Mini Mid-Face Lift Using PDO Cog Threads: A Minimally Invasive Rejuvenation for Mid-Face Descent
- Admin
- May 16
- 4 min read
Based on Myung & Jung | PRS Global Open, 2020
Introduction: A Minimally Invasive Alternative to Traditional Mid-Face Lifting
As mid-face aging progresses, sagging of the anterior cheek and deepening of the nasolabial fold become more pronounced, hallmarks of facial descent that often push patients to seek correction. While traditional surgical mid-face lifts can achieve long-term results, they come at the cost of general anesthesia, visible scarring, and extended downtime.
In response to patient demand for less invasive options, Dr. Yujin Myung and Dr. Chinkoo Jung (2020) investigated a minimally invasive approach using polydioxanone (PDO) cog threads. Their technique targets deep mid-facial fat and SMAS layers without the need for incision-based lifting or mechanical fixation. The result is a 15-minute office-based procedure under local anesthesia that yields measurable improvement in mid-face positioning and patient satisfaction for at least six months.
Surgical Technique: Sub-SMAS Thread Lifting with a Single Entry Point
The technique begins with a detailed facial assessment and local anesthesia. A small stab incision is made with an 18-gauge needle just above the lateral orbital rim, providing a concealed yet strategic entry point. Through this site, a blunt 12.5 cm cannula preloaded with a 15 cm PDO cog thread is introduced.
The cannula is advanced through the subperiosteal plane at the orbital rim and navigated inferiorly beneath the cheek. It continues deep to the SMAS and through the deep medial cheek fat, transitioning to a more superficial plane near the nasolabial fold. This sub-SMAS trajectory allows for secure anchoring of the barbs in supportive tissue while minimizing trauma to overlying skin.
Each patient received three threads per side, with insertion vectors radiating from the orbital rim to the medial cheek, providing a triangular lifting zone. Once the cannula reaches the endpoint, the thread is gently pulled back to engage the barbs. No knotting or fixation is needed, the barbs provide tension-based anchoring. The entry point is closed with steri-strips, and no sutures are necessary.
Clinical Results: Short Procedure, Strong Satisfaction
The study involved 64 women aged 33 to 60, with an average age of 48. All procedures were performed under local anesthesia in an outpatient setting. Results were assessed at 1 month, 6 months, and 1 year, using both patient self-ratings and physician evaluations via the Global Aesthetic Improvement Scale (GAIS).
Patient satisfaction was notably high in the early phase. Scores increased from a baseline of 2.5 to 4.7 at 1 month, and remained elevated at 4.1 at 6 months. By the 12-month mark, as the PDO threads fully dissolved, satisfaction scores gradually returned to near baseline levels (2.8). Physician assessments mirrored this trend, with GAIS scores peaking at 4.5 (“much improved”) at 1 month, declining to 3.8 at 6 months, and tapering to 3.1 at one year.
These images demonstrate visible lifting in a 36-year-old patient, with soft tissue repositioning and nasolabial fold reduction maintained through the 6-month follow-up.
While the primary lifting effect diminishes after thread resorption, the overall timeline aligns well with the expected biodegradation of PDO. The study confirms that the greatest improvement occurs within the first 6 months, offering patients a natural enhancement during a time of active tissue remodeling.
Safety Profile and Indications: Low Risk, High Yield
The safety profile of the mini mid-face lift was excellent across the cohort. No serious complications were reported. Mild bruising and swelling occurred in a few patients but resolved within a week or two. No cases of hematoma, infection, thread migration, or visible dimpling were documented. The deep-plane technique and the use of blunt cannulas likely contributed to this favorable outcome.
This technique is most appropriate for patients between 30 and 50 years of age, with mild to moderate soft tissue sagging in the mid-face. It works best in individuals who still have good skin quality and sufficient fat volume. Patients looking for a subtle lift with minimal downtime and no incisions are ideal candidates. However, this procedure is not recommended for individuals with significant laxity, severe volume loss, or those who would benefit more from surgical skin excision.
Advantages of the Mini Mid-Face Lift Using Cog Threads
This method offers several key clinical advantages:
Single entry point with minimal trauma
Deep, sub-SMAS anchoring without dissection or sutures
Short procedure time (~15 minutes per side)
No general anesthesia or sedation required
Minimal recovery, with most patients returning to daily life within 24–48 hours
No visible scarring, as the entry point is hidden in the hairline or temporal region
Collagen stimulation post-procedure for additional soft tissue support
In essence, this approach provides an excellent balance between efficacy, patient safety, and procedural efficiency, ideal for modern aesthetic practice.
Conclusion
The mini mid-face lift using PDO cog threads presents a well-balanced solution for early signs of mid-facial aging. For the appropriately selected patient, it offers a visible improvement in cheek contour, nasolabial fold depth, and overall mid-face projection without the burden of surgery. While results may not rival surgical longevity, the benefits in terms of convenience, comfort, and recovery make this technique an excellent entry point into thread-based facial rejuvenation.
As aesthetic practices continue to grow in the direction of nonsurgical solutions, the ability to offer a safe, quick, and effective lift backed by clinical evidence can significantly elevate patient satisfaction and expand treatment portfolios. With proper technique, anatomical understanding, and patient selection, PDO cog thread lifting becomes not only a trend but a reliable tool in modern aesthetic care.
Reference:
Myung Y, Jung C. Mini-midface Lift Using Polydioxanone Cog Threads. Plast Reconstr Surg Glob Open. 2020 Jun 24;8(6):e2920. doi: 10.1097/GOX.0000000000002920. PMID: 32766067; PMCID: PMC7339253.
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