Absorbable vs. permanent threads: differences and risks

When people talk about "threads" in the face, the patient usually hears a single word. But behind it there are very different materials and philosophies. The main division is between absorbable threads, which the body breaks down over time, and permanent ones, which are not absorbed. That difference changes what you expect from the result, the risk profile, and above all what happens if something goes wrong.

This guide is a review. It compares the two groups, explains the risks of each, and shows why, in general, the choice in the face falls on resorbable materials. It does not cover insertion technique or protocol, and it does not recommend products. Decisions belong to the licensed professional, according to the rules of their professional council in Brazil and the product's registration. The overview of types is in types of PDO threads.

What does absorbable mean?

An absorbable material is one that the body breaks down and eliminates, usually by hydrolysis or enzymatic action, over a period of time. This is biodegradability: the thread loses mass and strength, is replaced by tissue, and ceases to exist as a foreign body. The main materials used in absorbable facial threads are:

The times are approximate and depend on caliber, area, patient, and manufacturer. For the clinic, it is worth knowing the data for the specific material you use, not another one's.

What does permanent mean?

Permanent threads are made of materials that do not undergo significant degradation in the body, such as certain synthetic polymers used in surgical sutures and in lifting techniques. They stay in the tissue forever, surrounded by a fibrous capsule. Their use in aesthetic facial work is less common and more controversial than that of absorbable ones, precisely because there is no "expiration date" for a potential problem.

The argument in favor is the duration of the lifting effect. The argument against is that the face changes: fat redistributes, bone resorbs, skin ages, and the ideal thread position today is not the one a few years from now. What was well positioned may, over time, become palpable, visible, displaced, or cause deformity.

What is the difference in risk?

The types of complications are similar, but the course is different. With an absorbable thread, a mild complication, such as a palpable thread, a dimple, or an inflammatory nodule, tends to fade as the material is absorbed. With a permanent thread, the same problem can persist indefinitely.

In cases of infection with biofilm, the permanent foreign body is a particular problem: bacteria adhered to the material's surface shelter from antimicrobials, and resolution may require removing the thread. With absorbable threads, absorption helps eliminate that substrate. See the reasoning on infection in infection and biofilm after filler.

And removal: when is it discussed?

Absorbable threads, as a rule, are left to break down, and removal is reserved for specific situations: extrusion, persistent infection, a visible or palpable thread that bothers the patient, pain, or deformity. The decision belongs to the professional managing the case. The indications are in indications for thread removal and visibility problems in thread extrusion and visibility.

Removing permanent threads is another level of complexity. They are surrounded by fibrous tissue, can fragment, and can have long tracts. Complete removal is not always possible, and the procedure may leave a scar or deformity. That is why consent for a permanent thread needs to be more detailed than for an absorbable one.

How do you choose between the two?

In the face, the trend in practice is to prefer resorbable materials, precisely because of the safety margin that absorption brings. The choice between PDO, PLLA, or PCL depends on the goal (traction, biostimulation, or both), the area, skin quality, and what the manufacturer and the literature indicate. Anyone considering permanent threads should weigh:

• the benefit of longer duration against the risk of a problem with no end date;
• how the face changes over the years;
• the real ability to remove the thread if necessary;
• whether the product is registered for the purpose and the area;
• how clear the consent is about irreversibility.

What should you tell the patient?

The patient usually thinks "permanent" is a synonym for "better", because they associate it with durability. It is worth explaining the trade-off: more time of effect also means more time of exposure to any complication, in a face that keeps changing. The conversation can follow the script in PDO threads: risks and do PDO threads need to be removed.

How to document

The patient record should note the material, manufacturer, lot, area, number of threads, and date, plus the expected absorption time. If a problem comes up years later, knowing exactly which thread was placed and where is decisive. This is even more important with permanent threads, where the information may be needed for decades. See traceability of injectables for the logic of record keeping and patient record.

Harmy in planning

Harmy does not simulate threads, whether absorbable or permanent. It works with an illustrative volume projection on areas marked on a frontal photo, which helps visualize what the patient wants before deciding which resource is most suitable. The projection is illustrative and does not promise results. The choice of material, absorbable or not, always belongs to the professional.

Summary

Absorbable and permanent differ in what happens when something does not go as expected: the former tends to resolve over time, the latter stays. In the face, resorbable threads are the more frequent choice. Know the material, explain irreversibility when it applies, document rigorously, and make the removal plan clear from the consent stage.