Thread Lift Longevity: Crisscrossing PDO Threads to Strengthen Fibrous Architecture
- Admin
- May 16
- 5 min read
Based on Jennifer Kim Song et al. | Aesthetic Surgery Journal, 2021
Introduction: Refining PDO Thread Lift Techniques for Lasting Results
Polydioxanone (PDO) barbed threads have become a cornerstone in non-surgical facial rejuvenation procedures, offering patients immediate lifting effects with minimal downtime. However, a major challenge remains—how to improve the longevity of PDO thread lifts. As the threads biodegrade over time, results tend to diminish within a year. Instead of altering the material composition of threads, Dr. Jennifer Kim Song and colleagues (2021) explored whether modifying the implantation pattern could enhance the long-term effectiveness of thread lifts.
The study introduces a crisscrossing thread implantation technique designed to reinforce the skin’s fibrous architecture. Histological and clinical evidence supports this method’s ability to promote long-lasting lift, improve tissue tension distribution, and enhance aesthetic outcomes—all by adjusting how threads are placed.
Understanding the Problem: Why PDO Thread Lifts Often Don’t Last
Conventional PDO thread lifting techniques frequently use a fan-shaped configuration, where threads extend from a single entry point (commonly the temporal region) to lift various zones such as the jowls, nasolabial folds, and malar fat pads. While initially effective, this setup struggles to maintain long-term support as:
Barbs lose grip during degradation
Fibrosis is insufficiently dense or organized
Lift begins to fade within 6 to 12 months
Crisscrossing thread vectors may address this issue by creating intersecting lines of mechanical tension, which stimulate targeted collagen production. This mimics the function of retaining ligaments, offering a biomechanical and biological scaffold to maintain facial support over time.
Clinical Evidence: Over 300 Cases Using the Crisscross Technique
Over a 5-year clinical period, more than 300 patients underwent thread lifting using the crisscrossing technique. Many had previously received traditional fan-pattern lifts and returned due to premature loss of results.
Technique Summary:
Threads inserted through multiple entry and exit points
Targeted vectors addressed malar pads, nasolabial folds, jawline, and jowls
Multiple intersecting vectors promoted uniform lift and collagen stimulation
Clinical Advantages Observed:
Up to 24 months of maintained lift in many patients
Even distribution of tension, reducing postoperative discomfort
Less malar broadening, a common side effect of lateral pull techniques
No major complications such as migration, dimpling, or visibility
Animal Model Validation: Histological Evidence of Enhanced Fibrosis
To validate findings at a cellular level, the study used 12 immunodeficient nude mice—eliminating immune response variables.
Design Summary:
One side: fan-shaped thread pattern
Opposite side: crisscross thread pattern
Threads: MINT Easy™ PDO barbed threads
Implanted into 2.5 × 2.5 cm subcutaneous dorsal regions
Harvested after 6 weeks for histological analysis using:
Hematoxylin & Eosin (H&E)
Masson’s Trichrome
Sirius Red staining under polarized light
This schematic outlines the experimental setup in the mouse model, illustrating the designated areas of thread insertion and the side-by-side implantation of both thread patterns. The controlled nature of this model allowed for a quantitative and qualitative evaluation of the tissue's regenerative response to different thread arrangements.
Key Findings: Crisscross Technique Builds More Resilient Fibrous Tissue
1. Superior Fibrotic Capsule Formation
Crisscrossed threads produced thicker fibrotic capsules, especially at thread intersection zones. The intersection points acted as tension foci, intensifying fibroblast recruitment and collagen synthesis.
Fibrous tissue width was 5× greater in the crisscross group
Higher collagen density and better organization
Formation of scaffold-like structures maintained post-degradation support
These figures show histological comparisons using H&E, Masson’s Trichrome, and Sirius Red staining. Collagen deposition appears denser, broader, and more structured in the crisscross group—especially at overlapping nodes.
2. Increased Biostimulation and Collagen Synthesis
Barbed threads are known to activate fibroblasts via mechanical stimulation. The overlapping tension zones in the crisscross pattern amplify this response, leading to:
Increased TGF-β signaling
More abundant Type I/III collagen synthesis
Formation of pseudo-ligament structures mimicking native facial ligaments
This biological remodeling transforms the temporary lifting effect into a long-lasting structural reinforcement.
3. Better Tension Distribution, Fewer Complications
Crisscrossed threads distribute lifting forces more evenly, reducing stress concentration on individual threads.
Less pull per thread means lower risk of migration or breakage
Fewer irregular folds or dimpling
Smoother, more natural contour—especially in midface and mandibular regions
These diagrams demonstrate the difference in tension physics: in the fan-shaped layout, stress is localized and concentrated; in the crisscross method, stress is dispersed and supported by overlapping fibrotic reinforcement.
Practical Guide: Applying the Crisscross Thread Lift Technique
In practice, the crisscross technique involves customizing thread vectors to cross at the borders of sagging compartments, targeting the nasolabial fold, jowls, and cheek fat pads. Threads are inserted through multiple entry points such as the temple, preauricular region, or sideburns, and anchored to intersect beneath the skin.
How to Perform It:
Identify zones of ptosis (cheeks, nasolabial folds, jowls)
Insert threads through multiple entry points (temple, sideburns, preauricular areas)
Create crossed vectors beneath the skin
Use barbed PDO threads (e.g., MINT Lift™)
This technique is ideal for patients with mild to moderate facial laxity seeking minimally invasive, long-lasting facial rejuvenation.
Clinical and Biomechanical Implications
The crisscross pattern doesn’t just reposition tissue—it rebuilds support.
Distributed tension lowers the risk of complications
Wider fibrosis zones anchor tissue beyond thread degradation
Simulates natural ligament systems, stabilizing lifted areas for extended periods
Conclusion: A Paradigm Shift in PDO Thread Lift Strategy
The crisscross implantation technique marks a significant advancement in the field of PDO thread lifting. Rather than relying solely on material improvements, it reengineers the implantation strategy to promote longer-lasting, biologically supported lifting.
Key advantages include:
Multidirectional lift with improved aesthetics
Stronger, denser collagen scaffolding
Better lift retention beyond 12–24 months
Lower complication rates with smoother contours
For practitioners aiming to enhance the longevity and quality of thread lifts, adopting the crisscross technique represents a clinically validated and biomechanically superior alternative to traditional fan-shaped threading.
Reference:
Jennifer Kim Song, Jiyeon Chang, Kae Won Cho, Chang Yong Choi, Favorable Crisscrossing Pattern With Polydioxanone: Barbed Thread Lifting in Constructing Fibrous Architecture, Aesthetic Surgery Journal, Volume 41, Issue 7, July 2021, Pages NP875–NP886, https://doi.org/10.1093/asj/sjab153
Commentaires