Have you ever noticed that, in general, men tend to age more slowly than women? After menopause, wrinkles and sagging skin seem to exponentially increase for women, whereas men of the same age seem to have a more subtle decline. Beyond the societal double standards where aging men are considered distinguished yet aging women are just considered old. There are physiologic reasons as well. In men testosterone declines slowly and there is not the sudden drop off the estrogen cliff that women experience. Men have facial hair as well. Hair follicles in the dermis require supportive structures (think more collagen and connective tissue) and so men tend to have thicker skin. Those hairs act like tiny support beams all over the lower face, the place in the face where the most support is needed.

So, short of taking testosterone to grow a beard, what’s a girl to do? Surgery to lift the neck and jowls is one option. If surgery is out of the question what else is there? Fillers to the jowls and neck and/or laser treatments for collagen augmentation can be helpful, but often are not enough. This area of the face (jawline and jowls) and neck are notoriously hard to treat non-surgically. It is an area that has evaded non invasive attempts to fix for as long as non invasive treatments have been around. What if we could mimic the support structures in the skin that men have around their hair follicles, without having the actually grow hair?

Of course, the Asians and Europeans have already done that. For over a decade they have been placing polydioxanone threads in the deep dermis for tightening and support. Polydiaxanone (PDO) threads are actually tiny absorbable sutures that have been used in surgery on a daily basis in hospitals, since the 1950’s. There are no problems with allergic reactions or long term complications. The threads last 4 to 6 months before they are absorbed by the body and replaced with fibrosis. This fibrosis causes a thickening and tightening of the skin overlying the threads.

PDO threads can be used in placed where dermal fillers such as Juvederm may add to much bulk. We have all seen those women with too much filler in their upper lip, the lip protrudes over the lower lip and looks out of proportion. Before threads however, filler was the only way to get rid of those smoker’s lines (or a little Botox to the area). PDO threads can actually be placed above the lip to smooth wrinkles without bulking the area. They can also be used in areas where Botox is traditionally placed, such as the crows feet, to supplement the result and help it last longer.

It gets better. The threads come is spiral shapes and straight with tiny branches off the main thread. The branches are used to catch tissue and re-drape it and the spiral threads are used to add a bit of volume without bulking. The branched threads are ideal for treating the neck area to get a little bit of a lift when surgery is not needed or desired. The same is true for treatment of jowls. Lasers just don’t lift tissue that well (but they are great at smoothing it!) PDO threads are a minimally invasive answer for lifting tissue and fill a void in our treatment armamentarium.

Stay tuned for a blog from a patient who has had threads and our own before and after pictures. All this and more—coming soon!