جهت تماس و مشاوره:    02188337515

The innovative technique of non-surgical simple PDO’s thread lift for face and neck: A study performed on 521 patients without any pain or side effects.

Dr. Shohreh Shams. MD¹ |Dr. Fatemeh Nasri. MD²| Azita Aghbayat. D.M.D³


Introduction: In the modern world, people look for non-surgical, painless ways #FOR skin rejuvenation or even face and neck lift. A safe and affordable solution with minimum side effects and less recovery time required. In this study, for the first time, the results of years of practice and thousands of simple PDO threads implanted, an innovative technique for face and neck lift using the minimum number of thread needles while achieving the best outcome is introduced. With this special and innovative method, the effects of face and neck lift and rejuvenation are obvious in every patient, which is attached in the photos of this article. The advantages of this method are listed below: Filling wrinkles of the face and neck. Removal of deep wrinkles with subcision. Filling the laughter lines. Creating a cheek line and lifting the cheeks. Raising the crown of the eyebrows. Eye and eyebrow lift (mannequin lift) Removing darkness and dimples of the inferior eyelids. Creating a prominent lip line. Jawline Sharpness. Mandibular angle augmentation. Neck lift

Materials and methods:

In this perspective review chart clinical study, a total of 521 patients were included in the study from Jan. 2015 to agust.2022. All patients underwent thread lifting using 23139 simple sterilized absorbable polydioxanone sutures with a needle (mono or mono-screw, made in Korea). Patients were followed up after 2 weeks, 4 weeks and six months after the procedure. Outcomes were assessed by Dr.Shohreh shams and patients based on GAIS scores. In this method, the threads are used in some areas in the form of a mesh (horizontal and vertical) in two sessions with an interval of 10 to 14 days and in some areas of the face and neck in a back-and-forth manner.

Results: A total of 521 patients with a mean age of 46.1±11.48 years (18-82), 25(4.79%) men and 496 #WOMAN (95.20%) were included in the study. The sites for the non-surgical face lifting were lower-face region( 40.69%), mid-face region( 21.41%), neck region( 16.47%), temporal region( 11.28%), forehead region( 5.92%) and inferior eyelids region( 4.20%).The mid-face region was the most common part for the procedure and the lower eyelids were the least common site. The level of satisfaction immediately after the procedure was 90% and increased in the next follow-up (two weeks later) to 92.9%. By the end of the follow-up (six months later), the level of satisfaction was at 98.9%.

Conclusion: The splendid results of this innovative non-surgical technique using simple PDO threads are the results of a seven-year practice and experience of my_LIFE on 521 patients. Some of the patients revisit the clinic every 1-2 years to redo the procedure for longer lifting effects and rejuvenation of the skin. With these great results and a high rate of satisfaction with the _FREEDOM sensation in patients without a need for surgery, any pain or side effects, there is hope that this method will be used by aesthetics doctors for all of the people in the world.

Keywords: The non-surgical face and neck thread lift, innovative technique, simple PDO threads’ lift, no pain, no complication

1) Medical doctor -Skin and Aesthetic clinic, Tehran. Iran.      E-mail: drshohrehshams65@ gmail.com. Instagram page:@drshohrehshams                                  

2) Medical doctor. QUMS.

3) UFMCD student

Correspondence: Dr.Shohreh Shams M.D Medical Doctor of Dr.Shohreh Shams’ skin and aesthetic clinic. No.22, Golha Blv.Golha sq. Fatemi sq. Tehran. 1413873941. Iran


In today’s world, the importance of facial complexes and expressions at first sight in social interactions and communications is clear to everyone. The first impression of appearance and face have effects on many aspects of our life. Such as financial decisions and legal judgments, criminal punishments, and voting patterns in elections . Previous studies have shown that it is difficult to resist judging people by their faces and it has been observed that there is a general agreement to trust some faces. It takes only 100 to 200 milliseconds to understand basic emotions from the face and our guess is correct in 60-90 percent of cases. Because of recent scientific, cultural, and industrial exchanges and advances, people insist on having a beautiful face, to establish and influence as much as possible to succeed in these relationships. The aging process of the skin of the face and neck areas is shown by the loosening of the skin tissue and the formation of wrinkles. We observe facial and cervical soft tissue changes, sagging, and loosening as we grow older. Aging of the face is a complex process involving two important factors: volume loss throughout the face, and repetitive muscle movements that cause wrinkles and folds. The most important parts of the face that are affected by these changes are the forehead, eyebrows, cheeks, jawlines, and neck. Fat tissue atrophy, loss of elasticity of the skin, and the force of gravity are factors that induce facial skin aging. Patients currently seek anti-aging procedures with no incisions and minimal downtime such as thread-lifting with barbed sutures. Thread lifting has been widely adopted for its minimally invasive nature. The esthetic effects depend on the proper placement of threads in the optimal anatomic locations. The results showed that facial rejuvenation thread lifting is effective, safe, and cosmetically more accepted with minor complications than other face-lifting techniques. In this article, these biodegradable threads create a suspension system that is implanted carefully in the ptotic skin of the forehead, temporal, inferior eyelids, mid-face (cheeks), lower-face, double chin, and neck for resolving all degrees of sagging in the areas and removing deep and superficial wrinkles. Up until now, these sterilize simple Polydioxanone (P.D.O) threads were known and used only for their rejuvenating effects on the skin, resulting in collagen formation in the dermis. In this article an innovative technique by Dr. Shohreh shams is introduced and performed on 521 patients throughout 7 years, illustrating perfect results not only in the rejuvenation of the skin but also in face and neck-lift. All of the procedures were performed in Dr.Shohreh Shams Aesthetic Clinic, based in Tehran, Iran.  In line with this goal, plastic surgeons, aesthetic doctors, and patients are looking for low-risk methods that allow them to have a more beautiful, younger, and more impressive face without the need for rest time and with minimal side effects. Among these people who seek the face and neck rejuvenation, are some who are eighteen or above seventy years old or have underlying diseases like epilepsy, diabetes mellitus, lupus, or with allergy to local anesthetic drugs. Therefore a safe and non-invasive method is the solution for their needs. This innovative method of thread lift with simple sterilized absorbable PDO suture with the needle is more attractive with minimal or non-complications, no recovery time needed, for achieving the best results of facial and neck lift.

The thread of PDO ingredient has been used as a suture for a long period and it is proven to be safe. It lasts longer compared to Dexon and Vicryl and completely absorbs after 6 months and disappears from the body. Therefore, it has been used for closing the area which requires long tension. Accordingly, it has been accepted for its safety and sustainability as a suture. In general, a PDO is known to cause changes to the dermis. As discovered in several studies, it has the effect of improving pores or fine wrinkles. Especially, it is known to increase the thickness of the papillary dermis, which is done through the method of fostering collagen formation in the dermal matrix. In the granulation tissues, newly made collagenous connective tissues are abundantly observed. The newly made collagenous connective tissues converge into the pre-existing fibrous connective tissues nearby (merging effect). Through the merging effect, an inflammatory reaction is in progress to the surrounding area where the thread is inserted, and mechanotransduction (=cell signal delivery happens when granulation tissues are formed) starts and spreads as waves to surrounding tissues. Inside the granulation tissues which are newly made near the inserted thread, fibroblasts and myofibroblasts show. Myofibroblast is most clearly related to a wound contracture in the wound healing process, and it is a cell that serves a key role in causing elasticity in the area of the procedure and tight skin after the skin regeneration procedure. The cross-sectional area size of capillaries is larger in the experimental group where the PDO thread was inserted than in the control group. Also, many eosinophils were observed which shows effects for inducing fibrosis in the wound healing process. There was fat cell denaturation by granulation tissue only in the area where the thread was inserted, and there was no change in fat cells away from granulation tissues. Summary of histologic changes after inserting PDO: Newly developed fibrous connective tissue, merging with existing fibrous connective tissue, Tissue contraction by myofibroblast, increased capillary vessel size, Fat cell denaturation.


To perform this study, Dr.Shohreh Shams selected a total of 521 patients between 18 and 81 years old who were candidates for this innovative method of simple PDO thread lifting, from January 2015 to August 2022. For reducing the probable bias in the results of this study, people with relatively similar conditions (education and religion, and welfare status) were enrolled. All procedures were performed at Dr.Shohreh Shams’ skin and beauty clinic, in Tehran, Iran. The selected patients had average aging signs and needed a modest degree of lifting in the face and neck. According to the degree and region of skin sagging in each patient’s face and neck, and based on their beautification, the PDO threads were used in six regions (Figure 1 a, b):

  1. The Forehead region: For lifting the crown of the eyebrows and rising the eyebrows, filling the static and deep wrinkles in between the eyebrows, and removing wrinkles in the forehead area.
  2. The Temporal region: For filling the depression in the temporal area, lateral lifting of the eyes and raising this area (mannequin lift) and removing deep wrinkles around the eyes.

    3.The Inferior eyelid region: For eradicating darkness under the eyes and reducing eye bags, removing deep or fine wrinkles under

the eyes, and enhancing the zygomatic arc which has a major effect on lifting the cheeks and facial beautification.

4. The Mid-face region: For lifting the cheeks and forming cheek lines, filling the nasolabial folds leading to a more beautiful smile, and reducing the tear troughs.
5. The lower-face region: Jawline formation, jawline sharpness, Mandibular Augmentation, filling the concavities of the skin caused by aging in marionette triangle, filling deep wrinkles around the upper lip, lifting and highlighting lip lines in two sessions (2-4 weeks apart).
6. The Neck region: preventing double chin formation in younger adults, reducing the double chin (according to the sagging degree there might be the need for 3 sessions, 1 month apart), and neck lift and removing deep or superficial wrinkles of the neck, beautification of cellulite parts of the neck after double chin liposuction.

Figure1 a, b. Six Regions of the face

The materials used in this article throughout 7 years of data gathering, were SIMPLE P.D.O thread lifts made by South Korea. However for the last two years of the study due to increased quality and new structures of threads, MONO and MONO SCREW threads by Stellar 1⁺, Cosmedic co.Ltd. Based in South Korea were used. Which resulted in better lifting and rejuvenation in the face and neck. More than 23 thousand threads were used for 521 selected patients. Each patient was provided with two sets of forms. First, a thorough questionnaire involving medical records, drug history, and allergies of patients. Before performing this method a written consent form( second one) was collected from all patients.

2.1| treatment protocol:

To perform this innovative technique of simple thread lift or rejuvenation, a local anesthetic (Xyla-P cream=each 100gr contains: Lidocaine 2.5 gr /procaine 2.5 gr) is applied on the area and is left on the skin covered by cellophane paper for 60 minutes to reach maximum anesthetic effect. Next, the skin is disinfected by applying 96% ethanol on cotton pads. Before the procedure, each patient was examined and photographed for further evaluation. (All photos are available in dr. shams’ Instagram page @drshohrehshams) For achieving better results in the procedure, usually, two sessions with 2 to 4 weeks intervals are considered for patients. According to the degree of sagging of their skin, these sessions vary and may reach 3 to 4 sessions. In the first session, the simple PDO threads are planted horizontally, and in the second session, they are planted vertically in the dermis area of the skin. This method creates a fibrin-collagenous mesh-like construction underneath the skin which maintains its constancy for a longer duration and can last 2 to 5 years. The correct way of planting the PDO threads is always starting at the bottom (the neck) and going upward (the procedure ends at the forehead). The correct technique of the implantation of the thread determines the quality and outcome of the procedure. Therefore, knowing the proper depth of insertion and angles of the thread throughout the procedure is crucial for executing face and neck lift perfectly. Each needle-thread enters the skin at a 45-65 degree angle at the depth of 2-3 mm, (the blue point in figure 2) and then slowly moves forward to make its way to the deep dermis area at 180 degree angles and parallel to the skin (in the direction of the arrow in figure 2) so that the tip of the needle can be felt by the practitioner’s fingers every 5 mm. for stabilizing the threads, the needle goes deeper into the subcutaneous fat layer, but in some parts of the face these threads were stabilized in the superficial musculoaponeurotic system (SMAS), by screwing the head of the needle. Then the needle exits the skin, leaving the thread implanted in the deep dermis area (TECHNIQUE A). After taking out the needle, for preventing bruising or hematoma in the region, an icepack (10×13 cm) covered by a sterilized gauze is put on the area with mild pressure on it for 30-60 seconds (TECHNIQUE B).
many patients feel the lifting in the eyebrows and forehead immediately after the procedure. In the second session, preferably after 2-4 weeks, threads are planted parallel or oblique to the eyebrow line and the forehead, forming a mesh-like construction with the previous threads planted, to increase the lifting effect in the area (Figure 4).


Figure 3                                                                   Figure 4

For filling deep and static wrinkles of the forehead (Figure 5), simple PDO needle-thread (29G-38mm) were used. These threads were planted beneath horizontal lines using TECHNIQUE A. for achieving better filling effect before exiting the needle, by taking out the needle a bit and inserting it again in 2-3 directions in a fanning movement, delicate subcisions are preformed, causing small bleedings to occur in intradermal layer of the skin, then patient’s blood fills these gaps to prevent adherence to the lower layers of the skin (TECHNIQUE D).

Figure 5                                                                         Figure 6

Sometimes after the horizontal implantation of the threads, they can be implanted vertically under the wrinkles, however it requires the practitioner’s proficiency and experience. A complication that can occur in these situations is

 entanglement of the threads which can be prevented with avoiding the

path that has any resistance. In these cases divert the thread and cross the existing thread with ease.  For filling the frown line between eyebrows (figure 6) needle-thread PDO Mono 29G-38 mm or PDO Mono 29G-20mm were used based on the length of the line. The first needle-thread enters the deep dermis area under the wrinkle from above, using technique A. the thread is planted there. Before taking out the needle, using technique D, small subcisions are done in both sides of the central line. Then after exiting the needle technique B is executed to prevent any possible hematoma from entering the orbital ring. Then 2-4 needle-thread were planted in the middle section of the forehead using technique C, with 1cm distance   between the eyebrows for longer durability. Considering the anatomy of this area, we do not enter the supra orbital canal and high-rise region at all. The second needle-thread can be inserted 3-5mm from the first one in the opposite way. For lifting the lateral part of the eyes and eyebrows (Mannequin lift) as shown in figure 7and 8, technique A was used but the direction of the threads should be oblique.

FIGURE7                                                                 FIGURE8

Each part needs 5-8 needle-thread Mono 29G-38mm. the first thread enters from hairline aligned with the end of the eyebrow and in direction of hairline of the scalp. The second thread is planted in 4-5 mm distance of the first one and parallel to it and so on. The last thread was planted so that the end of the needle was in 5 mm distance from the orbital OS for reducing and removing the eye contour’s wrinkles. The needle-thread used in this part were 2-5 Mono 29G-25 mm (figure 9 ), and were planted in 1 mm depth of intradermic layer of the skin which is more superficial compared to other regions. It should be mentioned that preforming technique D in this region must be avoided.

Figure 9                                                            Figure 10

To remove dark circles under the eyes and filling the wrinkles and eye bags under the eyes, 1 to 2 sessions are recommended. Both sessions consist of planting 3 needle-threads in both sides of the face. The threads that were used were PDO Mono 29G-25 mm which were planted in the deep dermis and hypodermal fat layer of the lower eyelids in the depth of 2 mm or less. Considering the rich blood flow of this area, any pressure which may cause rupture of the blood vessels or hematoma must be avoided. The threads were planted in 1 cm distance of the eyelash growth line at 45 degree angle (figure 10) and 5 to 15 mm apart from each other. To reduce or prevent hematoma in this region, small balloons of ice covered with sterilized gauze were used to put low pressure on the upper part of zygomatic arc and not the eye socket directly( Figure 11 and 12).

FIGURE 11                                                                    FIGURE 12

To make the zygomatic arc more prominent, which has a major role in beautification and rejuvenation of the face, a PDO Mono/Mono Screw needle-thread was planted in each side of the face. The thread was planted using technique A at the lateral prominence of the cheek and moved along the cheek bow to reach the middle of the cheekbones. As shown in figure 2- part 4, in mid-face region, for cheeks’ lifting 2-3 PDO needle-threads Mono 27G-50 mm/ Mono 27G-38 mm were used. Threads were planted in a down-top manner, parallel to each other and in 5-10 mm intervals from each other with a 20 degree slope, technique A was used and the implantation of the threads were aligned with the cheeks and 3 cm from the hairline; although, they can also be planted in the hairline above the ears (Figure 2-part 4). Planting the threads in the adipose tissue of the cheeks must be avoided. To form a line under the cheeks to make them more prominent, a Mono thread-lift 27G-60 mm was planted on both sides precisely under the cheeks, lateral to the median hypothetical line of the face, with a 35-45 degree angle and in depth of 1-1.5 mm of the skin.

FIGURE 13                                                              FIGURE 14

For filling the nasolabial lines, also known as laughter lines, in the first session a Mono thread-needle 26G-60mm was planted on both sides of the face using technique A (figure 15). The thread enters the deep dermis area just under the NL line and 2 cm from the median chin line in an upward manner. When these lines were static and deep, technique D was used. With a needle-thread Mono-27G above the previous thread entry point, the thread was entered the deep dermis area to eliminate adhesion and filament formation in the area. In the second session the same method as the first session was performed to witness better results (Figure 16).

FIGURE 15                 FIGURE 16

In the lower-face region for creating jawline sharpness, longer threads like Mono/ Mono Screw 26G-90 mm were used 2-3 needle-threads were used in each side of the face. In the first session, the blue entry points were 1-2 cm lateral and beneath the mental protuberance. The threads move lateral of the entry points and toward mandibular angle (Figure 2 a-part 5). Each thread planted parallel to each other with a 5-10 mm interval, using technique A and C. For mandibular augmentation, after the previous method was performed, 2 needle -threads (Mono/Mono Screw 27G-60 mm) were planted on each side (using technique A and B). The main entry point of the first thread was selected 1-2 cm from the hypothetical median line of the face (the chin region).the thread moved parallel to the mandibular horizontal edge and was planted in the SMAS of the mandibular angle. Mono Screw threads, because of the extra volume they add to the region, are ideal for highlighting the mandibular angle (Figure 17 and 18).

FIGURE 17                                                      FIGURE 18

For lifting the lower-face, depending on the sagging degree of the region, a second session is needed using 6-7 thread-needles PDO Mono/mono screw 26G-60 mm. These threads were implanted in a down-top manner from nasolabial folds to lateral part of the face (the blue entry point in figure 2b-part 5) parallel to each other and 5-10 mm apart (Figure 19 and 20).

Figure 20.Lower-face lifting. Second session (vertical implantation)

Figure 19.Lower-face lifting. First session (horizontal implantation)

For filling the lines and fine wrinkles above the upper lip, one needle-thread Mono 25G-25 mm was used for each line with technique A, B and D respectively. In the same session or the second one, 2 needle-threads Mono 25G-25 mm or 27G-38 mm were planted perpendicular to the previous threads on each side, between the upper lip and nose, in the intradermal or hypodermal fat layer of the skin. For filling the Marionette triangle or grief lines (figure 2-part 5), the first session consists of entering the deep dermis area with 3 needle-threads Mono/Mono Screw 27G-38 mm in a cross and upward manner, using technique A, C and B respectively. Due to subcisions in this area and possibility of hematoma, the practitioner should mention to the patients that there is a possibility of bruising in this area in 7-10 days after the procedure and that by using this method there will not be a need to use filler such as gel or lipid to fill this region (figure 21 and 22).

FIGURE 21                                                             FIGURE 22

To highlight the lip lines, according to the size of the patient’s lips, 5-7 needle-threads Mono29G-25 mm or Mono 29G-38 mm were planted delicately just under the lip lines and technique B was used to reduce hematoma in the region. For removing and reducing the double chin, the volume of the fatty hypodermis and mild to severe degree of the sagging of this part are important factors to determine the number of the sessions needed for each patient. Some patients may need third or fourth session 3-6 months apart and some patients are recommended to undergo the thread-lifting procedure annually to reduce their double chin. In the first session 2-5 needle-threads Mono /Mono Screw 27G-38 mm were planted vertically and parallel to each other (along the hypothetical median line of the face), in the area under the chin and hypothetical line that separates chin and the neck on each side (figure 23 and 24) so that the end of each needle-thread was in the hypodermal fat layer of the skin.

FIGURE 23                                                        FIGURE 24

In the second session, 3-5 needle-threads Mono /Mono Screw 27G-38 mm were planted on each side (Figure 2 c), perpendicular to the previous threads in a back and forth manner and 1 cm apart from each other. Another method was the cross technique which consisted of 2 needle-threads Mono 26G-60 mm planted under the chin in a cross (×) form.


For lifting the neck, in the first session a needle-thread Mono 27G-50 mm was planted on each side gently at the depth of 1-2 mm of the skin (figure25 and 26). The entry point of the thread is 1 cm below the mandibular angle and is planted in the deep dermis area along the hypothetical line that separates chin and the neck (Figure 2 c). Then 2-4 threads were planted on each side, parallel to the first one and 5 mm apart from each other. The next session are performed like the first one and may need performing technique C to achieve better results. For removing wrinkles of the neck, 3-5 needle-threads Mono 29G-38 mm or Mono 29G-25 mm were planted on each side, under the neck lines or wrinkles from the lateral part of the neck toward the median line or contrariwise. Planting these needle-threads even in the décolleté area showed fantastic results in removing wrinkles and filling the lines in the area.

FIGURE 25                                                               FIGURE 26

2.3.| Finally, as soon as the PDO’s needles are ejected, a sterilized gauze (10.10 cm) is put on the area and an ice pack is placed on top of it. By applying mild pressure on the area using the palm of the hand (technique B) any possible bruising can be prevented. Immediately after the procedure, significant improvement in the skin is detectable.
2.4.| OUTCOMES ASSESSMENT: After this innovative technique, the results were assessed by Dr. Shohreh Shams and patients based on the GAIS (Global Aesthetic Improvement Scale) score. The patients were followed up 2 weeks, 4 weeks, and six months after the procedure. Outcomes were evaluated by asking them to rate their satisfaction on the following scale: Exceptional improvement, patient very improved, improved patient, unaltered patient (Table 1). This procedure that does not require surgery showed no pain or no side effects. It is a safe and easy method for aesthetic practitioners and patients. As the results of all selected patients in this study showed, the satisfaction rate of the procedure increased over the six months follow up which suggests that this innovative method of lifting by simple PDO needle-threads is the foremost method for lifting the face and neck.


In this non-surgical innovative technique, the skin of the face and the neck reached the best natural results of lifting and rejuvenation, six months after the procedure. In duration of 7 years of this study, many patients returned to repeat the procedure after 2 weeks, 4 weeks 3 or 6 months, occasionally after 1, 2 or 5 years. Which indicates their satisfaction of the procedure and the results. In this study great results were witnessed for patients with mild, moderate and severe degree of sagging of their skin. In patients with highly elastic (could not perform the pinch test on their skin, Figure27) and normal skin, this method showed Preservative and rejuvenation effect which was used to prevent sagging of the skin in the future. Many younger patients with high elasticity and firm skin, requested the procedure mainly to increase the sharpness of their jawline and reduce dark circles under the eyes which declared their satisfaction up to 99% of the times immediately after the procedure. According to few patients (1%) opinions, they felt slight discomfort and pain in the site that was undergoing the procedure which were reassured by the practitioner that after removing the needles the pain will disappear. On rare occasions a painkiller (Acetaminophen 500 mg) was prescribed for patients in case of pain. Any pain killer from NSAID group must not be prescribed because of their anti-inflammatory effects.

FIGURE 27                                                                  FIGURE 28

In this non-surgical innovative technique which showed no side effects, for not using injectable anesthetics, patients felt more at ease and people with needle phobia could undergo this procedure. Patients over 60, patient with underlying disease such as DM, epilepsy, lupus or hypothyroidism can easily benefit from this method without worrying about any complications.


The results illustrated that the level of satisfaction of patients and Dr.Shohreh shams increased over time. These results demonstrated that facial/neck lifting by this innovative non-surgical thread-needling with simple PDOs is a revolution in aesthetic procedures worldwide. This method is more effective and accepted by practitioners and patients which does not require rest time, surgery recovery or constant follow ups by the aesthetic doctor and patients can show up at work immediately after the procedure. Prescribing antibiotics, daily bandages or any post-surgery care are not required. (Figure 29, 30).

FIGURE 29                                                              FIGURE 30


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