Evaluating the Short-Term Safety of PDO Thread Lifting in Mild-to-Moderate Facial Sagging

Based on Dr. Moon Seop Choi et al. | Archives of Aesthetic Plastic Surgery, 2020

Introduction: The Growing Demand for Minimally Invasive Rejuvenation

Surgical rhytidectomy has long been the gold standard for addressing facial aging, but with it comes prolonged downtime, risk of nerve injury, scarring, and other complications. As more patients seek non-surgical alternatives, thread lifting has gained considerable traction, particularly among individuals with mild-to-moderate facial sagging. However, questions about safety, predictability, and complication rates continue to influence practitioner adoption.

To address these concerns, Dr. Moon Seop Choi and colleagues conducted a multicenter, retrospective study assessing the short-term safety of MINT Lift® PDO monofilament threads in facial rejuvenation. The study specifically focused on complication rates, surgical design, and patient outcomes in a real-world clinical setting.

Patient Evaluation and Criteria

Patient selection played a crucial role in ensuring both the safety and reliability of the outcomes observed in this study. To maintain procedural consistency and reduce confounding variables, Dr. Moon Seop Choi et al. implemented a set of defined clinical inclusion criteria and evaluation steps for all patients undergoing PDO thread lifting.

All patients were screened and evaluated by trained aesthetic practitioners from two aesthetic clinics in Seoul. The primary inclusion criterion was the presence of mild-to-moderate facial sagging, which included signs such as early nasolabial fold deepening, marionette line softening, mild jowling, and overall mid- to lower-face skin laxity. Patients with severe skin laxity, significant facial volume loss, or those with a prior history of thread lifting within the past 12 months were excluded.

Aesthetic assessment was performed using visual grading scales and clinical palpation, allowing practitioners to assess:

• Skin thickness and elasticity

• Degree of subcutaneous fat descent

• Facial symmetry and resting tone

• Vector mapping for optimal lifting effect

Furthermore, the pinch test and gravitational drop in the upright position helped identify candidates likely to benefit from mechanical lift versus those who may need volume restoration or surgical intervention instead. All included patients:

• Were between the ages of 30 and 65

• Had no active skin infections or inflammatory conditions

• Had no bleeding disorders, autoimmune diseases, or connective tissue disorders

• Were not pregnant or lactating

• Had not undergone other facial rejuvenation procedures (e.g., facelift, fat grafting, or laser resurfacing) within the past 6 months

Before proceeding with treatment, patients were thoroughly counseled about the expected degree of improvement, short-term downtime, and the temporary nature of PDO threads, which dissolve over 6–8 months. This transparent evaluation process ensured that patients had realistic expectations, and that results could be meaningfully evaluated without bias or secondary procedure influence.

The final cohort of 179 patients (173 women and 6 men) represented a consistent and homogenous group that allowed for accurate analysis of short-term safety and procedural outcomes following MINT Lift 17 and 43 thread insertion.

Methods: Thread Selection, Insertion Technique, and Treatment Design

This multicenter retrospective study examined the short-term safety of facial thread lifting procedures using absorbable polydioxanone (PDO) monofilament threads, specifically the MINT Lift® 17 and MINT Lift® 43, in patients with mild-to-moderate facial sagging. Procedures were performed across two aesthetic clinics in Seoul, Korea, between January 2016 and December 2018, and included a total of 179 patients (173 women, 6 men) with a mean age of 44.4 years.

The MINT Lift threads used in this study are characterized by bi-directional helical barbs, which are molded and not cut into the PDO monofilament. This design provides high tensile strength while ensuring even traction in opposite directions. Two different thread models were used based on the severity and pattern of sagging:

• MINT Lift 43 was used in cases of moderate facial ptosis and offered a longer length, allowing for deeper tissue engagement.

• MINT Lift 17 was applied in milder cases, where shorter, more localized lifting was sufficient.

The threads were inserted using a two-piece blunt cannula system, which reduces trauma during insertion and improves patient comfort. For MINT Lift 43 insertions, the technique included thread anchoring into the deep temporal fascia, approximately 2 cm medial to the temporal hairline. Threads were passed through the deep subcutaneous layer, emerging from a designed exit point in the midface.

Each insertion followed a carefully mapped pattern based on facial vectors of descent. Thread exit points were spaced 2–3 cm apart, ensuring even lift and distribution of tension. Typically, each side of the face receives two to four threads, depending on the degree of laxity and the specific region being treated (nasolabial folds, jowls, marionette lines, etc.).

For MINT Lift 17 threads, which do not require exit points, the threads were inserted in a looping pattern, with both ends remaining subdermal. Entry points were made in the temporal or preauricular hairline, and threads were guided toward key lifting zones—often just proximal to the nasolabial fold apex or marionette line—without breaking the skin again.

All procedures were performed under local anesthesia. Cannula advancement was done with gentle pressure to minimize trauma, and tension was applied evenly once the threads were in position. Excess thread was trimmed, and the entry point was sealed with tape. Patients were monitored for immediate post-procedural effects and returned for regular follow-up.

Source: Choi, M. S., Byeon, H. S., & Moon, H. J. (2020). Short-term safety of facial rejuvenation using an absorbable polydioxanone monofilament thread in patients with mild-to-moderate facial skin sagging. Archives of Aesthetic Plastic Surgery, 26(2), 53–56. https://doi.org/10.14730/aaps.2019.01928

Source: Choi, M. S., Byeon, H. S., & Moon, H. J. (2020). Short-term safety of facial rejuvenation using an absorbable polydioxanone monofilament thread in patients with mild-to-moderate facial skin sagging. Archives of Aesthetic Plastic Surgery, 26(2), 53–56. https://doi.org/10.14730/aaps.2019.01928

This standardized technique ensured procedural consistency across both study centers and enabled the authors to accurately assess post-treatment safety, complication rates, and patient satisfaction.

Results: High Safety and Rapid Recovery

Of the 179 patients included in the final analysis, 173 were women and 6 were men, with a mean age of 44.4 years. The average follow-up duration was 22.3 months, providing a meaningful window for short-term safety evaluation.

The overall complication rate was low:

• Ecchymosis (1.7%)

• Infection (0.4%)

• Thread extrusion (1.1%)

• Skin dimpling (1.5%)

Importantly, there were no cases of facial nerve injury or permanent complications. All side effects were minor and resolved spontaneously without the need for additional intervention. Patients resumed daily activities shortly after the procedure, confirming the minimal downtime and favorable risk profile associated with MINT Lift threads.

These outcomes align with previous reports suggesting that PDO threads, particularly when inserted using a cannula-based technique and subdermal design, are well tolerated and predictable in clinical practice.

Why MINT Lift Threads Offer a Safe Alternative

The MINT Lift system used in this study combines material safety, mechanical design, and ease of use. Composed of polydioxanone, the same absorbable material used in surgical sutures, MINT threads offer high tensile strength, biodegradability, and a low risk of tissue reaction. The bidirectional barbs provide strong anchoring without the need for knots or fixation points, minimizing trauma to adjacent structures.

From a procedural standpoint, the use of blunt cannulas and careful depth control likely contributed to the low complication rates. By operating in the deep subcutaneous and SMAS-adjacent planes, the technique avoids superficial vasculature and nerve branches. Additionally, precise mapping and consistent thread tensioning enhance patient comfort and aesthetic outcomes.

This safety profile was also supported by prior studies, including Baek et al., who found similarly low rates of minor complications such as swelling and dimpling, and Bae et al., who documented no major adverse events when using thread lifting in combination with other minimally invasive modalities.

Conclusion

The findings of this study offer compelling evidence that PDO monofilament threads like MINT Lift can be safely and effectively used in patients with mild-to-moderate facial skin sagging. With a very low rate of minor, self-limiting complications and no cases of nerve injury, this technique provides a predictable and low-risk alternative to surgical lifting, especially in early-stage facial aging.

For aesthetic physicians and plastic surgeons seeking to offer nonsurgical rejuvenation with minimal downtime, this approach represents a clinically validated option. While further long-term studies are warranted, the short-term safety outcomes support continued use and expanded indications for thread lifting procedures in well-selected patient populations.

Reference

1. Choi, M. S., Byeon, H. S., & Moon, H. J. (2020). Short-term safety of facial rejuvenation using an absorbable polydioxanone monofilament thread in patients with mild-to-moderate facial skin sagging. Archives of Aesthetic Plastic Surgery, 26(2), 53–56. https://doi.org/10.14730/aaps.2019.01928

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