REGISTRO DOI: 10.69849/revistaft/th10248091541
Nilda Alves Barbosa 1
Marivone Batista Ribeiro Polesso 1
Alberto Tadeu do Nascimento Borges 1
SUMMARY
In recent years, the demand for aesthetic treatments has increased, reflecting the search for effective and less invasive solutions for facial rejuvenation. Aging causes loss of elasticity and collagen in the skin, resulting in sagging and wrinkles, especially visible on the face. In Brazil, the popularity of aesthetic procedures has grown, with Polydioxanone (PDO) support threads standing out for their efficacy and minimally invasive profile. Promoting an immediate lifting effect and stimulating collagen production, providing improvements in firmness and facial contour. The objective of this study was to report a clinical case of 6 PDO support threads in the treatment of facial flaccidity in the zygomatic region. Patient N. R. N. G., 49 years old, had facial flaccidity. Clinical evaluation showed skin aging in the zygomatic area. The treatment included the insertion of 6 hairs. It is concluded that the PDO thread technique was effective for the treatment of facial sagging, offering a safe and minimally invasive alternative with satisfactory aesthetic results. The case showed a significant improvement in facial firmness and contour, corroborating the efficacy of PDO threads as recommended in the literature.
Keywords: Orofacial Harmonization, Polydioxanone Threads, Skin Aging.
RESUMO
Nos últimos anos, a procura por tratamentos estéticos tem aumentado, refletindo a procura de soluções eficazes e menos invasivas para o rejuvenescimento facial. O envelhecimento causa perda de elasticidade e colágeno na pele, resultando em flacidez e rugas, especialmente visíveis no rosto. No Brasil, a popularidade dos procedimentos estéticos tem crescido, destacando-se os fios de suporte de Polidioxanona (PDO) por sua eficácia e perfil minimamente invasivo. Promovendo um efeito lifting imediato e estimulando a produção de colágeno, proporcionando melhorias na firmeza e no contorno facial. O objetivo deste estudo foi relatar um caso clínico de 6 fios de suporte de PDO no tratamento da flacidez facial na região zigomática. O paciente N. R. N. G., 49 anos, apresentava flacidez facial. A avaliação clínica mostrou envelhecimento cutâneo na área zigomática. O tratamento incluiu a inserção de 6 fios de cabelo. Conclui-se que a técnica de fio PDO foi eficaz para o tratamento da flacidez facial, oferecendo uma alternativa segura e minimamente invasiva com resultados estéticos satisfatórios. O caso mostrou melhora significativa da firmeza e contorno facial, corroborando a eficácia dos fios de PDO conforme preconizado na literatura.
Palavras-chave: Harmonização Orofacial, Fios de Polidioxanona, Envelhecimento da Pele.
1 INTRODUCTION
The search for aesthetic procedures has intensified in recent decades, reflecting a growing demand for solutions that promote appearance improvement and rejuvenation. In a society where physical appearance plays a significant role in self-image and social interactions, the desire for treatments that offer visible and effective results, with less invasiveness and reduced recovery time, has become increasingly common (1–3).
Aging, for example, causes changes in the physical structures of the skin, such as loss of elasticity and a decrease in the content of the subcutaneous tissue, which makes the face one of the first areas to show visible signs of aging, such as wrinkles, sagging, and loss of contour. In this context, aesthetic treatments that provide remarkable improvements in facial appearance have gained prominence, responding to a growing demand for methods that combine effectiveness and comfort (4,5).
In Brazil, the prevalence of aesthetic procedures has shown a remarkable growth, reflecting the cultural and social appreciation of facial aesthetics. The country is recognized for its dynamic aesthetics and beauty market, which includes a wide range of treatments for rejuvenation and appearance enhancement. The popularity of aesthetic procedures in Brazil is evidenced by a growing number of specialized clinics and the advancement of available techniques and technologies. Among the various options, the treatment with Polydioxanone – PDO support threads has gained prominence due to its effectiveness in combating facial sagging and its minimally invasive profile (6,7).
Facial sagging is a common aesthetic challenge associated with skin aging. Over the years, the production of collagen and elastin, essential for the firmness and elasticity of the skin, decreases, leading to a gradual loss of the structure and support of the facial skin. This process results in visible aging features such as wrinkles, fine lines, and an overall appearance of sagging. The search for effective solutions to combat these signs of aging has driven the development of several rejuvenation techniques, including non-invasive approaches (8,9).
Among the emerging alternatives for the treatment of facial sagging, PDO support threads have stood out as a promising option. These threads are known for their biocompatible and absorbable properties, offering a solution that not only improves the immediate appearance of the skin but also promotes a long-term regenerative response. PDO thread treatment involves inserting thin, subtle threads into the dermal layer of the skin, where they act to provide structural support and stimulate collagen production. The ability of PDO yarns to create an effect Lifting Their immediate approach, together with their ability to induce the formation of new collagen, makes them a valuable tool in contemporary aesthetic practice (10,11).
The procedure is performed with minimally invasive techniques, which significantly reduces recovery time compared to traditional surgical methods. PDO threads are inserted through small incisions, which are usually subtle and barely visible after treatment. This minimally invasive aspect allows patients to quickly return to their daily activities, without the prolonged recovery periods associated with more invasive surgeries. Additionally, the procedure is considered safe, with side effects usually limited to minor bruising or temporary bumps (12,13).
Areas of the face that can be treated with PDO threads include the cheekbones region, where sagging and loss of volume are common, the jaw line, which can experience drooping and loss of contour, and the region around the eyes and eyebrows, where sagging can create a tired, aged look. In addition, the treatment can be applied to the zygomatic region, crucial for the definition of the face and the aesthetics of the smile, to the neck and perioral area, contributing to a firmer and more contoured appearance (14,15).
The aesthetic effect of PDO threads is a result not only of the Lifting provided by the hair, but also from the continuous process of skin regeneration. After the insertion of the threads, the body begins to produce collagen in response to the stimulus created by the presence of the threads in the skin. This collagen production process is gradual, leading to a progressive improvement in the skin’s firmness and elasticity over time. Therefore, PDO threads not only offer a quick solution to facial sagging, but also contribute to a sustained improvement in skin quality (6,7).
The objective of this study was to report a clinical case of 6 PDO support threads in the treatment of facial flaccidity in the zygomatic region.
2 CASE REPORT
Patient N. R. N. G., 49 years old, came to the Postgraduate Clinic in Orofacial Harmonization of the Faculty of Amazonas – IAES, with the main complaint of facial flaccidity. In the anamnesis, the patient did not use regular medication and reported that she had recurrent sun exposure, in addition to following an aesthetic regimen with the use of creams. She did not present significant systemic changes. During the clinical evaluation, skin aging was observed, especially in the middle and lower third of the face, which contributed to facial sagging (Figures 1 and 2). The patient signed the Informed Consent Form (ICF) and the authorization to use the image to start the aesthetic procedure.
The proposed treatment was 6 PDO support threads, with 3 19G 100×160 mm CoG spiculated threads being placed on each side of the face in the zygomatic region, aiming to improve the lifting effect and ensure a more balanced aesthetic result.
First, a straight line was drawn in the region of the zygomatic arch, directed to the nasolabial fold. Then, another straight line was drawn towards the lip commissure. Finally, an additional straight line was drawn toward the marionette wrinkle, all lines stopping at 5 mm to 10 mm before the wrinkle. These marks served as a reference for the insertion of the threads.
The insertion of the threads began with the application of local anesthesia, 2% Lidocaine with 1:100,000 vasoconstrictor (DFL®) to ensure the patient’s comfort. Anesthesia was applied on the pertito and along the lines marked on the path where the wire would pass. The object was opened with an 18G caliber needle. Next, the support thread was inserted through the subcutaneous layer, moving slowly to ensure proper fixation of the thread under the skin. Always be careful to prevent the wire from being excessively lifted during this process.
After the complete insertion of the support thread, light tension was made and a knot was terminated to ensure adequate fixation. The same thread was carefully pulled so that it was fixed under the skin.
With the wire correctly positioned, it was pulled gently, cutting the excess of support wire. The finish was accomplished by removing any ripples in the skin, applying light hand pressure to smooth the treated area. Finally, an adhesive dressing was used on the skin to protect the area and promote healing. 6 support threads were inserted (Figures 3 and 4), in addition to lip filler with hyaluronic acid.
The postoperative follow-up included guidance on skin care, such as avoiding excessive sun exposure and following the recommended cleansing and moisturizing routine. The patient was instructed to perform regular follow-up to assess progress and detect possible complications.
After treatment with PDO support sutures, the patient showed a significant improvement in facial flaccidity in the zygomatic region. Over the 30-day post-treatment period, a notable reduction in sagging of the zygomatic region and the middle and lower third of the face was noted, with a visible improvement in the definition and contour of the face. The patient reported satisfaction with the aesthetic results, highlighting an increase in skin firmness and a global rejuvenation of her facial appearance (Figure 5).
Clinical response to treatment was monitored during follow-up visits, with observations of adequate healing and absence of significant complications after 30 days. The patient followed the post-procedure guidelines, which included skin care and avoiding activities that could compromise the integrity of the hair (Figure 6).
The results demonstrated the effectiveness of PDO support threads in improving facial sagging, providing an immediate lifting effect and contributing to a more rejuvenated appearance. The treatment proved to be an effective minimally invasive alternative, aligning with the patient’s expectations and standing out as a valuable option in orofacial harmonization.
3 DISCUSSION
The search for minimally invasive aesthetic solutions for the treatment of facial sagging has been an area of growing interest in the area of orofacial harmonization. PDO support threads, a relatively recent innovation, have emerged as a promising alternative to traditional surgical procedures (16). According to Gülbitti et al. (17), polydioxanone (PDO) threads are widely used due to their ability to offer an effect Lifting Effective with less invasiveness and recovery time compared to conventional surgical techniques. The popularity of PDO wires is attributed not only to their effectiveness, but also to the flexibility of application and favorable safety profile.
The effectiveness of PDO threads is largely supported by clinical studies that highlight the ability of these threads to promote the production of collagen and elastin, which are essential for maintaining skin elasticity and firmness (18). Atiyeh, Chahine and Ghanem (19) observed that, during the resorption of the hair, there is a significant increase in the concentration of collagen in the skin, which contributes to the improvement of facial contour and reduction of sagging. This is particularly relevant in areas such as the zygomatic arch, where the loss of lift may be more visible and aesthetically impactful.
In addition, the PDO thread application technique offers advantages in terms of customization and adjustment during the procedure (20). Myung and Jung (21) highlight that PDO threads can be adjusted according to the specific needs of the patient, allowing a more precise approach to treat areas of facial sagging. This is crucial to achieve an optimal aesthetic result, especially in complex areas such as the zygomatic contour and perioral region, where definition and support are essential for a natural and harmonious result.
Safety and minimization of complications are fundamental aspects in the choice of aesthetic techniques (15). PDO threads are known for their high biocompatibility and low complication rate, as evidenced by studies by Park, Jeong, and Park (22). The absorbable nature of the threads reduces the risk of complications associated with permanent foreign bodies, and the favorable safety profile contributes to wider acceptance among patients.
In the Brazilian context, where the demand for non-invasive aesthetic treatments is particularly high, the use of PDO threads for the treatment of facial sagging has become increasingly common (21,23). The minimally invasive approach to PDO threads is attractive to many patients who seek significant aesthetic results with less impact on their daily lives. The growing acceptance of these procedures reflects the trend of seeking alternatives that reconcile effectiveness and practicality (16).
The case report presented corroborates the findings in the literature on the efficacy of PDO support sutures. The patient, who complained of facial sagging, showed a significant improvement after treatment with PDO threads, reflecting what other studies have shown. The application of the threads in the zygomatic region resulted in a visible rejuvenation and an effective correction of flaccidity, corroborating the effectiveness of the technique in real clinical contexts.
Despite the promising results presented and supported by the existing literature, some limitations should be considered. The study involves a single clinical case, which limits the generalizability of the findings to a broader population. Individual variability, including factors such as genetics, lifestyle, and biological response to treatment, can significantly influence outcomes. In addition, the long-term follow-up of the patient has not been detailed, which prevents a complete evaluation of the durability of the effects of PDO support thread treatment.
Studies with larger sample sizes and prolonged follow-up periods are needed to fully validate the efficacy and safety of this technique (20). In addition, the absence of comparisons with other treatment methods for facial sagging limits the understanding of the relative advantages of PDO threads over other therapeutic options.
4 CONCLUSION
It is concluded that the use of PDO support threads for the treatment of facial sagging proved to be an effective and minimally invasive technique, providing satisfactory aesthetic results and improving the general appearance of the skin in the zygomatic region. The clinical case presented here highlighted a significant improvement in the patient’s firmness and facial contour, corroborating the literature that supports the use of PDO threads as a valid alternative to more invasive methods.
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1 Specialist in Orofacial Harmonization, Faculty of Amazonas – IAES