Thread lift materials PDO, PLLA and PCL, and barb structure — what changes and what is not yet known
At thread lift consultations we are often asked, “What kind of thread is it?” Thread names differ from product to product, but what really sets them apart is two things: material (what it is made of) and structure (how it grips tissue). This article separates those two axes from a clinician’s point of view and sets them out with the evidence.
The short answer
Dissolving threads for the face are mainly PDO (polydioxanone), PLLA/PLGA types and PCL (polycaprolactone) types, and they grip tissue either with barbs (cog, barb) or with cones. In a review pooling the research, PDO was the most used (Riopelle 2025), and in data from 100,000 cases in Japan, PDO was used more in younger patients and PCL in older patients (Okumura 2025). Swelling and bruising were more common with PCL threads and barbed threads (Ojha 2025). However, we could not find a randomised trial directly comparing effect duration between materials. Miso Clinic (4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea; +82-53-428-2700) chooses material and structure based on skin thickness, the weight of the sagging and the anchoring points (mainly Hugel Blue Rose and HansBiomed MINT), and shows you the material and approval of the threads we use before treatment.
Material — what it is made of
| Type | Characteristics | What human data show |
|---|---|---|
| PDO (polydioxanone) | Long used as a suture material; the most common for thread lifting | The most studied material in a review of 12 studies (Riopelle 2025) |
| PLLA/PLGA types | Known for collagen response; used in cone threads | In 25 patients’ biopsies, collagen beside the thread increased up to 270 days (Goldberg 2020) |
| PCL (polycaprolactone) types | Known as a slowly dissolving material | Chosen more often in older patients (Okumura 2025); more swelling and bruising (Ojha 2025) |
Dissolving speed depends not only on the material itself but also on thread thickness, processing method and the product, so even for the same material we check each product’s approval documents separately. Before treatment we show you the box and approval label of the product we use (clinical judgement).
Miso Clinic uses threads from several manufacturers, mainly Hugel Blue Rose and HansBiomed MINT. MINT is a PDO thread with moulded 360-degree 3D barbs, approved in Korea as a facial tissue fixation thread. Blue Rose comes in PDO and PCL versions (manufacturer information and press reports). We do not rank one product over the other; we choose the material and structure that fit the face.
Structure — how it grips tissue
- Barbed (cog, barb) threads — tiny barbs cut or moulded into the thread surface hook tissue in one direction or both
- Cone threads — small cones fitted onto the thread grip the tissue
- Smooth threads (mono) — almost no lifting force; the aim is skin texture and tissue reaction
In a review comparing 19 studies (1,406 patients), barbed threads had more adverse events than smooth or cone threads (Ojha 2025). It appears that the greater the lifting force, the greater the tissue injury that comes with it.
Why does anchoring matter?
Even with the same thread, where it is anchored has a large influence on the result. Floating the thread in the fat layer without anchoring had more adverse events than anchoring it (Ojha 2025).
Recently, an anatomy-based technique was reported in 83 patients that hooks the zygomatic-cutaneous ligament (ZCL), anchors to the superficial layer of the deep temporal fascia, and makes use of the malar fat and the platysma-auricular ligament (Yu 2026). As a technique report without a comparison group, it is not evidence that it is ‘better’, but the direction of designing vectors around the facial ligaments is meaningful. The evidence behind claims of targeting ligaments is covered in Retaining ligament filler — the evidence.
How is the number of threads decided?
In data from 100,000 cases in Japan, the mean number of threads differed by material: 10.52 for PDO and 6.57 for PCL (Okumura 2025). However, we could not find a human study comparing number and effect, and more threads also means more swelling and bruising. We do not fix the number first; we work backwards from the weight of the sagging and the number of anchoring points (clinical judgement).
How far should animal studies be trusted?
In guinea pigs given PDO barbed threads, a fibrous capsule around the thread and collagen signals persisted for 7 months (Kim 2017), while in a rat study multi-strand PDO produced more collagen at 2 weeks but it fell sharply by 12 weeks (Shin 2019). The two results do not point the same way, and because they differ from human skin thickness and movement, we do not use them as grounds for choosing a product.
What to check at the consultation
- What material is the thread, and is it a product approved in Korea?
- Which of barbed, cone or smooth threads will you use, and why?
- Where will it be anchored? How is the vector (direction of pull) set?
- How many threads will be used, and what was that number based on?
If you first want to know whether your face suits a thread lift, start with Thread lifting in Daegu: which faces it suits.
Why material alone does not decide the result
Material, structure, anchoring, number and the layer they are placed in all produce the result together. So we do not make comparisons of the kind ‘this thread is the best’. Even threads with the same name are a different treatment if the design is different.
Thread lift materials: frequently asked questions
What is the difference between PDO and PCL threads?
PDO is the most studied material for thread lifting, while PCL is known as a slowly dissolving material and was chosen more often for older patients. One review found more swelling and bruising with PCL threads. We could not find a randomised trial directly comparing effect duration.
What is the difference between cog (barbed) threads and cone threads?
In barbed threads, tiny barbs on the thread surface grip the tissue; in cone threads, cones fitted onto the thread do. In a comparison of 19 studies, barbed threads had more adverse events than smooth or cone threads.
Where are the threads anchored?
Unanchored methods had more adverse events than anchored ones. We set the anchoring points and vectors according to the weight of the sagging and the structure of the facial ligaments.
How many threads are used?
In data from 100,000 cases in Japan, the mean was 10.52 for PDO and 6.57 for PCL. There is no human study comparing number and effect, so we work backwards from the weight of the sagging and the number of anchoring points.
Which thread is the best?
Material, structure, anchoring, number and layer produce the result together, so there is no evidence for calling any one thread the best.
Where can I have a thread lift consultation in Daegu?
Miso Clinic is at 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, in front of Exit 1 of Kyungpook National University Hospital Station. +82-53-428-2700. Weekdays 11:00–19:00, Saturdays 10:00–16:00 (no lunch break); closed Sundays and public holidays.
Read next
Product pages
Who wrote this
Written and reviewed by Lee Chi-Hak, MD, director of Miso Clinic, Daegu. The treatment standards and injection design set out here are the ones we use in practice.
| Medical director | Lee Chi-Hak, MD |
|---|---|
| Address | 4F Bombom Building, 125 Dongdeok-ro, Jung-gu, Daegu, South Korea · Exit 1, Kyungpook National University Hospital Station |
| Phone | +82-53-428-2700 |
| Hours | Weekdays 11:00–19:00 (lunch 13:00–14:00) / Saturday 10:00–16:00 (no lunch break) / Closed Sundays and public holidays |
| Columns | All clinical columns |
| Reference library | All booster and device references |
References
- Recent evidence on absorbable thread lifting — Riopelle AM et al., Dermatol Surg 2025;51(5):509–514, PMID 39662017, DOI 10.1097/DSS.0000000000004521. 12 studies from 2018–2022, 818 patients. PDO was the most common, followed by PLLA and PCL types. Every study reported immediate improvement; the longest follow-up was 2 years and complications were minor. Authors’ conclusion — there is an immediate effect, but data on long-term effect are lacking.
- Thread material choice in practice — 100,000 cases in Japan — Okumura K et al., Aesthetic Plast Surg 2026;50(3):786–794, PMID 41053478, DOI 10.1007/s00266-025-05302-z. 106,639 patients at 105 clinics, 2020–2024. PDO accounted for 57.2% and was more common in patients in their 20s and 30s; PCL was more common in older patients. Mean thread count: PDO 10.52 vs PCL 6.57. Retrospective data from a single aesthetic clinic group.
- Adverse events by absorbable thread material — Ojha AS et al., Dermatol Surg 2025;51(3):272–276, PMID 39442180, DOI 10.1097/DSS.0000000000004466. 19 studies, 1,406 patients. Bruising 19.49%, swelling 16.79%, tenderness 9.96%, infection 2.49%, sensory disturbance 1.14%, haematoma 0.64%. Swelling and bruising were more common with PCL threads, barbed threads and the midface; barbed threads had more adverse events than smooth or cone threads, and floating (unanchored) threads more than anchored threads.
- Collagen around PLLA/PLGA cone threads — Goldberg DJ, J Cosmet Dermatol 2020;19(5):1172–1178, PMID 32167231, DOI 10.1111/jocd.13371. Single-centre, open-label prospective study of 25 patients (17 completed biopsy). Collagen right next to the thread path began to appear at 90 days and had increased significantly at 180 and 270 days; nasolabial fold ratings improved up to 270 days. This study had no control group.
- PDO thread lifting anchored to anatomical structures — Yu AY, Pu LLQ, Plast Reconstr Surg 2026, PMID 41534851, DOI 10.1097/PRS.0000000000012812. A method that hooks the zygomatic-cutaneous ligament (ZCL), anchors to the superficial layer of the deep temporal fascia, and makes use of the malar fat and the platysma-auricular ligament, applied in 83 patients. The authors themselves wrote that the effect of PDO thread lifting is temporary. A technique report without a comparison group.
- Tissue changes around PDO barbed threads (animal) — Kim J et al., Dermatol Surg 2017;43(1):74–80, PMID 27748691, DOI 10.1097/DSS.0000000000000925. 12 guinea pigs. A fibrous capsule formed around the thread, and type I collagen and TGF-β1 stayed higher than in normal skin for 7 months. These are not human results.
- Collagen by absorbable thread type (animal) — Shin JJ et al., J Cosmet Laser Ther 2019;21(3):158–162, PMID 29979893, DOI 10.1080/14764172.2018.1493511. Rat dorsal skin. Multi-strand PDO produced more collagen at 2 weeks; collagen fell sharply by 12 weeks, and the threads remained enclosed in a capsule. These are not human results.
- MINT thread product information — HansBiomed product page. PDO (polydioxanone), moulded 360-degree 3D barbs; approved in Korea (MFDS, facial tissue fixation thread), US FDA 510(k) and EU CE. hansbiomed.com
- Blue Rose sutures — Hugel’s thread brand; dissolving PDO and PCL products, the PDO line being Blue Rose Forte. Dailypharm report, 2025. dailypharm.com
- Medical advertising law — Medical Service Act of Korea, Article 56(2), which prohibits testimonial advertising, comparison with other clinics, superlative claims and advertising that guarantees or implies a guaranteed treatment effect.
- Miso Clinic practice guidance — indication criteria, site-by-site design, and the explanation and consent procedure. This is the source for every sentence marked as clinical judgement.
Everything in this column is general information and does not replace medical diagnosis or treatment. Effects and side effects vary with individual skin condition, age and underlying illness, and the same result is not guaranteed for everyone. Any decision to proceed should be made in an in-person consultation with a physician.