Nasolabial folds are the creases that run from the sides of the nose to the corners of the mouth. They are part of normal anatomy, yet they deepen with age, weight shifts, sun exposure, and expressive habits. Hyaluronic acid fillers have long been the go-to for these lines, but in the past few years I have reached more often for PDO threads in select cases. Done well, a PDO thread lifting treatment does not stuff or over-plump the midface. It supports and stimulates, softening the fold while respecting natural contour.
This is a treatment with nuance. The right thread type, depth, and vector can give a gentle lift and long-term collagen stimulation. The wrong approach can bruise, pucker, or accentuate the fold. If you are considering a PDO thread facial treatment for smile lines, it pays to understand what they can and cannot do, where they shine, and how we use them safely.
What PDO threads are and how they work
PDO stands for polydioxanone, a biocompatible, biodegradable polymer that surgeons have used as suture material for decades. In aesthetic practice, PDO threads for face tightening come in different forms. Smooth threads act like micro scaffolds for collagen. Twisted or screw threads provide a touch more volume. Barbed or cog threads mechanically anchor into tissue for lifting. All are designed to absorb over several months and prompt collagen production as pdo threads near Orlando, FL they dissolve.
For nasolabial folds, I typically use a combination. Smooth or twisted threads can be placed in a fanning pattern under the fold to thicken the dermis and soften the crease. Short barbed threads, oriented along supportive vectors, can provide subtle elevation to tissue that is contributing to the fold, especially the cheek and the paranasal region. This is not a full PDO thread facelift; it is a focused PDO thread therapy for a defined area that supports facial definition without changing your features.
Collagen stimulation is the quiet hero. Patients often see an early effect from the physical presence of the threads. The more durable improvement arrives gradually, over 6 to 12 weeks, as new collagen forms around the threads. That is why PDO threads before and after photos look better at three months than at two weeks. In the best cases, results hold for 9 to 18 months, with variability based on thread type, placement, metabolism, and lifestyle.
Why nasolabial folds deepen in the first place
You can inject a fold and make it shallower for a few months, but that ignores the mechanics. With age, fat pads descend, ligament support loosens, and bone resorbs along the maxilla. The cheek loses its high point, which shifts weight toward the midface and the area around the nose. Skin thins and loses elasticity, so it molds more dramatically to the underlying change. Habitual smiling, pursing, and sleeping positions add to the crease.
I evaluate folds in motion and at rest, and I palpate the tissue. A deep fold in a young face usually reflects strong muscle pull or inherited facial structure. In a mature face, the fold is a symptom of global changes. Treating only the line can be like patching drywall while the beam behind it sags. That is where PDO threads for facial lifting can bring balance: support, not stuffing.
Who is a good candidate for PDO threads for smile lines
Not everyone benefits equally. PDO threads for nasolabial folds work best when the fold is moderate and the surrounding tissue has some thickness to hold a thread. If skin is very thin or heavily sun damaged, a thread can be visible or palpable. If the fold is deep because of pronounced volume loss or significant laxity, threads alone may underwhelm. In those cases, I discuss a staged plan with filler, energy-based tightening, or surgical lift as appropriate.
I like PDO threads for aging skin when:
- The fold deepens primarily from mild to moderate tissue descent and skin laxity, not just volume loss. The patient wants a non surgical facelift alternative with minimal downtime and natural results. There is reluctance to add bulk with filler in the midface, especially in patients who puff under the eyes when overfilled. The patient accepts a gradual improvement and understands that PDO thread results build over weeks rather than instantly.
The consultation that sets up success
A thoughtful PDO thread consultation is not a quick glance and a price quote. I review medical history, medications, and supplements that affect bleeding or healing. Anticoagulants, high-dose fish oil, and certain herbs increase bruising risk. Autoimmune disorders, active infections, or keloid history influence candidacy. We discuss prior fillers or surgical work. Threads can catch on or traverse old filler pockets if placement is not careful.
Photography from multiple angles helps me map vectors. I assess the smile line with and without expression, then check cheek support, marionette lines, and jawline position. I explain PDO thread side effects and recovery time with plain language, not gloss. I also show PDO threads before and after examples that match the patient’s age, skin type, and fold severity. Unrealistic expectations are the enemy of satisfaction, and honest previewing prevents that.
On costs, a focused PDO threads cosmetic treatment for nasolabial folds typically ranges from a few hundred dollars for simple smooth threads to well over a thousand when combining multiple thread types or expanding to the midface and jawline. Geographic location, experience level, and the number of threads used influence PDO threads treatment cost. I charge by the scope of work, not per thread, because quality placement matters more than a thread tally.
What happens on the day of the procedure
Here is what a typical PDO thread procedure looks like in my practice.
- Preparation and numbing: We photograph, cleanse with chlorhexidine or povidone-iodine, mark vectors, and use topical anesthetic for 20 to 30 minutes. For barbed threads, I add small wheals of lidocaine with epinephrine at entry points to keep the area comfortable and minimize bleeding. Placement technique: For softening a fold, I often create a micro-entry point near the alar base for short cogs, then glide the cannula along a subdermal plane that supports the paranasal area. Smooth or screw threads are layered superficially along and just lateral to the fold for collagen support. Correct depth is key. Too superficial causes ridging. Too deep and you miss the dermal support that improves texture. Symmetry and adjustment: I check both sides in neutral expression and a soft smile, then manipulate tension gently on barbed threads. Over-pulling is a common novice error. The aim is an incremental lift and smoothing that still looks right when you talk or grin. Finishing and aftercare: Entry points are covered with sterile strips or tiny dots of skin glue. We apply a cool compress briefly, then go over instructions to protect the lift and reduce swelling.
The entire PDO thread lifting procedure for smile lines usually takes 30 to 60 minutes, depending on complexity and whether we also treat marionette lines, cheeks, or the jawline.
Safety, discomfort, and downtime
Patients ask two things first: does it hurt and is it safe. With proper local anesthetic, most people describe a tugging or pressure rather than sharp pain. The sensation of a thread engaging tissue can feel odd the first time, but it is brief. For two to three days after a PDO thread facial treatment, you may feel tightness when you smile or chew. That light tension is expected and eases as tissue settles.
Common PDO thread side effects include swelling, pinpoint bruises, and mild soreness along the vectors. Bruising varies by person and technique; many return to work the next day, though some prefer a long weekend buffer. Visible rippling or puckering at entry points can occur with barbed threads and usually smooths within one to two weeks as the skin relaxes. Temporary asymmetry is possible if swelling is uneven. Rare but important risks include thread extrusion, dimpling that persists, infection, nerve irritation, or vessel injury. Good sterile technique, appropriate thread choice, and precise depth mitigate these.
For PDO threads recovery time, plan on:
- 24 to 72 hours of social downtime for most people, mainly for swelling or minor bruising. One to two weeks of being gentle with exaggerated expressions, heavy chewing, dental appointments, and face-down massages to protect the initial fixation. Avoiding intense workouts, saunas, and swimming for 3 to 5 days.
If you have a public event or photos, schedule your PDO thread appointment at least three weeks ahead to allow for optimal settling.
Where threads sit among other treatments for smile lines
There is no single best approach. Threads, fillers, energy devices, and even surgical lifts each solve different parts of the problem.
Fillers shine when the fold has a true volume deficit. A small amount of soft hyaluronic acid, placed deep and judiciously, can round a sharp crease. The risk is overfilling the midface or chasing the fold superficially, which can look puffy or create lumpiness with expression. Threads sidestep bulk and focus on support. They are ideal for a patient who fears looking overdone or who already has filler and wants lift and skin firming instead of more volume.
Energy-based devices like radiofrequency microneedling or ultrasound tighten skin and improve texture diffusely. They are great companions to PDO thread skin rejuvenation, as they address elasticity while threads provide focal support. I often combine radiofrequency-based treatments a month before or three months after threads for synergy.
Surgery remains the definitive solution for advanced sagging, but many patients in the mild to moderate range prefer PDO threads for facial sagging because the downtime is shorter, cost is lower, and the change is subtle. Your priorities should steer the plan: longevity and magnitude of change favor surgery; minimal recovery and incremental results favor non invasive options like PDO threads non surgical skin lift.
Technique details that matter more than marketing
Thread placement is carpentry with living tissue. The material helps, but the craft is in angles, planes, and restraint.
Depth: For nasolabial folds, I keep smooth or screw threads in the reticular dermis or immediate subdermal plane, where they can punch above their size for texture and firmness. Barbed threads ride a bit deeper, in the subcutaneous fat, to catch and support. Crossing into muscle invites discomfort and increases the follow this link risk of irregular motion.
Vector selection: Folds do not only run vertically. I map supportive lines from the lateral cheek toward the paranasal area and from the piriform fossa upward. A short vector that lifts the tissue adjacent to the fold usually looks more natural than pulling directly on the fold itself.
Number of threads: More is not better. In most cases, two to four smooth or screw threads along the fold and one to two short cogs per side, carefully tensioned, outperform a dense web that bruises and swells. For thin-skinned patients, fewer, finer threads prevent visibility.
Adjacency: If marionette lines are prominent, a simultaneous PDO thread under chin or jawline support may be smarter than focusing solely on the nasolabial region. Rebalancing load across the lower face can soften the mouth corners and indirectly ease the fold.
Setting expectations and reading results over time
Immediate results tend to split into two camps. Some patients see a clear smoothing right away from the mechanical support. Others notice only a small change, wondering if anything was done. I explain that PDO threads for skin rejuvenation behave like scaffolding that the body builds upon. The first two to three weeks are settling. Between week four and twelve, new collagen and elastin accumulate, and the improvement becomes more obvious in softer lighting and with motion.
PDO threads results are not static. As threads absorb over 6 to 9 months, the collagen they leave behind maintains part of the lift for longer. Patients who take care of their skin, stay hydrated, and protect from sun maintain gains better than those who do not. Smokers and those with rapid metabolism might see shorter duration.
Anecdotally, one of my mid-40s patients with moderate folds and early jowling saw a subtle lift at two weeks. At eight weeks, friends asked if she changed her skincare. She returned at ten months for a light touch-up with two additional smooth threads per side, not because the result vanished, but to keep the trajectory favorable. That is what PDO thread tightening therapy does best: incremental, believable refinement.
When threads are not the right move
I turn patients away from PDO thread lifting treatment in a few scenarios. If the fold stems from a pronounced dental malocclusion or missing molars, the structural deficit overwhelms any soft tissue fix. If the skin is very thin with etched-in lines, fractional laser resurfacing or biostimulatory injectables may serve better than threads. If there is pronounced midface hollowing and skeletal retrusion, strategic filler or fat grafting can restore the platform that threads alone cannot recreate. And if you expect a ten-year reversal from a thirty-minute procedure, you will not be happy, no matter how masterful the technique.
Practical aftercare that protects your investment
The first week sets the tone for healing. Sleep on your back with an extra pillow to keep swelling modest. Do not massage the treated area unless instructed. When you wash your face, support the skin with the palm rather than rubbing sideways. Skip dental cleanings or long mouth-open appointments for two weeks if possible, since wide retraction can stress early fixation. Keep workouts light for several days, and avoid saunas and hot yoga briefly. If you develop a small dimple at an entry point when you smile, resist the urge to press or fiddle; it usually smooths as the thread relaxes. Call your provider if you notice increasing redness, warmth, or discharge that could suggest infection.
Cost, value, and maintenance planning
Price varies. In most US cities, a focused PDO threads aesthetic procedure targeting nasolabial folds alone might land around 600 to 1,200 dollars. Combine with cheek support or a short jawline vector and you are more likely in the 1,200 to 2,500 range. Higher-end practices with deep expertise often charge more, but also tend to customize thread type and pattern in ways that reduce overuse and improve longevity. Value lives in the planning and the hands, not just the product.
" width="560" height="315" style="border: none;" allowfullscreen="" >
A smart maintenance plan stretches results. I like to reassess at three months to judge collagen response, then again around nine to twelve months to decide on a light refresher. For patients in their thirties and forties with early folds, this might mean a brief PDO thread skin lift treatment annually. For those in their fifties and sixties, alternating threads with energy-based tightening or targeted filler provides a balanced, natural result that avoids a one-note look.
How PDO threads compare across facial zones
Patients often pair nasolabial fold work with other zones. Short notes from practical experience:
Cheeks: PDO threads for cheeks can restore a gentle apex without adding filler bulk. Good for patients who retain fluid under the eyes or dislike a “pillow face.” I use short cogs and smooth threads to support, not inflate.
Jawline: PDO threads for jawline sharpen the mandibular border in early jowling. Helps indirectly with marionette lines.
Neck and under chin: PDO threads for neck and PDO thread under chin can improve texture and light crepiness, but for heavy submental fat, a thread alone struggles. Combine with deoxycholic acid or liposuction if fat is the primary issue.
Brow and under eye: PDO threads for brow lift can create a modest lateral lift. Under eye is delicate; I am conservative here. Threads for under eye area risk visibility if skin is thin. Often I favor energy devices or a whisper of filler instead.
Marionette lines: PDO threads for marionette lines often pair well with chin and jaw vectors. The improvement at the mouth corners can make the whole lower face look more relaxed.
The credential that counts: experienced hands
PDO threads are a tool. You want someone who can read faces, not just place lines. Look for a provider who does a high volume of thread work, not just occasionally. Ask to see PDO threads before and after images of patients who look like you. Ask how they decide among thread types and when they prefer filler or energy devices instead. Listen for nuance. If a consultation feels like a sales pitch rather than a plan, keep looking.
In my clinic, I have revised many thread outcomes from elsewhere, not because the product failed, but because the pattern did not respect anatomy. One patient arrived with heavy cogs placed straight down the fold, which bunched skin when she laughed. We removed the offending thread and later rebuilt support with lateral vectors and a few smooth threads along the crease. She looked normal again within days and subtly refreshed by six weeks. This kind of course correction underscores how much pattern and depth matter.
Evidence, realism, and what to expect long term
Published studies on PDO threads show modest to moderate improvements in skin laxity and wrinkle depth, with high satisfaction when expectations are aligned. Outcomes are operator dependent. Threads are not a replacement for a facelift, but they bridge a wide space between skincare alone and surgery. The sweet spot is a patient who values natural lift, tolerates a short recovery, and appreciates that collagen takes time.
Long term, repeating PDO thread therapy for face every 12 to 18 months, paired with sunscreen, retinoids or retinaldehyde at night, and perhaps annual collagen-boosting treatments, leads to a resilient dermis that ages more slowly. Think of it as steady maintenance, like keeping a roof in good shape instead of waiting for leaks.
Final thoughts from the treatment room
If your smile lines have started to cast a shadow you do not recognize, PDO threads for nasolabial folds can brighten that area in a quiet, believable way. They offer lift without puff, structure without the heaviness that sometimes follows overfilling. The treatment is quick, the recovery manageable, and the results build naturally as your collagen responds.
The art lies in the plan: understanding whether your fold needs support, volume, or both; choosing thread types that match your tissue; placing them at the right depth and vector; and resisting the urge to do too much at once. When those pieces align, PDO thread lifting benefits can be felt each time you smile and see a softer line looking back.