Thread lifts are one of the biggest breakthroughs we’ve had in the world of aesthetic medicine. Although they are not new, this non-surgical way to lift and rejuvenate the skin has come to the forefront rather recently.

But with multiple options on the market (PDO, PLLA, and PCL threads) how do you know which is the best fit for your patients? Each material behaves differently in the skin, influencing collagen production, longevity, and overall results. Some dissolve quickly, stimulating a short burst of collagen, while others provide extended structural support.

This guide explains the science, applications, and key differences between PDO, PLLA, and PCL threads to help you do the best possible job for your patients.

Thread Lift Materials

Thread lifts provide a non-surgical alternative to facelifts. They are biocompatible, absorbable sutures that reposition sagging skin.

Beyond their mechanical lifting effect, these threads trigger the body’s natural collagen production, which is another way to make skin firmer.

The three primary materials used in thread lifts:

• Polydioxanone (PDO)
• Poly-L-Lactic Acid (PLLA)
• Polycaprolactone (PCL)

Each has distinct characteristics that we will analyze now.

Polydioxanone (PDO) Threads

PDO threads are synthetic monofilament sutures composed of polydioxanone, a biodegradable polymer widely used in surgical applications. These threads undergo hydrolytic degradation, breaking down into CO₂ and water through natural metabolic processes.

Mechanism of Action

Upon insertion, PDO threads provide an immediate mechanical lift. Beyond the physical support, the threads act as a stimulus for the body’s natural wound-healing response. This localized inflammatory reaction triggers fibroblast activation, triggering the synthesis of type I and type III collagen. Over time, as the threads dissolve, the newly generated collagen strengthens the skin’s structure.

Duration of Effects and Applications

Although PDO threads themselves dissolve within four to six months, the collagen production they stimulate can extend visible results for up to 12 to 18 months. Some of the various facial and body applications are:

• Facial lifting – Enhancing the contours of the cheeks, eyebrows, jawline, and neck
• Skin tightening – Addressing mild to moderate skin laxity by improving overall texture and firmness
• Fine line reduction – Softening nasolabial folds, marionette lines, and crow’s feet
• Body contouring – Treating loose skin in areas like the arms, abdomen, and knees

PDO threads are available in mono, cog, and screw variations.

Advantages

• Proven safety – Extensive clinical use in surgery and aesthetics
• Minimal downtime – Quick recovery with low risk of complications
• Cost-effective – More affordable compared to PLLA and PCL threads
• Versatility – Suitable for lifting, tightening, and collagen stimulation

Limitations

• Shorter duration of effect – Compared to PLLA and PCL, PDO threads dissolve faster and may require more frequent treatments to maintain results
• Mild lifting capability – Best suited for mild to moderate laxity rather than severe sagging
• Limited volumization – Unlike PLLA or PCL, PDO threads primarily focus on skin tightening rather than adding volume

Despite these limitations, PDO threads remain one of the most widely used thread lift materials.

Poly-L-Lactic Acid (PLLA) Threads

PLLA threads are composed of poly-L-lactic acid (PLLA), a synthetic, biodegradable polymer that has been extensively utilized in medical applications, including sutures, soft tissue implants, and dermal fillers (such as Sculptra).

Their slower absorption rate contributes to more durable results.

Mechanism of Action

PLLA threads work through a dual-action process: they provide an initial scaffold-like support to reposition the skin, followed by progressive collagen biostimulation. Unlike PDO threads, which deliver immediate lifting, PLLA threads induce a gradual volumizing effect as fibroblasts generate new collagen around the inserted material.

Duration of Effects and Applications

One of the most significant advantages of PLLA threads is their long-lasting collagen induction. Even after the threads themselves dissolve (typically within 12 to 18 months), the newly formed collagen can sustain skin firmness and rejuvenation for up to two years.

PLLA threads are especially effective for:

• Deep nasolabial folds – Softening pronounced smile lines and restoring smoothness to the midface
• Marionette lines – Reducing sagging around the mouth and jawline for a more youthful appearance
• Midface volume loss – Enhancing cheek structure and improving facial contours
• Neck and décolletage rejuvenation – Strengthening thin, crepey skin in delicate areas
• Jawline contouring – Providing a more defined lower face profile over time

Advantages

• Extended collagen stimulation – Results can last up to 24 months due to continuous collagen remodeling
• Superior volumization – Effective for structural upgrade in areas with volume loss
• Improved skin quality – Boost thickness, elasticity, and hydration over time
• Gradual, natural-looking results – Ideal for patients who prefer subtle, progressive improvements

Limitations

• Delayed results – Unlike PDO threads, which provide instant lifting, PLLA threads take several months to show full effects
• Higher cost – More expensive than PDO threads
• Potential risk of granuloma formation – In rare cases, nodules or small lumps may develop due to excessive collagen deposition, especially if threads are improperly placed

Polycaprolactone (PCL) Threads

PCL threads are composed of polycaprolactone (PCL), a synthetic, biodegradable aliphatic polyester known for its high molecular stability and slow degradation rate.

Due to their biocompatibility and controlled degradation, PCL threads are commonly used in long-term dermal fillers and regenerative medicine applications. As they degrade, they break down into nontoxic monomers, which are naturally eliminated from the body through metabolic pathways.

Mechanism of Action

PCL threads function by providing immediate mechanical support while simultaneously acting as a collagen biostimulator, similar to other threads. Their insertion triggers a controlled wound-healing response, activating fibroblasts to produce Type I and Type III collagen.

On top of that, PCL has the potential to boost the production of elastin and hyaluronic acid

Duration of Effects and Applications

While PDO threads dissolve within 6 months and PLLA threads within 12 to 18 months, PCL threads can remain in the skin for up to three years.

They are particularly effective for:

• Severe skin laxity – Suitable for individuals with moderate to severe sagging, especially in the lower face and neck
• Deep-set wrinkles and folds – Reduces the appearance of nasolabial folds, marionette lines, and perioral wrinkles
• Jawline and chin contouring – Improve definition and structure in the lower face
• Midface volumization – Provides a subtle lifting and firming effect in the cheeks
• Neck and décolletage tightening – Improves skin tone, elasticity, and texture in delicate areas

Advantages

• Longest-lasting effects – Offers up to three years of collagen stimulation and skin improvement
• Superior biostimulatory action – Promotes high-quality Type I collagen, elastin, and hyaluronic acid production
• Deep tissue remodeling – Provides structural support and volume enhancement in addition to lifting
• Ideal for severe skin laxity – Best suited for advanced aging concerns requiring long-term correction
• Hydration and skin texture improvement – ​​Intensify overall skin quality and elasticity over with that

Limitations

• Higher cost – More expensive than both PDO and PLLA threads.
• Limited availability – Not as widely used or as readily available as PDO and PLLA threads in some regions
• Slower onset of visible results – Unlike PDO threads, which offer instant lifting, PCL threads take several months to show full effects

Comparison of PDO, PLLA, and PCL Threads

Now you already know all these differences individually, but let’s compare them directly in one place.

Collagen Stimulation Efficacy

Studies have demonstrated that PCL threads induce more substantial collagen formation compared to PDO threads. In a murine model, PCL threads showed increased collagen synthesis and tissue response. ​

Longevity of Results

PCL threads provide the most extended duration of effect, followed by PLLA and PDO threads. The choice of thread should align with the patient’s desired longevity of results

Tensile Strength and Lifting Capacity

All three thread types offer immediate lifting effects. However, PCL threads, due to their prolonged presence, may provide sustained mechanical support, enhancing long-term lifting capacity.

Safety Profiles and Potential Complications

While all thread types are generally safe, PLLA threads have been associated with a higher incidence of delayed granuloma formation.

Cost Considerations

PDO threads are typically more cost-effective. PLLA and PCL threads, offering longer-lasting results, come at a higher price point, which may influence patient decisions.

Clinical Considerations for Thread Selection

Several factors should be considered:

Age and Skin Elasticity

• Younger patients (20s–30s): Typically have mild to moderate skin laxity and require subtle lifting rather than aggressive volume restoration. PDO threads are often suitable due to their temporary support and collagen stimulation.
• Middle-aged patients (40s–50s): May require stronger lifting effects and sustained collagen remodeling. PLLA threads can be beneficial.
• Older patients (60s+): Often present with significant volume loss and deeper folds, requiring longer-lasting solutions. PCL threads are the best choice for extended collagen production and mechanical support.

Skin Type and Thickness

• Thin or delicate skin: PLLA and PDO threads are preferable, as they are less likely to be palpable or cause irregularities compared to thicker PCL threads.
• Thicker or more resilient skin: PCL threads can provide stronger lifting effects without the risk of excessive tension or migration.

Treatment Area Specificity

The selection of threads also depends on the targeted area.

Forehead and Eyebrow Lift:

• PDO threads are commonly used due to their immediate lifting effects and low risk of bulkiness in thinner skin areas.
• PLLA threads can be used for gradual tightening and collagen enhancement over time.

Mid-Face (Cheeks and Nasolabial Folds):

• PCL threads provide strong structural support for the cheeks, where heavier tissues require durable lifting.
• PLLA threads are beneficial for collagen remodeling in deep nasolabial folds.

Jawline and Jowls:

• PCL threads are the best option due to their high tensile strength.
• PDO threads can be used for mild contouring, but the results are typically less durable.

Neck and Décolletage:

• PDO threads can be useful for mild skin tightening and fine wrinkle reduction.
• PLLA and PCL threads are preferred for patients with significant laxity, as they provide longer-lasting support and collagen synthesis in the delicate neck area.

In Conclusion

Choosing the right thread lift solution is entirely based on an in-depth understanding of the properties, mechanisms, and longevity of PDO, PLLA, and PCL threads. Each material has distinct advantages: PDO for its affordability and safety, PLLA for its superior collagen stimulation, and PCL for its long-lasting results.

For clinics and hospitals, you need to analyze patient needs, treatment goals, and safety considerations along with many other factors. It is equally important that you have a source of high-quality products from reputable medical suppliers so that there are no unforeseen problems, primarily with effectiveness and regulatory compliance.

Frequently Asked Questions (FAQs)

How do PDO, PLLA, and PCL threads interact with different skin types?

PDO threads are suitable for practically all skin types but are best for patients with mild to moderate laxity. PLLA threads work particularly well for those with thinner skin. PCL threads provide the strongest structural support, making them suitable for mature or severely lax skin.

What factors influence the choice of thread material for male patients vs. female patients?

Male patients often have thicker skin and denser facial structures, requiring stronger threads like PCL for visible lifting. Women, especially those with thinner or more delicate skin, may benefit more from PDO or PLLA threads for natural collagen stimulation. Facial hair growth patterns also affect placement.

How do PDO, PLLA, and PCL threads perform in high-movement areas like the jawline or forehead?

PDO threads are effective in high-movement areas but degrade quickly. PLLA threads offer better structural support and collagen stimulation, so they are usually better for that region. PCL threads provide the most durable lifting effect in dynamic areas, but their firmness may cause slight rigidity.

Can thread lifts be performed on patients with a history of autoimmune diseases?

Patients with autoimmune diseases are at higher risk for adverse reactions, including excessive inflammation and poor wound healing. PLLA and PCL threads, in particular, may trigger immune responses due to their prolonged presence in the skin. PDO threads are generally safer but should still be used with caution. A consultation with an immunologist or dermatologist is necessary.

How smoking and sun exposure impact the longevity of thread lifts?

Smoking accelerates collagen breakdown, reducing the effectiveness of all thread types, particularly PDO. Excessive sun exposure increases oxidative stress and inflammation, also causing premature thread degradation. Patients should be advised to quit smoking and use high-SPF sunscreen to prolong results.

References

Soen M, Hidayat M, Widowati W. Enhancing dermal collagen density towards youthfulness: A comparative study of PCL, PLLA, and PDO thread implantation in aging rats model. Iran J Basic Med Sci. 2025;28(2):151-157. doi: 10.22038/ijbms.2024.80494.17428. PMID: 39850124; PMCID: PMC11756731.

Cho SW, Shin BH, Heo CY, Shim JH. Efficacy study of the new polycaprolactone thread compared with other commercialized threads in a murine model. J Cosmet Dermatol. 2021 Sep;20(9):2743-2749. doi: 10.1111/jocd.13883. Epub 2021 Jan 9. PMID: 33421303; PMCID: PMC8451902.

Ha YI, Kim JH, Park ES. Histological and molecular biological analysis on the reaction of absorbable thread; Polydioxanone and polycaprolactone in rat model. J Cosmet Dermatol. 2022 Jul;21(7):2774-2782. doi: 10.1111/jocd.14587. Epub 2021 Nov 30. PMID: 34847267.