PDO Treads Protocol

HAUS OF ÄSTHETIK

CROMA PDO THREADS AND COG THREADS (UP TO 4D) PROTOCOL

DATE OF IMPLEMENTATION 1ST APRIL 2025

REVIEW DATE 1ST APRIL 2026

VERSION NUMBER 1.1

INTRODUCTION

This protocol ensures that Croma PDO Threads and COG Threads (up to 4D) are administered safely, effectively, and in accordance with CQC, Save Face, NICE, GMC, NMC, MHRA, and HAUS OF ÄSTHETIK internal policies, including Medicines Management, Infection Control, Record Keeping, Consent, and Patient Safety Policies.

Only medically trained professionals (Doctors, Dentists, and Registered Nurses) who have undergone accredited PDO Thread Training or have relevant NHS experience may perform this treatment. A face-to-face consultation with a prescriber is mandatory before performing the treatment.

INDICATIONS FOR TREATMENT

PDO (Polydioxanone) threads are used for collagen stimulation, skin tightening, and facial lifting.

Indications include:

• Skin laxity of the mid-face, jawline, or neck

• Sagging of the lower face, jowls, or nasolabial folds

• Eyebrow lifting and non-surgical brow enhancement

• Mild to moderate volume loss with collagen depletion

• Fine lines and wrinkles in delicate areas such as the perioral or periorbital regions

• Rejuvenation of the décolletage, arms, and abdomen

PDO threads provide a dual mechanism of action: they offer an immediate mechanical lift and stimulate collagen synthesis, resulting in longer-term improvements in skin elasticity.

COG (barbed) threads support stronger mechanical lifting, particularly for mid-face sagging and jawline contouring. Up to 4D threads may be used depending on patient anatomy and treatment goals.

PRODUCT STORAGE INFORMATION

PDO and COG threads must be stored at room temperature in their sterile packaging. Threads must not be exposed to direct sunlight, humidity, or excessive heat. Expiry dates must be checked before treatment, and batch numbers must be recorded in the patient’s medical notes.

STAFF REQUIREMENTS

Only Doctors, Dentists, and Registered Nurses with specific PDO Thread and COG Thread training may perform this treatment. Training must be gained through accredited aesthetic courses or through relevant NHS experience in dermatology, maxillofacial medicine, or plastic surgery.

Practitioners must hold valid indemnity insurance for PDO thread placement and ensure they operate within their scope of competency and clinical governance standards.

INCLUSION CRITERIA

Patients must be:

• Over the age of 18

• Medically fit with no contraindications

• Able to comply with aftercare instructions

• Realistic about expected results, as PDO threads do not replace surgical lifting procedures

• Not currently on anticoagulation therapy or medications that increase bruising risk

EXCLUSION CRITERIA

PDO thread treatment is contraindicated in:

• Patients under 18 (Refer to the Clinic’s Safeguarding Policy and the Children’s Act 2021)

• Pregnant or breastfeeding individuals

• Active infections, inflammation, or open wounds at the injection site

• Autoimmune conditions requiring immunosuppressive therapy

• Severe keloid or hypertrophic scarring history

• Diabetes with poor glycaemic control

• Recent history of dermal fillers in the same treatment area (less than four weeks prior)

• Patients with unrealistic expectations or suspected Body Dysmorphic Disorder (BDD)

• History of severe allergic reactions to lidocaine or local anaesthesia (if used)

Relative contraindications include patients over 65, those on long-term steroid use, and individuals with compromised healing capacity. These cases require a specialist consultation before treatment.

PRE-TREATMENT ASSESSMENT

A comprehensive consultation must be conducted, including:

• Full medical history and aesthetic assessment

• Analysis of facial volume loss, skin laxity, and treatment goals

• Pre-treatment photographs for medical documentation

• Informed consent, including discussion of potential complications and expected outcomes

• Review of any medication changes since the last visit

• Confirmation of contraindications and allergy history

• Skin cleansing with a medical antiseptic solution

ASEPTIC PROCEDURE PREPARATION

• Hand hygiene and sterile gloves must be worn throughout the procedure

• A fully aseptic field must be created using sterile drapes and disposable instruments

• **The patient’s skin must be cleansed thoroughly with Chlorhexidine or 70% isopropyl alcohol **

• Local anaesthesia (1% Lidocaine) may be used for improved patient comfort upon request

• A sterile single-use marker may be used to mark insertion points

PDO AND COG THREAD PROCEDURE

   1. Patient Positioning

      • Ensure the patient is lying in a comfortable supine position

      • The head should be stabilized to prevent movement

   2. Insertion of Threads

      • Attach a sterile 18G cannula or fine-gauge introducer needle to create the entry points

      • Insert PDO threads along the pre-marked vectors following the subcutaneous or deep dermal layer

      • For COG threads, ensure correct anchoring to prevent migration

      • Massage the area gently to ensure the threads are evenly distributed and settled in the correct plane

   3. Layering and Thread Positioning

      • PDO mono threads should be placed in a cross-hatching or mesh pattern to maximize collagen stimulation

      • COG threads should be positioned in a lifting vector along the natural tension lines of the face

      • Excess thread material should be trimmed carefully to avoid extrusion

   4. Final Adjustments

      • Once the threads are fully inserted, the skin must be assessed for symmetry

      • The patient should be provided with a mirror to discuss immediate outcomes

POST-PROCEDURE CARE

   • Dispose of all sharps immediately in a clinical waste bin

   • Apply sterile gauze and gentle pressure to minimize bruising

   • Re-cleanse the area with an antiseptic solution

   • Advise the patient to avoid excessive facial movements, heat exposure, and strenuous activities for 48 hours

   • Provide written aftercare instructions, including signs of potential complications

   • Schedule a follow-up appointment within 4-6 weeks

MEDICAL RECORD KEEPING

All patient notes must comply with GDPR and HAUS OF ÄSTHETIK’s Medical Records Policy. Records must include:

   • Patient details, medical history, and consent forms

   • Thread type, brand, batch number, and expiry date

   • Injection sites, number of threads used, and depth of insertion

   • Pre- and post-procedure photographs

   • Any complications or adverse reactions

ADVERSE EVENTS MANAGEMENT

Minor side effects such as bruising, swelling, and mild discomfort are expected and should be explained to the patient.

Serious complications that require escalation include:

   • Thread migration or extrusion

   • Severe infection or abscess formation

   • Asymmetry requiring correction

   • Hematoma or excessive bleeding

Urgent cases must be referred to a prescriber for assessment. If vascular occlusion is suspected, the clinic's emergency protocol must be followed. Severe complications must be reported to the MHRA via the Yellow Card Scheme.

QUALITY ASSURANCE AND TRAINING

Practitioners must maintain ongoing CPD in PDO and COG thread techniques, complications management, and patient assessment. Clinical audits and peer reviews will be conducted to ensure adherence to best practice standards.

This protocol will be reviewed annually or sooner if new clinical guidelines or regulatory changes arise.

CONCLUSION

The PDO and COG Thread Protocol at HAUS OF ÄSTHETIK ensures the safe, effective, and compliant treatment administration. Adherence to these guidelines maintains the highest standards of patient care, safety, and clinical governance.