Incidence and Predictors of Complications After Polydioxanone Thread Lift: A Multicenter Retrospective Cohort Study

Polydioxanone (PDO) thread-lift is a minimally invasive technique used for facial rejuvenation. However, high-quality evidence regarding the incidence of complications and its predictive factors remains scarce.

In this study, we aimed to determine the incidence of complications following PDO thread-lift procedures, identify the independent predictors for complications, and construct a clinically applicable risk-scoring model.

In this multicenter retrospective study, we analyzed 2000 randomly selected cases of PDO thread lifting performed at 105 clinics between November 2020 and December 2023. Age, sex, thread count, and incidence of postoperative complications were evaluated. Multivariate logistic regression and receiver operating characteristic curve analyses were used to identify predictors and validate model performance. A weighted risk score was developed using thread count and age as covariates.

The overall complication rate was 12.4%. The most common adverse events were skin retraction (6.35%), asymmetry (2.9%), and pain (1.75%). Multivariate analysis identified thread count (odds ratio [OR]: 1.12 per thread, 95% confidence interval: 1.09-1.15) and older age (OR: 2.14 for 40-49; 3.38 for 50-59; 5.08 for ≥60) as independent predictors of postoperative complications. A risk score combining these variables demonstrated strong discrimination (area under the curve = 0.747), with a cutoff of 9 points, yielding a sensitivity of 90.3% and specificity of 46.9%.

This study presents the first large-scale, validated, PDO-specific scoring model for predicting complications after thread lifting. By enabling objective preoperative risk stratification, the model supports safe, evidence-based, and personalized aesthetic treatment planning.

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