Combining Botulinum Toxin and PDO Threads Offers Effective Solution for Upper Face Wrinkles: Study Reveals

"While PDO threads have their benefits, combining them with botulinum toxin allows for a more effective and aesthetically pleasing solution, especially for patients with persistent or advanced wrinkles," the researchers wrote in the Archives of Dermatological Research.

With aging, facial lines on the forehead and glabella often transition from dynamic to static, contributing to an aged appearance. Polydioxanone sutures have gained popularity as an effective treatment for correcting deep static wrinkles in the upper face. Nourhan Anis, Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt, and colleagues aimed to evaluate the combined efficacy of botulinum toxin injections and PDO threads in addressing upper face static wrinkles.

For this purpose, the researchers included 30 adult patients with static forehead wrinkles. Participants were randomly assigned to one of two groups: one group received only thread insertion, while the other group received thread insertion combined with botulinum toxin injections. The treatment's effectiveness was assessed after two months using the Global Aesthetic Improvement Scale.

The key findings of the study were as follows:

• The study found a statistically significant reduction in forehead wrinkles in Group II compared to Group I.
• A trend toward improvement in glabellar wrinkles was observed in Group II compared to Group I.
• However, the improvement in glabellar wrinkles did not reach statistical significance.

PDO threads and botulinum toxin work synergistically to target multiple factors contributing to aging, providing a comprehensive anti-aging solution for individual customization based on the patient’s needs. This innovative therapy has proven especially effective for treating wrinkles in the forehead, between the brows, and near the eyes.

In conclusion, combining botulinum toxin with PDO threads offers an advanced, non-surgical solution for upper face static wrinkles. This approach provides a more natural-looking outcome with higher patient satisfaction while positioning PDO threads as a reliable third-line option alongside botulinum toxin and soft tissue fillers.

"Absorbable polydioxanone threads can be regarded as a third-line option for wrinkle correction, complementing botulinum toxin and soft tissue fillers. While threads alone may not address all cases, combining them with botulinum toxin offers improved, natural-looking results and higher patient satisfaction," the researchers wrote.

Reference:

Bessar, H., Nassar, A., Saad Eldin, R.M. et al. The synergistic effect of combining botulinum toxin with polydioxanone threads on the upper face static wrinkles. Arch Dermatol Res 317, 123 (2025). https://doi.org/10.1007/s00403-024-03420-3