The Procedure


Local anaesthetic is injected into the treatment area. The PDO thread will then be introduced using a cannula or fine needle into the required area. The procedure rakes around 45-60 minutes depending on what treatment the patient requires, and the number of threads used. The patient can fully resume their everyday routine and social commitments within a couple of days. PDO therapy is a tailor-made treatment which can be adjusted to the patients’ requirements at any time. When PDO therapy is combined with PRP, fillers and Botox, even greater results can be achieved.

PDO Insertion Protocol

Depth of PDO / Cog Insertion:

The correct depth for inserting barbed cogs is in the Superficial Muscular Aponeurotic System (SMAS).









What is SMAS?

Superficial Muscular Aponeurotic System (SMAS) indicates upper Musculo aponeurotic system located

directly through the skin. Thus, correction in SMAS is essential in face lift and TOP CLASS can solve this fundamental problem to bring your original beauty back.

If they are inserted too superficial within the dermal plane then they may be seen or felt and would fail to provide the required lifting and collagen production stimulation. Placed too deep and they would pose a greater rise of damage to arteries, veins, the facial nerve and causing other structural damage.

Therefore, it is crucial for the aesthetic practitioner performing any treatment with PDO threads to have a detailed in-depth knowledge of head and neck anatomy.

Particularly they should note the importance of mansions point which provides 100% identification of the facial artery within 3mm in living human subjects.

Mapping of the facial artery and its relationship to anatomical landmarks; frontal view (A) and lateral view (B). Results presented as median and quartiles. Yellow lines indicate the Manson’s point (M), which is an area on the face that can be located based on surface landmarks and the facial artery to be located with a very high probability. AA, angular artery; ILA, inferior labial artery; SA, submental artery; SLA, superior labial artery, X, Y, Z – from the inferior border of the mandible body to the lowest contour of the branching point for ILA, SLA, and LNA.

PDO or Cog Thread Treatment Procedure

  1. Decide on the anatomical features related to the vector of contraction for connective tissue, lifting and required skin tightening.
  2. Decision making on which barbed cogs to use.
  3. Apply topical anaesthetic cream such as EMLA 5% or LMX4-4%.
  4. Consider if antibiotics are needed in case of Cogs therapy, depending on number of threads and insertions (Azithromycin 500mg 1 hour before treatment followed by 500mg daily for 2 days – 3 x 500mg in total).
  5. Take photographs before treatment, after performing procedure on 1 side (to demonstrate the difference) and after treatment.
  6. Remove all make up if applicable and disinfect the skin with Chlorhexidine or alcohol-based swabs.
  7. Use marker pencil for treatment plan.
  8. Application of aseptic technique is essential.

i) Ensure that hair is covered, and ears and hairlines are meticulously cleansed with surgical spirits or Chlorhexidine. To prevent any contamination of      needles/Cannulas in the insertion point, cover the ears and any hairs sticking out with gauze soaked in Chlorhexidine or surgical spirit tape.

ii) Pre-cleanse the skin every time before mono. Twist barbed cogs insertion.

9. Consider nerve blocks prior to COG procedure.

i) Cog thread insertion points Lidocaine Hydrochloride 2% (with 1:80,000 x 0.3-0.4 ml for each insertion point).

ii) Dental Infusion.

iii) Massage the infiltrated areas well and wait a few minutes.

10. Make the insertion passage for COGS with 18 or 19G introducer needles

11.Ensure the COGS are advanced correctly at the insertion point with final ends placed underneath the skin to avoid protrusion.

12. Follow mapped symmetry of the draw ings with insertion of the cogs beginning at the bottom of the face working upwards until the procedure is completed.


Providing adequate anaesthesia is an important part of performing PDO Thread procedures. Providing a better and more comfortable procedure for your client.

Anaesthesia methods for PDO Thread Lift;

  • Injectable
    • Local infiltration
    • Ring blocks
  • Topical
  • Ice and other coolants

The anesthetic method used is largely dependent on the sensitivity of the treatment area and the pain tolerance of the client, as well as the need to preserve the baseline anatomy. Clients who have never had injectable cosmetic treatments previously may have higher anxiety levels and lower pain tolerance and may require injectable anesthetics for a more comfortable procedure. Clients with high pain thresholds can be made more comfortable with the use of topical anesthetics or topical coolants, especially when lidocaine-based dermal fillers are used, which have less treatment discomfort. Sensitive areas such as the lips almost always require injectable anesthesia regardless of the client’s pain threshold.

Before using anesthetic:

  • Confirm that the client has no previous allergies to anesthetics or adverse responses with injectable procedures.
  • Confirm that the client has eaten in the last 3-4 hours to reduce the risk of hypoglycemia.
  • Address anxiety symptoms and defer the procedure if the client is particularly apprehensive.
  • Obtain informed consent

Injectable anesthetics

Lidocaine is the most commonly used injectable anesthetic used for PDO Threads treatments. It has a fast onset of effect for pain reduction within a few minutes of being injected. Pressure, temperature and touch sensations are also reduced.

Complications with injectable anesthetic

  • Vasovagal episode
  • Hypoglycemia
  • Anxiety
  • Bruising
  • Infection
  • Nerve injury
  • Allergic reaction
  • Anaphylaxis
  • Lidocaine toxicity of the central nervous system
    • Dizziness
    • Tongue numbness
    • Tinnitus
    • Diplopia
    • Nystagmus
    • Slurred speech
    • Seizures
    • Respiratory distress
  • Lidocaine toxicity of the cardiovascular system
    • Arrhythmias
    • Hypotension
    • Cardiac Arrest
  • Epinephrine adverse response
    • Tachycardia
    • Tremor
    • Anxiety
    • Local hypoperfusion

Topical anesthetics

Topical anesthetics are often used with any treatment that breaks the skin and may be uncomfortable for the client.

Topical anesthetics have the same mechanism of action as injectable anesthetics by blocking sensory nerves through neuronal impulse inhibition and they reduce discomfort associated with the insertion of the needle.

Commonly used topical anesthetics

  • L-M-X (lidocaine 4%-5%)
  • EMLA (lidocaine 2.5%. prilocaine 2.5%)

Complications of topical anesthetics

  • Allergic reactions
  • Lidocaine toxicity of the central nervous system
    • Dizziness
    • Tongue numbness
    • Tinnitus
    • Diplopia
    • Nystagmus
    • Slurred speech
    • Seizures
    • Respiratory distress
  • Lidocaine toxicity of the cardiovascular system
    • Arrhythmias
    • Hypotension
    • Cardiac Arrest

Ice and other coolants

Ice may be applied to the skin immediately before injection for approximately 1-2 minutes, until the skin is erythematous but not blanched

PDO / Cog Threads Procedure 

  • You will first need to conduct a consultation session to check the client’s suitability for treatment and take before photographs.
  • The treatment area will need to be suitably numbed prior to the procedure. Choose between either a topically applied numbing cream for 20-30 minutes or inject a local anaesthetic.
  • The treatment area should be laid out with everything that you need to hand on a disposable, single-use tray to assure hygiene.
  • Hands should be washed and PPE, such as single-use, nitrile gloves worn.
  • Cover the client’s hair with a disposable hair band or hair net.
  • Cleanse the treatment area and wipe over with Chlorohexidine or surgical spirit.
  • Mark the treatment area and directions where you wish to insert the threads using a sterile marker.
  • Select the correct threads.
  • Ensure you take extra care during the treatment to avoid the facial nerve.
  • When inserting Mono threads, insert with a twist and then twist twice when the thread is in the skin.
  • Lift the skin in the direction you want it to be as you remove the thread.
  • After the procedure, check for symmetry.
  • Ice packs may be used to reduce swelling and bruising.
  • Apply arnica to the treatment area.

Your Tutor will now discuss possible techniques for the following indications. You can draw on the heads below and make notes of sample protocols.

Brow Lift


Placement Technique Thread Choice


Fox Eye Lift


Placement Technique Thread Choice


Thread Lip


Placement Technique Thread Choice


Nasolabial Lift


Placement Technique Thread Choice

Neck Lift


Placement Technique Thread Choice


Jawline Lift


Placement Technique Thread Choice





Cheek Volume/Skin Rejuvenation of the Lower Face


Placement Technique Thread Choice


Nose Threads


Placement Technique Thread Choice


Double Chin/Chin Lift


Placement Technique Thread Choice


Breast Lift


Placement Technique Thread Choice




Placement Technique Thread Choice


Bum Lift


Placement Technique Thread Choice



Complications post-treatment include swelling for a few days, with bruising being highly likely, especially when using a needle – which can last for 10-14 days. Infection is possible too, which is why it is important to ensure that everything used is sterile, and the area and clients’ skin are cleaned thoroughly prior to starting. Granulomas can occur if threads are not implanted deep enough.

The thread is also capable of migrating, especially when using uni or bi-directional cogs. When using cogs, they must be sufficiently embedded underneath the skin because they can migrate outside of the insertion point. Facial nerve damage is possible when using needles. You will also need to be aware of asymmetry.

Possible complications

  • Swelling, erythema
  • Occasional haemorrhage or haematoma
    • A haematoma can last up to 2 weeks
  • Temporary irregularities
    • Can take up to 7 days to straighten
    • If irregularities are severe, the skin should be smoothed immediately after treatment to smooth
  • Infection as a result of failing to comply with antiseptic procedures
    • Infection needs medical treatment
    • Irritation or allergy can also occur
  • Translucence of threads in case of abnormally superficially placed during the procedure
    • The thread is no longer visible after 2 weeks
  • Painful to touch, or pain on chewing
    • Can last up to 2-7 days after treatment but will then disappear.
  • Bruising depending on individual reaction
  • Formation of small bumps where the thread ends under the skin.
    • Massage and mesotherapy
    • Triamcinolone
    • Remove the thread


  • An SPF 30 is advised to avoid post-inflammatory hyperpigmentation (PIH), especially in Fitzpatrick skin types IV-VI.
  • Avoid making long dental appointments for at least four weeks after treatment because mouth opening may be restricted.
  • No facial massaging for two weeks and blood thinning herbs and vitamins like Vitamin E should be terminated seven days before the treatment and for another seven days’ post-treatment.
  • For discomfort, paracetamol should be sufficient, and NSAIDs like ibuprofen should be avoided because inflammation is necessary for fibrosis.
  • No alcohol for three days’ post-treatment
  • No sauna for seven days or heat treatments.
  • Arnica (in pill form) may be effective against swelling.
  • No heat-generating devices such as lasers or RF before 12 weeks’ post-treatment because the heat will cause distortion of the threads.


Example Diagrams





























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