Polydioxanone threads have moved from niche technique to a dependable tool in medical aesthetics. Used well, PDO thread lifting treatment can refine contours, soften folds, and tighten early sagging without a scalpel. Used poorly, it can bruise a patient’s trust as fast as it bruises the skin. The question patients ask most at a PDO thread consultation is deceptively simple: how many threads do I need? The honest answer depends on the anatomy, the type of thread, and the job you want the thread to do.
I have placed thousands of threads over the years. The numbers below are not slogans from a brochure, they are realistic working ranges that account for variation in skin thickness, laxity, and facial volume. Think of them as well-worn guardrails rather than strict rules. Your own plan should come from a hands-on assessment, a discussion of priorities, and a willingness to stage treatment if needed.
What thread does what
PDO threads come in three broad categories that behave differently in tissue.
- Smooth or mono threads. These are fine filaments used for collagen stimulation, texture improvement, and subtle tightening. They do not grip, they seed the area with points that trigger a repair response. You use many of them. They shine for under eye crepiness, barcode lines around the mouth, and general skin rejuvenation. Twisted or screw threads. These add a touch more volume and spring than smooth threads, helpful for etched lines and mild hollows. You still use several per zone, but not as many as monos. Barbed or cog threads. These are the workhorses of a PDO thread lift for facial lifting. Micro barbs anchor in the subdermal plane and can reposition soft tissue, giving a non surgical facelift effect. You use far fewer, and placement matters more than count.
The right mix produces better results than any one category alone. For example, in the lower face I often pair four to eight barbed threads for lift with a field of twenty to forty smooth threads for skin tightening treatment and collagen boost. That combination supports both shape and skin quality.
How to think about “how many” before you count
Several factors nudge the number up or down. Moderate laxity needs more support points, thick sebaceous skin needs stronger vectors, and very thin skin needs gentler threading but often more of it to distribute traction.
Age is not the only driver. I have seen a lean 36 year old after massive weight loss need more PDO threads for facial lifting than a 52 year old with good bone support and consistent sunscreen use. Ethnicity and dermal thickness matter. So does the history of fillers, neuromodulators, and collagen stimulating treatments such as biostimulators or microneedling RF. If you come in with strong zygomatic support from prior filler, I can use fewer lifting threads in the midface and devote more budget to jawline finesse.
Plan for asymmetry. Almost every face is heavier on one side. Build in an extra lifting thread or two for the side that falls sooner, or add more mono threads on the side with thinner dermis. The most natural pdo threads results come when we stop insisting on perfect symmetry and instead aim for balanced light and shadow.
Area by area: realistic thread counts and patterns
Numbers below reference a typical primary treatment for someone with mild to moderate laxity. Severe laxity, major weight loss, or advanced photoaging will stretch these numbers and may call for alternative or staged approaches.
Brow and temple lift
Goal: open the eye, soften hooding, and improve lateral brow position without a surgical brow lift. For true lifting, barbed threads run from the hairline or temporal scalp toward the lateral brow tail. Smooth threads can be added to the crow’s feet for skin rejuvenation.
Typical counts:
- Barbed threads: 2 to 4 per side, usually two longer vectors that fan from the temple, with an optional shorter vector if the brow tail is heavy. Smooth threads: 10 to 20 per side around the lateral canthus and temple for fine lines and skin firming.
What changes the count: strong frontalis activity, thin skin over the lateral brow, and prior upper blepharoplasty may require more gentle reinforcement rather than aggressive lift. If the brow sits low due to heavy eyelid skin, a PDO thread cosmetic lift offers only modest change; it is safer to set expectations and possibly combine with neuromodulator to reduce brow depressors.
Under eye area and tear trough zone
Goal: reduce crepiness and fine lines. PDO threads for the under eye area should avoid heavy tethers. Smooth threads work best here for collagen stimulation.
Typical counts:
- Smooth threads: 8 to 20 total, split between both eyes, laid in a lattice just below the orbital rim and into the malar junction. Screw threads: 2 to 4 per side in carefully selected patients with mild hollowing, though many do better with filler or a mixed approach.
What changes the count: very thin skin means lighter threading and smaller numbers at first. If there is significant fat pad pseudoherniation or true tear trough hollow, PDO thread therapy may be supportive but not primary. For that anatomy, pdo threads for fine lines pair well with conservative filler or energy based tightening.
Cheeks and midface
Goal: restore cheek projection and reduce nasolabial fold heaviness by elevating the ptotic tissue toward the zygoma. The pdo thread lifting procedure here uses barbed threads placed from preauricular or temporal entry points.
Typical counts:
- Barbed threads: 2 to 4 per side, angled to capture the malar fat pad and midface. Heavier tissue calls for four per side. Smooth threads: 10 to 30 per side for skin support treatment along the malar mound and over the nasolabial region, especially if the skin shows fine wrinkling.
What changes the count: prior midface filler decreases the barbed thread count because volume already supports the cheek. However, post filler skin often benefits from mono threads to refine texture. If the zygomatic arch is flat, even well placed threads will struggle to hold, which nudges the plan toward combination therapy.
Nasolabial folds and smile lines
Goal: soften etched lines. True lifting from the lateral face improves these folds more than stacking threads directly into the fold, but smooth or screw threads can be used to stimulate collagen where the crease is etched.
Typical counts:
- Smooth or screw threads: 6 to 12 per side placed parallel and slightly oblique to the fold, not directly into the crease, to avoid bunching.
What changes the count: deep folds from volume loss in the piriform area rarely respond to threads alone. A thoughtful blend of collagen stimulators or hyaluronic acid plus a couple of lifting vectors in the midface gives a better result than trying to overthread the fold.
Marionette lines and prejowl sulcus
Goal: reduce the downturned corner of the mouth and the early jowl crease. The pdo threads for marionette lines often combine barbed vectors pulling upward and slightly posterior with a few smooth threads to support the dermis around the commissure.
Typical counts:
- Barbed threads: 2 to 3 per side for lower face lifting, following vectors from near the marionette line up toward the ear or lateral cheek. Smooth threads: 6 to 12 per side around the commissure and mental crease.
What changes the count: a heavy platysma with strong depressor anguli oris pull can overpower threads. In that setting, a low dose neuromodulator in the DAO and platysma bands plus two extra lifting vectors makes a marked difference.
Jawline definition
Goal: sharpen the mandibular line, reduce early jowling, and support the area under the chin. Here, pdo threads for jawline are typically barbed, laid along the mandibular border with firm anchoring points.
Typical counts:
- Barbed threads: 3 to 5 per side along the jawline from the angle toward the chin point. Smooth threads: 10 to 20 across the submental and submandibular skin for additional tightening and texture improvement.
What changes the count: a deep pre jowl sulcus and bony retrusion need structural support from filler or long lasting biostimulators. Threads can only do so much without something to lift against. If the skin is thick and sebaceous, I lean toward more robust cogs and an extra vector per side.
Double chin and submental region
Goal: tighten the thin, lax submental skin that wrinkles when you look down, and provide subtle support under the chin. PDO threads for double chin rely mostly on smooth threads to cause dermal thickening and mild tightening.
Typical counts:
- Smooth threads: 20 to 40 across the submental zone in a crisscross lattice. Some providers add 2 short barbed threads horizontally, but I prefer to reserve cogs for the jawline or midface.
What changes the count: if the issue is fat volume rather than lax skin, lipolysis, deoxycholic acid, or energy based reduction first will let the threads succeed with fewer passes. Treat fat first, then tighten.
Neck tightening
Goal: improve horizontal necklace lines and overall creepiness. PDO threads for neck tightening are almost entirely smooth or screw, placed in a sheetlike pattern across the anterior neck and lateral platysmal areas.
Typical counts:
- Smooth or screw threads: 30 to 60 across the neck, depending on skin surface area and laxity. Shorter lengths allow more precise placement around horizontal lines.
What changes the count: pronounced vertical platysmal bands do not respond well to threads alone. They need neuromodulator or a surgical approach. In heavy photoaging, I stage the neck over two appointments, about eight to twelve weeks apart, rather than blasting all at once.
Lip lines and perioral area
Goal: reduce barcode lines and improve perioral skin texture. PDO thread anti wrinkle treatment here relies on small smooth threads.
Typical counts:
- Smooth threads: 10 to 20 around the upper lip and lower lip, angled like sun rays rather than packed into the vermilion border.
What changes the count: smokers, or those with strong orbicularis oris activity, often benefit from pairing threads with microdoses of neuromodulator and skin resurfacing. Do not try to replace deep structural changes with more threads, it leads to stiffness.
Lower face consolidation
Goal: integrate multiple zones for a coherent result. A pdo thread facelift is not a single pass, it is a coordinated set of vectors and skin support. In a typical lower face session for moderate laxity, a reasonable plan might include four barbed threads per side for the jawline and marionette area, two barbed threads per side for midface support, and twenty to thirty smooth threads per side to reinforce the dermis around the jawline, marionette, and submental skin. That mix yields a visible, natural lift and firmer skin without the overdone pulled look.
How many threads by concern, not just by area
Patients rarely sit down and ask for a certain thread count. They point to the mirror and say, this part drops, this line bothers me, this looks tired. Mapping counts to concerns helps.
- Early jowls with good skin quality: 6 to 8 barbed threads total, plus 10 to 20 smooth threads along the jawline. Flattened cheeks and deepening nasolabial shadows: 4 to 6 barbed threads total in the midface, with 10 to 20 smooth threads over the malar and fold region for skin support. Crepey neck without heavy bands: 40 to 60 smooth threads over one or two sessions. Under eye crepiness and mild hollow: 12 to 20 smooth threads total, possibly paired with a conservative filler if needed. Global skin rejuvenation without lift: 60 to 120 smooth threads over the face and neck, staged across two appointments for comfort and even collagen stimulation.
These are practical numbers, not marketing promises. If a practitioner suggests two barbed threads for a full lower face lift in a patient with clear laxity, pause and ask about plan B and expected durability.
What to expect from a pdo thread procedure, step by step
The pdo thread procedure steps are straightforward when done by an experienced hand. After a detailed pdo thread consultation, we clean and mark vectors with the patient upright to read gravity properly. Numbing can be topical, injected local anesthetic, or both. Barbed threads sit in cannulas or blunt needles; smooth threads load into fine needles.
I usually start with lifting vectors first, since they set the new contour. After passing a cog, I tension gently, check for even lift, and trim the tail. Then I layer smooth threads in the dermis to seed collagen and stabilize the new shape. The entire pdo thread therapy for face can take 30 to 75 minutes depending on the plan.
Bruising is possible, especially with smooth threads where we place many. Swelling peaks in the first 48 hours. Mild puckering near the entry point can appear when you move. This generally smooths within a week or two as the thread integrates. Pdo threads recovery time for most patients is brief: back to desk work the same day or the next, gym after 3 to 5 days, dental work delayed two weeks to avoid opening the mouth wide against new vectors. Sleeping on your back for the first few nights helps protect the lift.
Safety, side effects, and realistic limits
PDO threads are absorbable and have a long safety https://www.facebook.com/people/Soluma-Aesthetics/100089425911968/ history in surgery. That does not make them trivial. Common pdo thread side effects include bruising, swelling, tenderness, transient puckering, and small entry site marks that resolve. Less common issues include thread visibility in thin skin, palpable knots, asymmetry, and rare infection. In skilled hands, these are manageable. I prefer to undercorrect slightly on day one, then review at the two to four week mark to decide if a touch up thread or two will perfect the result.
Where threads underperform:
- Heavy lower face with significant skin laxity that folds on itself when looking down. Advanced platysmal banding in the neck. Strong bony retrusion of the chin or midface. Very thick, oily skin that fights subtle redraping.
In these cases, you can still use pdo threads for skin tightening as part of a broader plan, but do not lean on them to do the whole job. The best pdo threads aesthetic treatment sits alongside neuromodulators, judicious fillers, energy based tightening, skin resurfacing, and a disciplined skincare routine.
How long results last and when to repeat
The lift from barbed threads generally holds for 6 to 12 months in mild laxity, sometimes up to 18 months when vectors are ideal and tissue is cooperative. The collagen from smooth threads builds for about three months and can persist beyond a year. Longevity depends on lifestyle, weight stability, sun behavior, and your baseline support structures.
For maintenance, patients who love the effect often schedule a lighter touch session every 9 to 12 months. I tend to refresh the skin field with smooth threads annually, then re place the most hard working lifting vectors every 12 to 18 months as needed. If you gained or lost significant weight, re evaluate earlier.
Cost ranges and how count affects your budget
PDO threads treatment cost varies by region, thread type, and operator skill. Clinics price by thread, by area, or by package. A single barbed thread can cost as little as 150 or as much as 400 in some cities. Smooth threads often bundle, with sets of ten to twenty priced together. A full lower face and jawline pdo thread lift may range from 1,200 to 3,500 or more. A neck field of forty to sixty smooth threads might sit around 800 to 2,000 depending on the market. If the plan calls for 8 to 10 cogs plus 40 monos, expect package pricing rather than a la carte; it is almost always more cost effective that way.
At a pdo thread appointment, ask exactly how many of each thread type is included and what additional touch ups cost. Clear numbers prevent mismatch between expectation and wallet.
Before and after: what counts as a win
Good pdo threads before and after photos show:
- A softer, straighter jawline with less shadow under the jowl. Milder nasolabial and marionette shadows because the cheek mass sits higher. Fresher skin texture, subtler lines, and better light reflection on the cheek. A lateral brow that sits a few millimeters higher without a surprised look.
The wrong metric is a centimeter of lift in a downward facing selfie the next day. Early swelling and tension exaggerate change. Judge at three to six weeks, and again at three months when collagen stimulation has matured.
How we stage multi area plans
When several areas need work, I prefer to stage. Lift first, then texture. On day one, place the barbed threads for facial contouring and functional support. Let the swelling settle for a week or two. Then, if we plan a dense field of smooth threads for skin rejuvenation, we can focus them with more accuracy. Staging also makes recovery easier and gives space to address asymmetries before locking in more collagen.
For example, a 48 year old with early jowls, mild cheek descent, and necklace lines might follow this path: session one, eight cogs across midface and jawline with ten smooth threads per side for reinforcement. Session two, at three weeks, thirty to forty smooth threads across the neck and perioral area. Session three, at three months, reassess and add six to ten smooth threads under the eyes if needed. This approach respects biology and the patient’s schedule.
Technique matters more than raw numbers
Two providers can use the same number of threads and deliver different outcomes. Vectors must align with ligamentous anatomy and respect the retaining ligaments like the zygomatic and mandibular ligaments. Entry points should avoid danger zones, and depth must sit in the correct plane to prevent rippling or visibility. For smooth threads, uniform spacing and consistent depth make the collagen field even. For barbed threads, secure anchoring and gentle post tensioning create a natural slope rather than a step off.
I tell patients: count matters, but hands matter more. If a clinic quotes a surprisingly low count for broad goals, ask to see pdo threads before and after images from similar pdo threads near Orlando, FL faces. If they quote a very high count without explaining why, ask how vectors and collagen fields will work together, not just how many needles will touch your skin.
A quick readiness checklist
- Your goals match what PDO threads can deliver: lift of a few millimeters, better contour, tighter skin, not a surgical result. You accept short downtime: swelling and bruising for a few days, puckering that relaxes in one to two weeks. You can pause vigorous exercise and dental work briefly, and you can sleep face up early on. You are open to combination care: neuromodulator, filler, or energy based tightening if anatomy calls for it. You can commit to maintenance every year or so for best longevity.
Final word on numbers
For most faces with mild to moderate laxity, a credible pdo threads cosmetic treatment plan will sit in one of these ranges:
- 6 to 12 barbed threads total to lift the midface and lower face. 20 to 60 smooth threads across targeted facial zones for collagen support. 30 to 60 smooth threads for the neck when crepiness is the main concern.
From there, we fine tune based on skin thickness, fat pads, bone support, and your priorities. PDO threads are a tool, not a doctrine. When placed with judgment, they provide a natural lift, more defined features, and a real boost in skin quality. When counted like confetti or rationed like ration cards, they disappoint. Ask good questions, expect a tailored map, and choose an operator who sees both your anatomy and your calendar. That is how you turn numbers on a tray into results in the mirror.