Immediate treatment of botulinum toxin type A-induced brow ptosis with polydioxanone cog thread insertion

Background: Botulinum toxin is most commonly used as a safe cosmetic injectable to improve dynamic wrinkles. However, side effects still occur. Among them, brow ptosis is known to occur relatively infrequently. The condition is self-limiting; however, for about 3 months post-injection, the patient must endure related uncomfortable symptoms. Several methods have been recommended to prevent this complication; however, no treatment has been developed to improve such symptoms instantly. Currently, various processed threads, such as polydioxanone (PDO), are widely used for facial rejuvenation; PDO thread is bio-absorbable. Objective: The authors performed brow lifting using a cogged PDO thread to improve uncomfortable symptoms associated with brow ptosis. Methods: In total, 14 PDO threads with multi-bidirectional cogs (two 1.0 threads, with lengths of 9.0 cm each, and twelve 1.0 threads, with lengths of 6.0 cm each) were placed in 7 rows, which were inserted into the superficial fat layer and deep fat layer (dual plan insertion) separately, at approximately 1.0-cm intervals. Results: Following the use of the thread, the positions of the left and right eyebrows were observed to have slightly increased by an average of 1.43±0.65 mm and 1.7±0.9 mm after two weeks, respectively; the patients indicated a high degree of satisfaction with immediate improvement of the uncomfortable symptoms. Conclusion: It is suggested that PDO thread brow lifting would be a reliable procedure to immediately treat botulonum-toxin induced brow ptisos noninvasively.