Abstract
Introduction: The fascination with beauty attracts optimizations of surgical techniques through the use of PDO (polydioxanone) threads. In recent years, the use of barbed tensor threads has gained popularity as a means of rejuvenating the face. Objective: This study presented the main clinical and aesthetic approaches to optimizing techniques using PDO threads for facial rejuvenation. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 101 articles were found. A total of 17 articles were evaluated and 14 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 38 studies with a high risk of bias and 35 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=65.7%>50%. It was concluded that the combination of lower blepharoplasty and midface lift using PDO threads is a comprehensive and effective approach for facial rejuvenation. It significantly improves wrinkle reduction, midface lift, and patient satisfaction. Ultrasound-guided thread lift, a method of evaluating and performing midface lift, proves to be safe and efficient. This approach holds promise as a future option in anti-aging cosmetic surgery, presenting a minimally invasive alternative with natural-looking results and reduced downtime. The Cartesian Technique™ with Smart PDOs™ is an effective protocol for skin resurfacing that enhances cellular biostimulation through the release of bioactive drugs. Using PDO threads for midface lifting is simpler, faster, and less invasive than conventional surgical methods, and this method simultaneously achieves satisfactory results. The combination of hyaluronic acid fillers and PDO threads was effective in achieving and maintaining long-term improvements in facial volume and contour. Thread lifting with short, wedge-shaped PDO sutures is safe and effective for facial rejuvenation. The vertical lifting technique has shown advantages over current approaches. Wedgeshaped PDO sutures in a folded configuration are a promising treatment option for deep static wrinkles in the upper face. The “Half Moon Base” incision and use of 4.0 PDO threads have shown significant aesthetic results in the eyebrow.