Best Practices for Hair Regrowth with PDO Threads

This is Part 2 of a 2-part series

Part 1: Threads Stimulate Hair Regrowth

Dr. Bauman recommends that doctors try using 29 g smooth PDO in 28 mm and 35 mm lengths.

While serious complications from PDO thread procedures are rare, the threads can work their ways out of the scalp.

“The key to safe and effective treatment is the careful placement of the PDO threads, know your anatomy of the skin and the location of the hair follicles. They should be not too deep, but not too shallow either. You have to make sure when you place the threads that they’re fully embedded, or under the skin. If a piece of the thread or end of the thread is poking out, then obviously that’s an opening where bacteria and other microorganisms could gain entry and cause irritation, inflammation or even infection,” he says.

The worst complication Dr. Bauman has seen is patients’ threads becoming extruded, where the tips come to the surface. Patients might feel this and describe it as feeling like stubble or exposed fishing line. It’s simple to fix, he says. Patients come to the office and he removes the rogue thread.

“The procedure is relatively quick, like a PRP. We can put up to 100 threads in or more during a single treatment session,” he says. “I use Pro-Nox, which is a nitrous oxide delivery system for analgesia while we apply the local anesthetic ring block, which makes it super comfortable. The numbness lasts for three or four hours or more. Patients don’t really feel anything in that area. They can wash their hair immediately. Sometimes if they tap their scalp a day or two later, they can feel a little tenderness. Most patients don’t need anything at all for pain.”

Dr. Bauman recommends that patients combine the threads with PRP, unless they are not candidates for PRP. Some can’t have or don’t want their blood drawn. Another contraindication could be if they have a platelet disorder. But most patients are candidates for PRP.

“The scalp is already numb, why not use a high-quality PRP?” he says.

In addition to PRP, Dr. Bauman might add biological scaffolding in the form of porcine bladder matrix or, more recently, a human allograft like placental tissue.

“When applied with PRP and other topicals, we can use this approach to better stimulate hair regrowth in the scalp,” he says. “I’ve also used PDO threads in combination with hair transplant procedures to maintain or improve areas where we are not using the FUE [follicular unit extraction] grafts.”

Patients should be prepared to understand that whether they receive only the threads or a combination of treatments, hair growth takes time.

“Hair growth rates are essentially a third of a millimeter a day across all ages, which equates to about a centimeter a month or a quarter to a half inch a month,” Dr. Bauman says. “Even if you have a spectacular result developing, you might not see it for three to six months with the naked eye. You can measure it with a HairCheck trichometer during that time to see which areas are responding and how well the Hair Mass Index is improving and maintaining. Over the course of six months or more is when you’ll really perceive the visual results using standardized global photography and patients feel the difference.

References:

1. Bharti J, Sonthalia S, Patil P, Dhurat R. Scalp threading with polydioxanone monofilament threads: a novel, effective and safe modality for hair restoration. J Eur Acad Dermatol Venereol. 2017;31(11):e492-e493.
2. Metwalli M, Khattab FM, Mandour S. Monofilament threads in treatment of female hair loss. J Dermatolog Treat. 2020;:1-5.