Background: Polydioxanone (PDO) thread is commonly used as a skin rejuvenation material in the field of cosmetic medicine. Its usefulness in the aged eye area was described previously, but, to date, no clinical study has proven it.
Objective: The purpose of this study was to investigate the rejuvenation effects of PDO thread on the aged lower eye area thorough quantitative and qualitative analysis.
Methods: We examined the changes in the lid-cheek junction in 32 participants who underwent the PDO thread insertion. They were followed up during 12 weeks after PDO thread insertion into the orbital fat area. Participants were categorized into three groups by tear trough grade; the eyelid to junction distance (EJD)/eyebrow to junction distance (BJD) ratio was measured before and after the PDO thread insertion. Differences in EJD to BJD ratio after PDO thread insertion and post-procedural differences in EJD to BJD ratio by tear trough grade were compared by the paired t-test.
Results: After PDO insertion into the infraorbital fat pad area, the overall EJD to BJD ratio significantly decreased from 0.35±0.03 to 0.33±0.04 (p=0.001). The significant post-procedural improvements in EJD to BJD ratio were found in grade 1 group and grade 2 group: 0.35±0.03 to 0.34±0.04 for grade 1 group (p=0.02), and 0.34±0.04 to 0.32±0.04 for grade 2 group (p=0.03); however, the changes were not found in the grade 3 group (p=0.21).
Conclusion: PDO thread insertion into the aged lower eyelid may be an effective method for improving signs of lower aged eyelid particularly in individuals with tear trough group 1 and group 2.

Keywords: EJD/BJD, infraorbital fat protrusion, lid-cheek junction, polydioxanone, rejuvenation

1. Farkas JP, Pessa JE, Hubbard B, Rohrich RJ. The science and theory behind facial aging. Plast Reconstr Surg Glob Open 2013;1:e8-15.
   
2. Levesque AY, de la Torre JI. Midface anatomy, aging, and aesthetic analysis. Facial Plast Surg Clin North Am 2015;23:129-36.
   
3. Friedmann DP, Goldman MP. Dark circles: etiology and management options. Clin Plast Surg 2015;42:33-50.
   
4. Hwang UK, Kwon YH, Kang KJ. Improvement of aged lower eyelid by insertion of polydioxanone threads. J Cosme Med 2017;1:57-9.
   
5. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007;120:1367-76; discussion 1377.
   
6. Hester TR Jr, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging:maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000;105:393-406; discussion 407-8.
   
7. Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg 2010;125:699-708.
   
8. Kang KJ, Yang HH, Chai CY. Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty. J Cosmet Med 2017;1:30-8.
   
9. Yoon JH, Kim SS, Kim DI. Skin rejuvenation to make use of absorbable PDO suture in regenerative medicine. Seoul: MD WORLD Medical Publishing Co.; 2012.
10. Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol 2006;207:767-74.
    
11. Gerarduzzi C, Di Battista JA. Myofibroblast repair mechanisms post-inflammatory response: a fibrotic perspective. Inflamm Res 2017;66:451-65.
    
12. Kim J, Zheng Z, Kim H, Nam KA, Chung KY. Investigation on the cutaneous change induced by face-lifting monodirectional barbed polydioxanone thread. Dermatol Surg 2017;43:74-80.
    
13. Kim WS, Park SH, Ahn SJ, Kim HK, Park JS, Lee GY, et al. Whitening effect of adipose-derived stem cells: a critical role of TGF-beta 1. Biol Pharm Bull 2008;31:606-10.