Predictors of Dissatisfaction After Polydioxanone Thread Lift: A Multicenter Retrospective Analysis

Background: Polydioxanone (PDO) thread lift is a widely used technique for minimally invasive facial rejuvenation. Although the technical outcomes and complications are well-documented, postoperative dissatisfaction remains underexplored, particularly among large multicenter cohorts. This study aimed to identify the predictors of dissatisfaction after PDO thread lift. Methods: We performed a multicenter retrospective analysis of 1500 patients who underwent PDO thread lifts at cosmetic surgery clinics in Japan. Postoperative dissatisfaction was defined as a return visit due to insufficient results. Univariate and multivariate logistic regression analyses evaluated the associations between age, thread count, sex, and dissatisfaction. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff values using the Youden index. Results: Postoperative dissatisfaction was reported in 51 (3.4%) patients, with age (odds ratio = 1.06; 95% confidence interval = 1.03–1.08; P < 0.001) and thread count (odds ratio = 1.09; 95% confidence interval = 1.03–1.16; P = 0.001) as significant predictors. Receiver operating characteristic analysis identified an optimal cutoff of 43 years (area under the curve [AUC] = 0.701; sensitivity = 0.725; specificity = 0.615) and 10 threads (AUC = 0.674; sensitivity = 0.784; specificity = 0.566). The AUC of the combined multivariate model was 0.754. Conclusions: Increased age and higher thread count were independent predictors of dissatisfaction after PDO thread lifts. These findings underscore the need for individualized risk stratification, age- and volume-adapted thread strategies, and preoperative counseling to align expectations with realistic procedural outcomes.