Mastering the BussoLyft: Your Ultimate Guide to PDO Thread Lifting

By: Dr. Mariano Busso


Polydioxanone (PDO) thread lifting, also known as suture suspension, represents an innovative facial rejuvenation technique where PDO threads are delicately inserted beneath the skin's surface. These threads are then carefully pulled to elevate sagging tissues and securely anchored at their entry points. This cosmetic procedure, with over two decades of clinical study, aims to reposition soft tissues, such as superficial fat pads, while prioritizing patient safety and delivering long-lasting results. Traditionally, thread lifts have been considered suitable for middle-aged patients with mildly to moderately sagging tissues and good skin quality. However, recent advancements, such as the BussoLyft technique, have extended the potential of this technique, making it a viable option for a broader range of candidates.

The Art of Thread Lifting: A Step-by-Step Protocol


In the world of PDO thread lifting, superficial fat pads are pivotal. The BussoLyft technique involves creating vectors through volumization and utilizing tissue-engaging PDO threads. Volumization, for instance, can create lifting vectors when applied to the fixed-masticatory area of the face. An excellent example of this is the lateral orbital superficial fat pad, which can be volumized and anchored using the zygomatic retaining ligament. This process results in both vertical and oblique medial vectors, achieving the desired lift.

In contrast, superficial fat pads in the mobile-mimetic zone of the face are better addressed with oblique vectors, crafted by tissue-engaging PDO threads.


Each thread placement for a BussoLyft involves a series of meticulous decisions to ensure proper tissue repositioning. Here is a simplified breakdown: 

  1. Identify the Target Structure: Start by understanding the anatomical structure and its unique characteristics. These factors guide the selection of thread design, material, and length. 
  2. Know the Anatomy of the Thread: Familiarize yourself with the components of a bidirectional thread, including the trim zone, lifting cogs, intermediate area without cogs, anchoring cogs, and disengagement component. 
  3. Select an Appropriate Entry Point: Depending on the structure to be repositioned, choose a proximal, middle, or distal entry point, considering factors like control and skin folding. 
  4. Determine the Lifting Vector: Decide on the direction, number, and magnitude of the lifting vector. Oblique vectors are often preferred for distributing weight evenly. 
  5. Place Escalating Sub-vectors: Multiple sub-vectors can be created by placing threads through the same entry point, allowing for optimal lift. 
  6. Position the Fat Pad: Visualize the final outcome and ensure proper fat pad placement, taking care not to manipulate tissues after thread release. 
  7. Decide How the Cannula Should Advance: The technique for advancing the cannula varies depending on the cog distribution on the thread. 
  8. Advance the Cannula: The extent of lift is influenced by the placement of the last anchoring cog. 
  9. Spread the Facial Skin Along the Cannula: Before releasing the thread, it's essential to spread or reposition the skin along the cannula to prevent wrinkles. 
  10. Maintain the Golden Ratio: Ensure that the fat pad is in its desired position, and the lifting and anchoring cogs are appropriately aligned with the correct structures. 
  11. Trim the Excess Smooth Thread: Trim smooth thread to the first lifting cog to avoid discomfort and potential complications. 
  12. Aim for Mechanobiological Adaptation: Understand the three stages of fat pad lifting and their dependence on mechanical interaction, tissue adhesion, and mechanobiological adaptation.


It's vital to consider contraindications before opting for a PDO thread lift. Absolute contraindications include infection/inflammation at the treatment site, pregnancy, and unrealistic patient expectations. Relative contraindications are thin skin and heavy tissues, but experienced practitioners may still be able to address these concerns with expertise.

The duration of PDO thread lifting results varies based on the technique used. Mechanical tissue lifting typically lasts around three months, while tissue adhesion-based lifting can extend to six to twelve months. For results exceeding a year, mechanobiological adaptation of supporting structures is key.

In conclusion, thread lifting is a transformative technique with a detailed step-by-step protocol. By following these guidelines and considering innovative techniques like the BussoLyft, practitioners can achieve optimal results and offer patients a safe and effective non-surgical facelift option.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.