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Updated: May 7, 2026

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Reverse Knot Technique for Face Lifting With Polydioxanone Thread.

Ana Paula Dornelles Manzoni1, Alessandra Haddad2, Andréia Fogaça3

  • 1Complexo Hospitalar Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Journal of Cosmetic Dermatology
|May 6, 2026
PubMed
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The novel reverse knot technique for polydioxanone thread lifting offers effective midface support for patients with heavy faces. This minimally invasive procedure provides immediate results and high patient satisfaction with minimal complications.

Area of Science:

  • Aesthetic medicine
  • Dermatologic surgery

Background:

  • Polydioxanone threads are increasingly used for facial rejuvenation, offering good safety and tissue integration.
  • Their application includes soft-tissue repositioning and stimulating collagen production.

Purpose of the Study:

  • To introduce and describe the reverse knot technique for polydioxanone suspension thread implantation.
  • This technique aims to enhance facial lifting, particularly for individuals with heavier facial structures.

Main Methods:

  • An original polydioxanone thread-lifting technique is presented, termed the reverse knot technique.
  • The method involves placing the knot anteriorly, below the zygomatic cutaneous ligament, and anchoring the thread in the temporal fascia.
  • This creates a lever mechanism for improved lifting of the mid and lower face.
Keywords:
facial asymmetryheavy facenonsurgical liftpolydioxanonethreadthread‐lift

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Main Results:

  • The reverse knot technique provides immediate and effective support for midface soft tissues.
  • It serves as a minimally invasive alternative to traditional face-lifting procedures.
  • High patient satisfaction and minimal morbidity were observed.

Conclusions:

  • The reverse knot technique is an effective method for midface rejuvenation.
  • Experienced practitioners should perform the procedure, as medial knot placement can increase support but also risks localized depressions.