Long‐Term Clinical Outcomes of Combined Polydioxanone and Thin Nonabsorbable Polypropylene Thread Lifting in Korean Adults Aged 60 Years and Older
Young Keun Lee, Sung Hun Jung, Jin‐Su Chung, Guk Hyun Shin, Soo Yeon Park, Kyu‐Ho YiABSTRACT
Background
In adults aged 60 years and older with advanced facial laxity or ptosis, surgical facelift remains the gold‐standard and most predictable treatment. Thread lifting should therefore be considered a minimally invasive option for appropriately selected patients rather than an equivalent substitute for rhytidectomy. This study evaluated the long‐term effectiveness and safety of a combined absorbable polydioxanone (PDO) and thin nonabsorbable polypropylene (PP) thread‐lifting strategy in an older Korean cohort.
Methods
This retrospective, consecutive, single‐center case series included 243 Korean patients treated from January 2018 through December 2020. Mean age was 64.3 years (range, 60–78 years), and 221 patients (90.9%) were women. Patients had moderate‐to‐severe facial ptosis (Grade 2–3 using the clinic's routine grading system). Treatment used a standardized bilateral construct of 36 threads (Long V threads), each 20 cm long, delivered through nine entry points per hemiface: nine thicker PDO threads and nine thinner PP threads per side. The PDO component was intended to provide greater initial mechanical tissue engagement, whereas the permanent PP component was intended to provide ongoing structural support over time. Median follow‐up was 24 months (range, 6–36 months). Effectiveness was assessed using serial clinical photographs and nonblinded physician‐assessed Global Aesthetic Improvement Scale (GAIS) scores; safety events were abstracted from clinical records.
Results
Follow‐up was available for 243/243 patients at 6 months, 218/243 (89.7%) at 1 year, 167/243 (68.7%) at 2 years, and 89/243 (36.6%) at 3 years. Mean GAIS scores were 4.2 ± 0.6, 3.9 ± 0.7, and 3.5 ± 0.8 at 6 months, 1 year, and 2 years, respectively. Bruising occurred in 78 patients (32.1%) and resolved within 2 weeks; edema occurred in 45 (18.5%), asymmetry in 12 (4.9%), infection in 1 (0.4%), and granuloma in 1 (0.4%). Two patients (0.8%) required hook‐assisted thread removal for persistent dimpling. Selected longitudinal photographs showed qualitative persistence of contour change for up to 3 years, but photography was nonstandardized and was not used as an objective quantitative endpoint.
Conclusions
Combined PDO‐PP thread lifting was associated with persistent clinical improvement in selected Korean adults aged 60 years and older. However, the noncomparative design, nonstandardized photography, nonblinded GAIS assessment, follow‐up attrition, and absence of pure‐PDO or pure‐PP comparator groups prevent attribution of early or late effects to either material and preclude claims of superiority or synergy. In patients with advanced skin excess or cervicofacial ptosis, surgical facelift remains the reference treatment; thread lifting should be reserved for carefully selected patients after realistic counseling regarding magnitude, durability, complications, and the potential need for removal of a malpositioned permanent thread.