Sculptra vs PDL Threads for neck rejuvenation? (Photo)

Question

I'm 46 yrs old and two yrs ago I lost about 55lbs. Now my neck skin is very thin and loose. I've seen two different doctors. One who suggests doing PDO Threads, the other using Sculptra. But neither of them perform both procedures. So I don't know if their recommendation is only based on what they offer, rather than what would be best for ME. Any suggestion?

Anna Chacon, MD, FAAD · Answer

I completely understand why you’re questioning the recommendations, especially when the two doctors are each recommending the procedure they personally offer. After a 55-pound weight loss, however, the neck can look quite different because you may have a combination of loss of volume, thinner skin, reduced collagen, and actual skin laxity. So there really isn't a universal “best” treatment.

Between the two options you mentioned, Sculptra and PDO threads are doing somewhat different things.

Sculptra (poly-L-lactic acid) is a collagen-stimulating treatment. Rather than physically pulling the skin upward, it gradually encourages your body to produce more collagen, which can improve skin thickness, texture, crepiness, and some laxity over time. There is published evidence supporting the use of PLLA in the neck, including improvement in skin laxity and wrinkles, although the evidence base is still smaller than what we have for facial treatment.

PDO threads, particularly lifting/cog threads, work more by mechanically repositioning tissue while also producing some collagen remodeling. They can give a more immediate lifting effect, but that effect is temporary, and the evidence supporting thread lifting is less robust than many of the promotional claims you may see online.

For someone describing the neck as very thin and loose after substantial weight loss, I would be more interested in improving the quality and thickness of the skin rather than simply pulling it upward. In that situation, Sculptra may make more sense than PDO threads if the predominant problem is crepey, thin skin with mild-to-moderate laxity. Recent reviews and expert consensus also support PLLA as a potentially useful option for neck rejuvenation, while acknowledging that more standardized research is still needed.

That doesn't mean Sculptra will replace a neck lift if there is a significant amount of redundant skin. No injectable or thread can truly remove excess skin. If the laxity is primarily from substantial skin excess after weight loss, the improvement from nonsurgical treatments will naturally be limited.

I also wouldn't necessarily think of this as an either/or decision. Depending on the anatomy, some patients benefit from a combination or staged approach—addressing skin quality first and then determining whether there is enough residual laxity to justify a lifting treatment. Current approaches to nonsurgical neck rejuvenation emphasize identifying whether the dominant problem is skin laxity, volume loss, excess fat, platysmal changes, or structural support before selecting the treatment.

So, if I had to choose based only on your description, I would lean toward Sculptra rather than PDO threads for thin, crepey neck skin following major weight loss, provided the laxity is not severe. I would be much less enthusiastic about threads if the goal is simply to tighten very thin skin, because they can provide a temporary lift but don't address the underlying loss of skin quality nearly as directly.

And your concern about whether each doctor is recommending what they offer is a very reasonable one. The best treatment should be determined by what your neck actually needs, not by which procedure happens to be available in that particular office.

Jason Emer, MD · Answer

In the right hands, well-placed Sculptra will give you great results. Keep in mind, it takes 3-6 months to see results with Sculptra. Sculptra is a great product for improving facial volume and collagen building, but for best results, I recommend using it in a combination depending on desired results. I combine Sculptra with other fillers, lasers, toxins and skin care to give immediate results.

Nelson Lee Novick, MD · Answer

I gave up using threads a number of years ago. Contrary to what had been hoped, they have proved all too often to engender quite a few adverse reactions, including the development of unsightly skin divets and puckering, infection, spitting out or extrusion of the threads. And the promise of the results being very long lost lasting are seldom realized. Sculptra, which I also stopped using a number of years back, tends to be expensive and typically requires three treatment sessions to achieve any results. However, there is no specific enzyme (unlike with natural HA fillers where hyaluronidase can be used for dissolving) that can dissolve it should the need arise. Profhilo or Skinvive in the U.S. is a HA biomodulater that can be used to improve skin quality, hydration, and tautness. If necessary, other HA fillers may be used to perform a "nonsurgical filler necklift." You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist with experience with all the foregoing. Hope this helps and best of luck.

Darryl J. Blinski, MD · Answer

Based on your nicely post of photos, non-surgical or minimally invasive, surgery is not the correct answer. You must entertain the thought of a mini face neck lift with muscle plication. Best to see board certified Plastic or facial plastic surgeons or virtual consult with us. Expect fees to range from $5000-$10,000. If you only want minimally invasive or non-invasive treatments, you will be very unhappy after a few weeks to months. Good luck.

Sculptra vs PDL Threads for neck rejuvenation? (Photo)

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