Clinically Proven Effective Mid-Face Rejuvenation: Combining HA Fillers and PDO Thread Lifting
The pursuit of a youthful appearance is universal, and in recent years, combined treatments using hyaluronic acid (HA) fillers and polydioxanone (PDO) thread lifting have gained popularity, particularly for mid-face rejuvenation. This is especially evident in the Asian population, where the primary focus often centers on enhancing the contours and volume of the mid-face. While both HA fillers and PDO threads are effective individually, their combination for long-term rejuvenation of the mid-face has not been extensively studied until now.
A recent pilot study by Wan J, Park HJ, Choi HS, and Yi KH (2025) offers critical insights into the combined use of HA dermal fillers and PDO thread lifting. This study examined the efficacy and safety of this dual approach over a 24-month period, providing valuable evidence regarding its long-term benefits. Conducted with 11 Korean participants aged 29–70 years, the study highlights the significant benefits and minimal risks associated with this combination therapy. In this article, we will explore the study's findings and examine how the combination of HA fillers and PDO threads can offer effective, long-lasting results for mid-face rejuvenation. We will also provide a step-by-step guide on how to perform this combined treatment, ensuring safe and effective outcomes for patients.
The Study Design: Assessing the Long-Term Outcomes
This blinded, prospective, and open-label clinical trial aimed to evaluate the long-term effects of combining HA fillers and PDO threads for mid-face contour enhancement. Participants were treated with crosslinked HA dermal fillers and PDO threads in the mid-face region, specifically targeting the upper anteromedial cheeks. The study tracked various parameters, including volumetric changes, mid-face width reductions, and patient satisfaction over the course of 24 months.
Key Findings: Long-Term Benefits
Mid-Face and Lower-Face Contouring: A major highlight of the study was the significant reduction in both mid-face and lower-face width, a key indicator of successful rejuvenation. Using the Morpheus 3D system for precise volumetric measurements, the study revealed that mid-face width decreased from an average baseline of 149.27 mm to 145.00 mm at 24 months, showing consistent reduction in facial volume. Similarly, lower-face width was reduced from 130.36 mm to 117.27 mm, suggesting that the combination therapy led to improved facial definition and enhanced contours.
Consistent Reduction in Mid-Face Fullness: The fullness of the antero-medial cheek region, a critical area for mid-face projection, was monitored throughout the study. Over time, seven participants showed significant and consistent reduction in cheek fullness, resulting in a more lifted, youthful appearance. Although some subjects experienced moderate reduction, the overall trend indicated that the combination treatment effectively restored volume, ensuring continuous facial rejuvenation.
High Patient Satisfaction: Using the Global Aesthetic Improvement Scale (GAIS), patient satisfaction was assessed at multiple intervals. Nine out of the 11 participants reported consistent satisfaction or improvement over the 24-month period. The combination therapy's ability to provide both immediate and long-term results underscores its effectiveness. This high level of satisfaction is further validated by the investigators’ clinical evaluations, which demonstrated significant improvements in mid-face volume restoration.
Step-By-Step Guide on Performing The Procedure
Combining HA dermal fillers with PDO suspension threads offers a powerful solution for mid-face rejuvenation, providing both volumizing and lifting effects. Based on the findings of the research study, here is a step-by-step technique for performing this combination treatment.
Pre-Procedure Preparation
Before starting, ensure that the patient meets the criteria for treatment, such as the absence of any contraindications (e.g., active skin infection, allergy to HA or PDO threads) and an understanding of the procedure and potential risks.
Steps for Preparation:
Patient Consultation: Begin by assessing the patient’s facial anatomy, mid-face volume loss, and any skin laxity or sagging. Use the antero-medial cheek fullness scale to grade the mid-face and lower-face areas.
Design a Treatment Plan: Determine the amount of filler and the number of PDO threads needed based on the patient’s facial structure and goals.
Mark Treatment Zones: Use a non-permanent marker to outline the areas of injection and thread placement. Typically, the HA filler will be injected into the upper antero-medial cheek to support retaining ligaments and create lifting tension.
Step 1: PDO Thread Placement
The PDO threads are placed to address skin laxity and improve the lifting effect. PDO threads provide mechanical support while stimulating collagen production.
Technique for PDO Thread Placement:
Needle Selection: Use a needle appropriate for the PDO thread (usually an 18G or 19G needle for barbed threads). The PDO threads are often barbed, which allow them to anchor securely within the tissues, providing a lifting effect.
Thread Insertion: Insert the PDO threads subcutaneously along the mid-face area, focusing on the nasolabial fold, the cheek, and the malar region. The threads are typically placed in a vector that corresponds to the desired lifting direction.
Thread Number: For each side of the face, typically 2–4 PDO threads are inserted. The exact number depends on the degree of lifting and volume restoration required.
Tensioning: Gently pull on the PDO threads to create the desired lifting effect. The tension should be moderate to avoid excessive tightness, which could lead to discomfort or visible ripples in the skin.
Distribution: Spread the threads evenly along the mid-face, making sure that the lifting effect is symmetrically distributed for a balanced outcome.
Step 2: Injection of Hyaluronic Acid Dermal Filler
The primary goal of the HA filler injection is to restore lost volume and create lifting tension in the mid-face, particularly in the upper antero-medial cheek region.
Technique for HA Filler Injection:
Needle Selection: Use a fine needle for precise injections (often a 30G or 27G needle). For deeper layers, a blunt cannula may be more appropriate.
Injection Depth: Inject the HA filler submuscularly, targeting the deep dermal layer and periosteum for structural support. This enhances cheek projection and supports underlying tissues.
Injection Pattern: Inject small boluses of filler along the mid-face area, following the natural contours of the cheek. For more severe volume loss, you may use up to 1.5 cc of filler per side of the face.
Amount: Administer between 0.25 cc and 1.5 cc of HA filler per side, depending on the patient’s needs and aesthetic goals.
Post-Procedure Care
Post-procedure care is essential to ensure optimal results and minimize the risk of complications.
Key Post-Treatment Instructions:
Cold Compress: Apply a cold compress to the treated area to minimize swelling and bruising.
Avoid Touching the Area: Instruct the patient to avoid touching or massaging the treated area for at least 24–48 hours to allow the filler and PDO threads to settle.
Activity Restrictions: Patients should avoid strenuous physical activities for 48 hours post-treatment to prevent excessive movement or pressure on the treated areas.
Follow-Up Appointments: Schedule follow-up visits at 1 month, 3 months, and 6 months to monitor the results and address any concerns. The PDO threads should begin to dissolve naturally over the next few months, while the HA filler will provide immediate results.
Safety Considerations
Both HA fillers and PDO threads are generally safe when performed correctly. However, as with any cosmetic procedure, certain risks may arise:
Bruising and Swelling: These are common side effects that typically resolve within a few days.
Infection: Proper aseptic technique and patient compliance with post-care instructions reduce the risk of infection.
Thread Migration or Visibility: Though rare, PDO threads can sometimes become visible or migrate if the lifting tension is too high or if they are not properly anchored.
Minimal Adverse Events and Safe Outcomes
One of the primary concerns with aesthetic treatments is the risk of complications. However, this study reported minimal adverse events, with no serious complications occurring over the two-year period. This is especially noteworthy given the long-lasting effects of the combination therapy, as PDO threads gradually dissolve while HA fillers provide immediate volume restoration. The safety profile of both treatments combined makes this an attractive option for practitioners looking to offer reliable and low-risk rejuvenation procedures to their patients.
Results and Long-Term Effects
The combination of HA fillers and PDO threads offers both immediate and long-term benefits:
Immediate Effects: HA fillers restore volume to the mid-face, leading to a more youthful and lifted appearance right after the procedure. PDO threads begin to provide a subtle lifting effect, which improves as the collagen remodeling occurs.
Long-Term Effects: Over time, the PDO threads dissolve and stimulate collagen production, which continues to improve skin texture, elasticity, and overall facial volume. The results are gradual but can last for up to 2 years or longer, depending on the individual’s skin condition and lifestyle.
The Morpheus 3D system can be used to monitor volumetric changes, providing both objective and subjective assessments of facial rejuvenation.
Mechanisms of Action: PDO Threads and HA Fillers
PDO Threads:
PDO threads are a popular choice for lifting and tightening sagging tissues. These absorbable threads offer a non-invasive method to address gravitational tissue ptosis, especially in the mid-face. As PDO threads dissolve, they stimulate collagen production, which contributes to sustained tissue remodeling and an overall improvement in skin elasticity.
HA Fillers:
Hyaluronic acid is a biocompatible substance that can restore volume and provide structural support to the skin. In the mid-face, HA fillers help enhance facial contours by lifting the soft tissues and promoting a youthful, three-dimensional appearance. By providing immediate volume restoration, HA fillers support the effects of PDO threads, which work on lifting and tissue tightening.
Clinical Implications for Practitioners
For doctors, nurses, and surgeons interested in integrating PDO threads and HA fillers into their practice, this study provides a compelling case for the combined approach. The 24-month follow-up demonstrates the long-term efficacy of the treatment, making it an excellent option for patients seeking lasting facial rejuvenation. By offering a dual treatment plan, clinicians can address both volume loss and skin laxity, achieving comprehensive mid-face rejuvenation.
Additionally, the combination approach provides a broader range of treatment options tailored to the patient’s needs. For those with significant mid-face volume loss or more severe facial sagging, this combination treatment may offer superior results compared to either treatment alone.
Conclusion: A Winning Combination for Mid-Face Rejuvenation
This study offers valuable insights into the combination of HA dermal fillers and PDO thread lifting for mid-face contour enhancement, with long-term safety and efficacy. The results suggest that this dual therapy is highly effective in restoring facial volume, enhancing mid-face projection, and providing lasting improvements to facial contours. For practitioners, this approach represents an opportunity to offer patients a non-surgical solution with sustained results and minimal risk.
As the study illustrates, combining PDO threads and HA fillers provides more than just short-term aesthetic benefits. It supports ongoing tissue remodeling, ensuring that patients continue to see improvements beyond the immediate post-treatment period. With minimal complications and significant patient satisfaction, this combination therapy is poised to become a go-to technique for mid-face rejuvenation.
Reference:
Wan J, Park HJ, Choi HS, Yi KH. A Pilot One and Two-Year Prospective, Blinded Clinical Evaluation of Efficacy, and Safety of Combined Treatment With Crosslinked Hyaluronic Acid Dermal Filler and Barbed Polydioxanone Suspension Threads for Mid-Face Contour Enhancement. J Cosmet Dermatol. 2025 Feb;24(2):e16700. doi: 10.1111/jocd.16700. Epub 2024 Dec 18. PMID: 39692727; PMCID: PMC11845956.
Learn techniques behind Tailored Aesthetic Injections
in our upcoming master class:
IFAAS Master Class (Hands-On)
Tailored Aesthetic Injections Combination Therapies
May 17-18, 2025 - Singapore - [Register Now]
June 10-11, 2025 - Tokyo, Japan - [Register Now]
More Upcoming Global Events
Kommentare