(401) A Systematic Review of Polydioxanone Thread Lifts for Facial Rejuvenation: Outcomes and Complications

Introduction: Minimally invasive alternatives to surgical rhytidectomy for facial rejuvenation have increased in popularity, including absorbable polydioxanone (PDO) thread lifts. This systematic review evaluates physician- and patient-reported aesthetic outcomes and complications associated with PDO thread lifts.

Methods: A systematic review was conducted following PRISMA guidelines using Medline, Embase, and the Cochrane Library from inception through July 2025, yielding 217 studies. Prospective and retrospective clinical studies evaluating PDO thread lifts for facial rejuvenation were included. After review, thirty-one studies met the inclusion criteria, with procedures performed between April 2012 and August 2024. Primary outcomes included physician-determined and patient-reported Global Aesthetic Improvement Scale (GAIS) scores and complication rates.

Results: Thirty-one studies comprising 1,717 patients (89.1% female; mean age 47.4 ± 7.2 years) were included. The pooled mean physician-determined GAIS score was 3.7 ± 0.2 (n=648) at a mean follow-up of 37 ± 29 weeks, while the pooled mean patient-reported GAIS score was 3.7 ± 0.2 (n=603) at a mean follow-up of 46 ± 35 weeks, corresponding to ratings between “improved” and “much improved.” Overall, 92.0% of patients reported satisfaction with the procedure. The most common minor adverse events were swelling or ecchymosis (27.6%), pain (14.1%), and dimpling or skin irregularities (11.3%). Major complications were rare ( < 1%) and included foreign body granuloma, infection, and parotid gland injury.

Conclusions: PDO thread lifts provide significant but temporary aesthetic improvement with high patient satisfaction and a low rate of major complications. Counseling on the degree of improvement, longevity of effect, and possible complications is imperative to manage patient expectations and satisfaction.