The Art of the Lift: Why More Is More When It Comes to PDO Threads
One of the most common questions I hear is simple: "How many threads do you use?" But the answer is anything but simple. It's a question that reveals a deep misunderstanding of what PDO threads can actually do. Most people—and frankly, many providers—think of threads as just a quick lift. They see the dramatic videos online: long, spiky barbed threads, sometimes called cog threads, that tunnel through the skin and pull everything back into place. It looks impressive, and it works—for a while.
But here's the hidden truth that doesn't get enough attention: if you're only using the pulling threads, you are building a house on a weak foundation. The lifting threads provide immediate gratification, but they don't address the core issue of aging. The real magic, the lasting transformation, happens when you stop thinking about threads as a simple tug-of-war and start thinking about them as a way to rebuild the very structure of your skin.
Beyond the Pull: The Three Pillars of a Thread Lift
Let's break down the types of threads. There are essentially three categories. First, the barbed threads—those are the ones you know, used for pulling and lifting. Second, we have smooth threads. Think of them like short pieces of dental floss, one-and-a-half to two-and-a-half inches long. They don't pull anything; they are the scaffolding. Finally, we have twist threads, which are smooth but coiled, like a miniature spring.
Now, here is the crucial insight that separates a temporary fix from a long-term rejuvenation. The pulling threads are for the immediate show. The smooths and the twists are for building the foundation of collagen. If I just lift your skin with barbs today, in six months, when the PDO material dissolves, your results will likely disappear with it. That's the biggest fear people have, and it's a valid one when a treatment is done incompletely. You leave the office looking fantastic, but a few months later, you're back to square one.
To make results last a year and a half to two years, you must build the quality of your skin. You must stimulate that deep collagen net. That is why my approach is different. Yes, I will lift everything back and up. But that is only the first step. After the lift, I lay a whole meshing of smooth and twist threads across the entire area. Deep nasolabial folds and marionette lines get the coiled twists, as they provide more structure in those deep creases. Then, all over the soft tissue of the mid-face, I grid the area with smooth threads to trigger a powerful, lasting collagen response.
The Real Number: Why 40-50 Threads is the Standard
This brings me back to the original question about numbers. When I tell a new client that I use anywhere from 40 to 50 threads just for the mid-face area, the reaction is almost always shock. They either have tried threads before and received only 8 to 10, or they are new to the treatment and have only seen those online videos of a provider placing a half-dozen barbed threads.
This explains the price confusion as well. A client comes in with a fixed price in their mind based on a treatment that used only 10 threads. They see my quote and think we are simply charging more. That's not the case at all. We are not charging more for the same thing. It is the same principle as Botox or fillers. You can be quoted for 20 units, or you can be quoted for 50 units. You can be quoted for one syringe of filler, or you can be quoted for six. You will get a result from one syringe, but you will not get the result—the full correction, the transformation that lasts. It's not about doing more to charge more; it's about charging for what is necessary to achieve the lasting outcome you deserve.
Think about the aging process itself. We all age the same way: we lose bone, we lose fat, we lose collagen, and even a component of muscle. What you are left with is just loose skin, which then slides forward and downward. You see hollowing around the temples, hollowing in the cheeks. If I simply lift that loose skin back, I have not addressed the hollowness beneath it. I have not addressed the collagen loss. I have just moved the problem.
So, how many threads do I truly use? For a typical patient in their 40s, 50s, or 60s, I can easily push that number to 50 or even 60 threads by the time the main treatment and a possible follow-up are complete. For someone in their 20s, with better skin quality, it might be 20 to 30. The number is not just a number; it is a prescription. It is the precise amount needed to fully correct the lifting, the collagen production, the improvement of skin quality, and that overall, undeniable glow. That is the totality of what PDO threads can offer, and it cannot be achieved with a quick pull.
That is why I do it this way. It is the right way. It is the way that gives you full correction and lasting, beautiful results.