bottom line, minus the hype
PDO threads for loose skin answer a specific need: a mechanical, subtle lift with biological support from new collagen, delivered without incisions. They do not replace fat removal or bone structure, and they are not a permanent fix. In the right hands, on the right face, the benefits are real: sharper jawlines, lifted cheeks, softer marionettes, tighter under-chin skin, and a general sense that your features are sitting where they used to, not sliding toward center.
If you are thinking about it, schedule a PDO thread appointment with a provider who can show you their work and talk straight about limitations. Bring photos of how you looked five to ten years ago, because they help align goals. Expect to look like yourself, just better rested and more defined. And keep the basics close: sunscreen, consistent skincare, and a plan for maintenance. That is how you get a result you notice in the mirror every morning, not only on the day you leave the clinic.