PDO Smooth & Lifting Threads - Clinical SOP

Evidence note: Randomised data for thread lifting is limited. Recommendations are based on systematic reviews, consensus statements and device/clinical governance documents. Where data are heterogeneous or from preprints, this is stated.

1. Purpose

Provide a concise, evidence‑based and regulator‑aligned protocol for the safe use of PDO smooth (mono/screw) and barbed/cog lifting threads — indications, contraindications, adverse effects, thread selection by area, mechanisms, outcomes and NSW/Australia 2025 governance. ¹ ²

2. Scope

Applies to medical practitioners and nurses practising under delegation in NSW/Australia using ARTG‑listed PDO threads in accredited outpatient settings. Includes sedation thresholds, documentation and reporting duties.

3. Indications

Mild—moderate facial laxity with early jowling, midface descent, blunted ogee curve — suitable for barbed/cog threads to reposition soft tissue (supra‑SMAS vectors). ¹⁴ ¹⁶
Skin‑quality/crepey change (cheeks, neck, perioral): smooth/mono or screw threads in a mesh for biostimulation and micro‑tensioning. ¹⁴
Nose (selected cases): limited tip support/rotation; counsel on higher complication variability vs fillers/surgery. ¹⁷ ¹⁸

4. Contraindications

Absolute: active local infection; active inflammatory dermatosis along the tract; pregnancy/breastfeeding; implanted permanent fillers in the same vector; uncontrolled coagulopathy. ¹⁵
Relative: autoimmune disease in flare, immunosuppression, poorly controlled diabetes, heavy anticoagulation/antiplatelets, keloid history, very thin dermis over bony contours, prior threads in same vectors, unrealistic expectations. ¹³ ¹⁶

5. Adverse effects (incidence ranges)

Most are transient (swelling, bruising, tightness, mild pain). Meta‑analyses and reviews report pooled rates around: swelling ~33%, dimpling ~12%, paresthesia ~7%, visible/palpable threads ~2%, infection ~3%, extrusion ~2—4% — heterogeneity is high and techniques vary. ¹¹ ¹² ¹⁹

Important but uncommon: contour asymmetry, prolonged dimpling/irregularity, thread breakage, salivary‑duct irritation, neurapraxia. Manage with massage/hydrodissection/subcision, targeted removal if extrusion, antibiotics and drainage for infection, and specialty referral for nerve/duct injury. ¹³ ¹⁵

6. Mechanisms of action

Mechanical vectoring (barbed/cog): barbs engage fibroseptal tissue to reposition ptotic compartments relative to retaining ligaments; typically placed supra‑SMAS to avoid major neurovascular structures. ¹⁶ ¹⁴
Biostimulation (all PDO, especially smooth/screw): controlled foreign‑body response → neocollagenesis (types I/III) and tissue remodelling over weeks to months; PDO resorbs by ~6—7 months while collagen persists longer. ¹⁴

7. Thread choice by area

Area	Aim	Preferred thread	Plane & vector	Notes/risks
Brow/temple	Lateral brow support	Barbed (I‑shape or U‑shape)	Supra‑SMAS temporal vectors	Respect STA/veins; exit‑site dimpling risk higher with U‑shape
Midface/cheek	Ogee support; midface reposition	Barbed (I‑shape); add smooth mesh for skin	Vectors toward firm temporal/zygomatic tissue	Avoid over‑promising in heavy/ptotic faces
Jawline/jowl	Jowl reduction, jaw contour	Barbed along mandibular vectors	Supra‑SMAS; careful near marginal mandibular nerve	Expect modest effect; combination plans common
Nasolabial/marionette	Skin quality & fine rhytids	Smooth/mono or screw mesh	Dermal‑subdermal mesh	True fold lift often needs volume support as well
Neck	Crepey skin; mild banding	Smooth/mono or screw mesh	Superficial vectors, avoid platysma edges	Visibility risk in very thin dermis
Nose (selected)	Minor tip support/rotation	PDO nasal threads	Conservative; avoid dorsal pressure points	Higher variability; counsel on complication profile

Evidence/reviews informing the table: ¹⁶ ¹⁴ ¹⁸ ¹⁷

8. Outcomes & durability

Set expectations to modest, temporary improvement. Most reviews report visible lift for ~6—12 months with gradual attenuation; skin‑quality gains may last longer from collagen remodelling. Results are best in mild—moderate laxity and average‑thickness skin. ¹¹ ¹⁴ ¹³

9. Technique & aftercare (risk minimisation)

Plane: generally supra‑SMAS; map vectors to avoid vessels/ducts; ultrasound planning is reasonable in high‑risk zones.
Entry/exit discipline: small nicks, haemostasis, consider blunt cannula entries.
Aftercare: avoid side‑sleeping/face‑down pressure for ~2 weeks in treated areas; no vigorous massage unless directed; review at 2—3 weeks to address dimples/contour. ¹⁶ ¹⁴

10. NSW/Australian governance (2025)

Practitioners must comply with AHPRA’s 2025 non‑surgical cosmetic procedure guidelines (scope, consent, advertising). ¹ ² ³
Advertising: PDO threads are Class III devices and may be advertised to the public **only** if the specific device is ARTG‑listed and content complies with the Therapeutic Goods Advertising Code; do not advertise S4 medicines. ⁴ ⁵
Adverse events: report device incidents via the TGA MDIR pathway; maintain internal incident records. ⁶
NSW medicines law: comply with the Medicines, Poisons and Therapeutic Goods Act 2022 for Schedule medicines (local anaesthetic), storage, records and authority. ⁷
Procedural safety: apply NSW Clinical Procedure Safety PD2025_006 (timeouts/site checks/incident reporting) and sedation standards if using anxiolysis/analgesia; escalate sedation only within competence and with monitoring/recovery per ANZCA PG09(G). ⁸ ⁹ ¹⁰

11. Patient counselling — honest script

"Threads can reposition soft tissue modestly and stimulate collagen. Expect a temporary, subtle lift; you’ll likely want maintenance in 6—12 months. Bruising, swelling and small dimples are common early; serious problems are uncommon but can include infection, extrusion or contour irregularities. We’ll avoid pressure on treated areas for ~2 weeks and review you at 2—3 weeks."

Sources

AHPRA (2025) Performing non‑surgical cosmetic procedures — guidelines (in force 2 Sep 2025)., viewed 05 November 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩
AHPRA (2025) News: New guidelines for cosmetic procedures — in effect 2 Sep 2025., viewed 05 November 2025, https://www.ahpra.gov.au/News/2025-09-02-New-guidelines-for-cosmetic-procedures.aspx ↩
AHPRA (2025) Advertising higher risk non‑surgical cosmetic procedures — guidelines., viewed 05 November 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-advertising-guidelines.aspx ↩
TGA (2025) Advertising health services & cosmetic injections — FAQs (PDO threads are Class III & may be advertised if ARTG‑listed)., viewed 05 November 2025, https://www.tga.gov.au/products/regulations-all-products/advertising/specialised-advertising-issues-and-topics/advertising-health-services-and-cosmetic-injections-frequently-asked-questions-and-answers ↩
TGA (2025) Advertising health services & cosmetic injections — FAQs (PDF)., viewed 05 November 2025, https://www.tga.gov.au/sites/default/files/2024-04/advertising-health-services-cosmetic-injections-faqs.pdf ↩
TGA (2022—) Obligations to report an adverse event for medical devices (MDIR)., viewed 05 November 2025, https://www.tga.gov.au/safety/adverse-events/medical-device-adverse-events/obligations-report-adverse-event-medical-devices ↩
NSW Legislation (current) Medicines, Poisons and Therapeutic Goods Act 2022 (NSW)., viewed 05 November 2025, https://legislation.nsw.gov.au/view/html/inforce/current/act-2022-073 ↩
NSW Health (2025) Clinical Procedure Safety — Policy Directive PD2025_006., viewed 05 November 2025, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2025_006.pdf ↩
ANZCA (2023) PG09(G) Guideline on procedural sedation., viewed 05 November 2025, https://www.anzca.edu.au/getContentAsset/3faa17f6-a6e0-4719-9992-9d67acef952b/80feb437-d24d-46b8-a858-4a2a28b9b970/PG09(G)-Sedation-2023.pdf?language=en ↩
ACSQHC (2023) National Safety and Quality Cosmetic Surgery Standards., viewed 05 November 2025, https://www.safetyandquality.gov.au/standards/national-safety-and-quality-cosmetic-surgery-standards ↩
Niu Z. et al. (2021) Meta‑analysis of complications following facial thread lifting. Aesthetic Plast Surg. PMID:33821308., viewed 05 November 2025, https://pubmed.ncbi.nlm.nih.gov/33821308/ ↩
Wu W‑T‑L. et al. (2021) Invited discussion on thread‑lifting meta‑analysis (complication rates summary). PMC8481211., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8481211/ ↩
Yi K‑H. et al. (2025) Facial thread lifting complications. J Cosmet Dermatol., viewed 05 November 2025, https://onlinelibrary.wiley.com/doi/10.1111/jocd.16745 ↩
Hong G‑W. et al. (2024) Thread lifting materials — technical & mechanical perspective. CCID. PMC11086642., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11086642/ ↩
Wang C‑K. et al. (2020) Complications of thread lift about skin dimpling and management. Plast Aesthet Res. PMC7507174., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7507174/ ↩
de Pinho Tavares J. (2017) Facial thread lifting with suture suspension — review. Plast Aesthet Res. PMC9449186., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9449186/ ↩
Park S‑Y. et al. (2024) Non‑surgical rhinoplasty — thread complications & considerations. J Stomatol Oral Maxillofac Surg. PMC10818120., viewed 05 November 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC10818120/ ↩
Sulyman O. et al. (2024) Non‑surgical rhinoplasty using PDO threads. J Cosmet Dermatol., viewed 05 November 2025, https://onlinelibrary.wiley.com/doi/10.1111/jocd.15894 ↩
Zhou X‑C. et al. (2025 preprint) Meta‑analysis of thread‑lifting complications (medRxiv)., viewed 05 November 2025, https://www.medrxiv.org/content/10.1101/2025.03.10.25323087v1.full-text ↩

Disclaimer for Newcastle Cosmetic Doctor Policies & Procedures

The policies and procedures contained within this document are the exclusive property of Newcastle Cosmetic Doctor and are provided for internal clinical governance and educational purposes only. These materials represent the internal operational framework, safety standards, and evidence-based protocols developed and implemented by Dr. Bart John Scanlon and the Newcastle Cosmetic Doctor team. They are designed specifically for use within Newcastle Cosmetic Doctor and reflect our clinic’s own professional standards, risk assessments, and compliance obligations under Australian law and regulatory authorities. External individuals, practitioners, or organisations must not copy, reproduce, distribute, or rely upon these materials, in whole or in part, for their own clinical, commercial, or educational use without prior written consent from Newcastle Cosmetic Doctor. These materials do not constitute medical, legal, or professional advice and are not intended to be adopted as official protocols or procedures by any other entity. Any external use or adaptation must be independently reviewed and modified to meet the relevant laws, guidelines, and standards applicable to the user’s own jurisdiction, scope of practice, and facility operations. Newcastle Cosmetic Doctor and Dr. Bart Scanlon accept no liability for any loss, injury, or damage arising from the unauthorised use, reliance upon, or misinterpretation of this material.